Oral Effects of Cannabis Use

The use of cannabis, particularly marijuana smoking, has been associated with poor quality of oral health,but etiology has been complicated by number of factors including xerostomia (dry mouth), which can contribute to a number of oral health conditions.Further, the main psychotropic agent, THC, is an appetite stimulant, which often leads users to consume cariogenic snack foods (foods that contain more sugar which will then increase the incidence of caries). Regular cannabis users are known to have significantly higher numbers of caries than nonusers.

Woman smoking marijuana joint.

Leukoedema (a white or whitish-gray edematous lesion of the cheek or lip region) is more common among cannabis users than non-users but it is unclear whether associated irritants, such as orally inhaled smoke, rather than cannabis itself, may be contributing causes.Smoking marijuana is associated with gingival (gum) enlargement,and chronic inflammation of the oral mucosa that can develop into malignant lesions. It has been reported that a synergistic effect between tobacco and cannabis smoke may increase oral and neck cancer risk for people who smoke both.The risk and aggressiveness of cancers associated with cannabis appear to be higher in younger (i.e.,
The immunosuppressive effects of cannabis may contribute to a higher prevalence of oral candidiasis (yeast infection) compared to non-users.It has also been hypothesized that hydrocarbons present in cannabis provide an energy source for Candida albicans, resulting in increased presence and density of colonies leading to more oral health issues.

Marijuana leaves on dark background.

A number of studies have suggested a direct relationship between cannabis use and periodontal disease.Recent studies have tested the relationship between periodontitis and frequent cannabis use and found significantly higher rates of periodontitis were observed among the frequent users compared to non-users, with significantly higher numbers of sites with high pocket depths (≥4mm) and attachment/bone loss.Further, periodontitis may occur at an earlier age in marijuana users than the general population with chronic periodontitis. A study of adolescents in Chile, however, found no association between regular use of cannabis and periodontal disease,but it may be expected that long-term use would result in periodontal disease later in life.In a histometric experiment, laboratory rats exposed to marijuana smoke had a significant increase in alveolar bone loss due to periodontitis,23 despite research that has indicated that specific cannabinoids, such as the non-psychotropic cannabidiol, may prevent bone loss.

Marijuana buds with Marijuana Joints

When dental health-care providers suspect cannabis use, it is recommended to:

  • Complete a comprehensive oral examination and include questions about cannabis use in a thorough dental and medical history.
  • Emphasize the importance of regular dental visits and oral care.
  • Encourage healthy, nutritious snacks over sweet, cariogenic snacks.
  • Consider employing preventive measures, such as topical fluorides.
  • Consider treatment for xerostomia, while avoiding alcohol-containing products.

References:

  1. Cho CM, Hirsch R, Johnstone S. General and oral health implications of cannabis use. Aust Dent J 2005;50(2):70-4.
  2. Rawal SY, Tatakis DN, Tipton D. Periodontal and oral manifestations of marijuana use. Journal of the Tennessee Dental Association 2012;92(2):26.
  3. Rechthand MM, Bashirelahi N. What every dentist needs to know about cannabis. Gen Dent 2016;64(1):40-3.
  4. McCarthy J. One in Eight US Adults Say They Smoke Marijuana. Gallup Social Series: Gallup; 2016.
  5. National Academies of Sciences E, and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington (DC): National Academies Press; 2017.
  6. McGill N. As marijuana decriminalization spreads, public health prepares: Health effects, regulations examined. The Nation’s Health 2014;44(7):1,14.
  7. Joshi S, Ashley M. Cannabis: A joint problem for patients and the dental profession. Br Dent J 2016;220(11):597-601.

To find our more Contact Smile Dental Centre.

The Smile Dental Centre, dentists in London Ontario offers a full range of general and cosmetic dental services backed by outstanding patient care for children and adults. The Smile Dental Centre won the Consumer Choice Award six years in a row (2013 – 2018) for general and cosmetic dentistry in the London, ON region. Now that’s something to smile about!

