CDA Essentials 2017 • Volume 4 • Issue 6

31 Issue 6 | 2017 | I ssues and P eople Treating Cannabis Users “There is a deficit in clinical research on the potential risks involved in treating dental patients who use cannabis for either medicinal or recreational purposes,” stresses a 2016 JADA article. 7 The authors explain that little is known regarding treatment while cannabis is still pharmacologically active in the body: “Within minutes of inhalation, a user may experience elevated heart rate, bloodshot eyes, and slowed respiration rate. Cannabis use can result in elevated blood pressure while the user is sitting supine but may result in orthostatic hypotension and subsequent dizziness or fainting on standing.” The article also mentions that the risks associated with treatment may vary according to the type of users. “Providers also may differentiate between patients using marijuana for medical purposes, such as reduction of nausea during chemotherapy, and patients using cannabis purely for pleasure. In these instances, the medical risk of dental treatment may be higher in the former because of other medical conditions.” The study authors strongly encourage dentists to become familiar with the signs and symptoms of acute intoxication (which can help determine whether the patient can give informed consent), to favour a non-judgmental approach, and to learn about the potential effects of cannabis on overall health. Assessing patients’ intoxication level is crucial not only to ensure informed consent, but also because “dental treatment on intoxicated patients can result in the patient experiencing acute anxiety, dysphoria and psychotic-like paranoiac thoughts,” notes another study. 8 Oral adverse effects Xerostomia Cannabinoids are associated with an increased risk of adverse effects, including xerostomia. 9 This might be linked to the parasympatholytic properties of cannabis. Dental caries Xerostomia and poor diet can lead to an increased rate of dental caries in cannabis users. 8 Periodontal disease Xerostomia, combined with poor oral hygiene, may explain the increased risk of periodontal disease in cannabis users. “It is well known that frequent tobacco use can increase the risk of periodontal disease, but it was surprising to see that recreational cannabis users may also be at risk,” mentioned Dr. Jaffer Shariff of Columbia University in an interview with MedicalXpress. He and his colleagues recently published an article on the subject in the Journal of Periodontology . 10 “Even controlling for other factors linked to gum disease, such as cigarette smoking, frequent recreational cannabis smokers are twice as likely as non-frequent users to have signs of periodontal disease.” The research also concluded that recreational use of cannabis is linked to deeper probing depths and clinical attachment loss. 10 Stomatitis, leukoedema and leukoplakia Marijuana smoking and chewing affect the oral epithelium, and clinical signs may include erythema, stomatitis, leukoedema and hyperkeratosis. Chronic use may also lead to chronic inflammation and leukoplakia, and potentially neoplasia. 8 The nabiximols oromucosal spray may cause reversible sublingual white lesions, which could be attributed to the peppermint agent. 11 Infections Cannabis users are more prone to oral infections such as candidiasis, which might be explained by a compromised immune response, the hydrocarbons contained