How Do Different Vitamins and Micronutrients Affect Our Oral and Overall health PART 2

  • Vitamin D is a fat soluble vitamin naturally found in very few foods, added to foods and available as a dietary supplement.
  • It is also produced when ultraviolet rays from sunlight hit the skin and trigger vitamin D synthesis.
  • Vitamin D promotes calcium absorption in the gut and maintains adequate serum calcium and phosphate to enable normal mineralization of bone and prevent hypocalcemic tetany.
  • It is needed for bone growth and remodeling of osteoblast and osteoclasts.
  • Without sufficient vitamin D, bones can become brittle, thin, or misshapen. Vitamin D helps prevent Rickets in children and osteomalacia in adults. Vitamin D and calcium helps prevent osteoporosis.
  • Vitamin D has other uses in the body; 
- Modulation of cell growth 
- Immune and neuromuscular function – Reduction inflammation
  • Vitamin D status could affect cancer risk. Vitamin D plays a role in prevention of colon, prostate and breast cancers.
  • Research shows vitamin D might play a role in the prevention of type 1 and 2 diabetes, hypertension, glucose intolerance and multiple sclerosis.
  • Very few foods naturally have vitamin D: Flesh of fatty fish ( salmon, tuna, mackerel and fish liver oils), small amounts are in beef liver, cheese, egg yolks and some mushrooms, Infant formula contains Vit D, ready to eat breakfast cereals, milk and ice cream

Sun Exposure

  • Sunscreen that is an SPF of 8 or higher block Vitamin D from the sun. An individual requires direct sunlight without sunscreen for 5-30 minutes between 10am-3pm, 2 times per week, to usually lead to sufficient Vitamin D uptake.
  • The use of tanning beds in small doses is also an effective way to gain Vitamin D uptake. (both of these contradict the warnings for sun exposure in regards to skin cancers)

Dietary Supplements

  • A safer way to obtain exposure to vitamin D is through supplements. They are available in 2 forms, based on their ability to cure Rickets. These are through pill form and liquid form. Taken on their own or through food.
  • Past guidelines for Vitamin D levels were between 400-600iu per day. The new upper limit recommendations are 4000iu per day for ages 9 and older and 2000iu for 1-9.

Palm of hand with a variety of vitamins being poured into it.

Interactions With Medications

  • Vitamin D supplements have the potential to interact with several medications. A few examples are:
  • Corticosteroids-prednisone (often prescribed to reduce inflammation). Can reduce calcium absorption and impair vitamin D metabolism. These effects can further contribute to the loss of bone and the development of osteoporosis associated with long term use.
  • Both the weight loss drug Orlistat (Xenical and Alli) and the cholesterol lowering drug Cholestyramine (Questran, LoCholest, and Prevalite) can reduce absorption of Vit D and other fat soluble vitamins.
  • Phenobarbital and Phenytoin (Dilantin) used to prevent seizures, increase the hepatic metabolism of vitamin D to inactive compounds and reduce calcium absorption.
  • Without adequate Vitamin D levels, calcium does very little on its own to strengthen teeth and bones.
  • Vitamin D deficiencies may reside in the teeth of every human being and remain viable for hundreds of years or more. Teeth act as essential fossils and help anthropologists gain information on humans. When the body is deprived of vitamin D, permanent microscopic abnormalities form in the layers of dentin. The dentin creates an ongoing record that can later be read like the rings of a tree. Dentin is not remodeled and the enamel protects the dentin long after death, making teeth a rich and accurate source of archaeological information.

REFERENCES 
1) revista-fi.com.br
 2) ods.od.nih.gov
 3) food.ndtv.com 
4) Lori D’Ortenzio, doctoral candidate at McMaster University

Pill capsule opened up and shooting out nutritional foods such as vegetables and fruits

For healthier gums try eating more of these foods:

Leafy greens:

Vegetables like kale and spinach are filled with mouth healthy vitamins and minerals. They hold vitamin C, which boosts the production of red blood cells and reduces inflammation. Both these benefits battle against irritation and gum disease. Leafy greens require more chewing, thanks to their high fiber content, which is good for gums because the chewing action creates more saliva. This helps to flush out food particles, bacteria, and plaque that may be sticking to your teeth near the gum line.

Onions:

Onions have been proven to be a fantastic food for healthy gums because they neutralize oral bacteria. They have microbial properties that target the most common types of bacteria that cause gum disease and cavities.

Green Tea:

There is some research which shows that this antioxidant-rich tea can help stave off inflammation in the body. Green tea has specific antioxidants called catechins which help gums fight inflammation caused by the one of the types of oral bacteria responsible for gum disease.

Peppers and citrus fruits:

Vitamin C is also high in vegetables like peppers of all colors and acidic fruits such as oranges, kiwis, pineapple, and strawberries.

Shiitake mushrooms:

Lentinan is an antibacterial compound found in shiitake mushrooms and it fights against plaque-building bacteria in the mouth. This type of bacteria breeds in hard to reach places in the mouth such as in between teeth and along the gum line, and can cause irritation and possibly lead to gingivitis and gum disease. You can incorporate shiitake mushrooms into your meals in a variety of different ways.

Celery, carrots, and apples:

Foods that are very crunchy are excellent at scraping away stuck on food and plaque. The hard bits of foods like celery, carrots, and apples get in between teeth and into tooth crevices and can help keep your mouth fresh between brushings. Crunchy fruits and vegetables also happen to be high in fiber, which, again, means they take longer to chew and generate more saliva. Saliva is great for flushing the mouth of bacteria near the gum line.

Milk, yogurt, and cheese:

Dairy products are great for your gums. This is because of a protein called casein that is found in most dairy products which helps to neutralize oral acids that are produced by bacteria in the mouth. These acids can be destructive to tooth enamel and gum tissue.

To find our more Contact Smile Dental Centre.

The Smile Dental Centre, dentists in London Ontario offers a full range of general and cosmetic dental services backed by outstanding patient care for children and adults. The Smile Dental Centre won the Consumer Choice Award six years in a row (2013 – 2018) for general and cosmetic dentistry in the London, ON region. Now that’s something to smile about!

How Do Different Vitamins and Micronutrients Affect Our Oral and Overall Health? – PART 1

The first sign of deficiency of some micronutrients are seen first in the mouth as glossitis, cheilitis and gingivitis.

Zinc:

  • Helps in tissue repair. It is a metal and is called an essential trace element as a very  small amount is needed for human health.
  • Deficiency can slow down wound healing.
  • Needed for immune function, wound healing and blood clotting.
  • Found in meats, seafood, dairy products, nuts, legumes and whole 
greens.
  • Zinc citrate is used in toothpaste and mouthwash to prevent dental plaque formation and gingivitis.

Variety of vitamin pills laying out on a table.

Vitamin A:

  • Known as retinol because it produces the pigments in the retina of the eye.
  • Helps maintain healthy teeth, skeletal and soft tissue, mucous membranes and skin.
  • Found in cod liver oil, carrots, liver, sweet potato, broccoli and leafy vegetables.
  • Strengthens the outer skin on the gums (gingiva) and makes it more resistant to infection.

Calcium:

  • 99% of our calcium is used to keep bones and teeth strong thereby supporting skeletal structure and function. The rest of the calcium found in our body plays a key role in cell signalling, blood clotting, muscle contraction and nerve function.
  • If the body doesn’t get enough calcium, it takes it from your BONES. Losing bone mass makes bones weak/porous and puts one at risk of osteoporosis.
  • Deficiency in calcium and vitamin D result in loss of bone density and more increased inflammation.

Vitamin B:

  • Thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, biotin, folic acid and B12
  • Needed for cell growth and healthy blood which contributes to healthy gum tissue.
  • Involved in wound healing and decreased intake may delay repair of gums (gingiva).
  • Used in sugar metabolism and a higher sugar diet may deplete B12 while 
simultaneously increasing periodontal risk.
  • Supplementation with B vitamins may accelerate post surgical healing.

Sources for Vitamin B:

B1: liver, oats, pork, potatoes, eggs
B2: bananas, dairy, green beans
B3: eggs, fish, meat, mushrooms, nuts
B5: avocados, meat, broccoli
B6: meat, vegetables, nuts, bananas
B7: raw eggs, liver, leafy vegetables, peanuts
B9: cereals, leafy vegetables
B12: animal products.

Spoonful of vitamin pills with a background of different colourful vegetables.

Vitamin C (ascorbic acid):

  • Helps repair and regenerate connective tissue, protects against heart disease, aids in the absorption of iron, prevents scurvy, and decreases total/LDL cholesterol and triglycerides.
  • Will also help maintain a healthy immune system
  • Signs of a deficiency include fatigue, muscle weakness, joint and muscle aches, bleeding gums, and leg rashes.
  • In the mouth, a deficiency can increase ones risk of periodontal disease. A severe case can play a role in ones spongy, bleeding gums with tooth mobility and bone loss.

The recommended daily allowance for adults over 19 are as follows:

  • Men, 90 mg per day
  • Women, 75 mg per day
  • Pregnant women, 85 mg per day
  • Breastfeeding women, 120 mg per day

Sources For Vitamin C:

Apples, asparagus, berries, broccoli, cabbage, melon (cantaloupe, honeydew, watermelon), cauliflower, citrus fruits (lemons, limes, oranges), kiwi, fortified foods (breads, grains, cereal), dark leafy greens (kale, spinach), peppers (especially red bell peppers, which have among the highest per-serving vitamin C content), potatoes, and tomatoes.

Magnesium:

  • Plays a significant role in over 300 enzymatic reactions within the body including the metabolism of food, nerve muscle and heart function, protein synthesis, blood sugar balance, blood pressure regulation, energy production, bone development, DNA and RNA synthesis and calcium/potassium transport.
  • Conditions associated with a deficiency include diabetes, hypertension, heart disease and osteoporosis.
  • It does offer weight loss support. Specifically, magnesium citrate helps you lose water weight and stool weight. Magnesium also helps your overall energy production by lowering your insulin resistance and improving blood sugar levels – both of which are beneficial components needed to achieve and maintain a healthy weight.
  • Improves sleep by stimulating melatonin production and activating ones parasympathetic nervous system.
  • Improves mood and lowers ones risk of depression.
  • Aids with PMS, migraine headaches, heart health, calcium absorption, 
relieving anxiety, etc…
  • Is well known for it’s anti-inflammatory effects on the body!! As we all know periodontal disease and so many other conditions in the body are caused by or exacerbated by inflammation. One way we can reduce inflammation is by making sure we are getting enough magnesium in our diet.

RDA Recommendations for daily intake:

  •       From 1 to 3 years of age: 80 mg a day
  •       From 4 to 8 years: 130 mg a day
  •       from 9 to 13 years: 240 mg a day

From 14 years of age, the requirements are different for men and women.

  • Males aged 14 to 18 years: 410 mg a day
  • Males aged 19 years and over: 400 to 420 mg a day
  • Females aged 14 to 18 years: 360 mg a day
  • Females aged 19 years and over: 310 to 320 mg a day
  • During pregnancy: 350 to 400 mg a day
  • During breast feeding: 310 to 360 mg a day

Signs of deficiency include:

  • Loss of appetite, nausea, fatigue, muscle cramps, seizures, heart palpitations, etc.
  • Orally one might see ulcers, burning tongue and dry mouth. One might also develop cramping of the TMJ

Sources For Magnesium:

Almonds, shrimp, sunflower seeds and leafy vegetables.

Vitamin pill filled with green vegetables on a fork

Iron:

  • Helps produce red blood cells and transports oxygen throughout the entire body.
  • There is heme and non-heme iron.
  • Heme iron is more easily absorbed and includes poultry, meat and fish.
  • Non-heme iron such as pasta, eggs and grains are more easily absorbed when eaten with a form of heme iron and/ or with foods rich in vitamin C.
  • Signs of an iron deficiency, a form of anemia, include fatigue, paleness, shortness of breath, headaches, heart palpitations, shortness of breath, dry hair and skin, brittle fingernails, restless legs and most importantly for us
  • Orally one might see swelling and soreness of the tongue and mouth.
  • Low hemoglobin in iron deficiency can cause the tongue to become pale, while lower levels of myoglobin can cause it to become sore, smooth and swollen.
  • Myoglobin is a protein in red blood cells that supports your muscles, such as the muscle that makes up the tongue.
  • Iron deficiency can also cause dry mouth, sore red cracks at the corners of the mouth (cheilitis) or mouth ulcers.

Sources For Iron:

Dried fruits (apricots, prunes, raisins), eggs, fish, seafood, enriched grain products (breakfast cereal and pasta), legumes (beans, lentils, peas, soybeans) meat (beef, lamb, pork, veal), poultry (chicken and turkey), some vegetables (asparagus and spinach).

To find out more on how vitamins and micronutrients affect our oral health or to book an appointment, Contact Smile Dental Centre.

The Smile Dental Centre, dentists in London Ontario offers a full range of general and cosmetic dental services backed by outstanding patient care for children and adults. The Smile Dental Centre won the Consumer Choice Award six years in a row (2013 – 2018) for general and cosmetic dentistry in the London, ON region. Now that’s something to smile about!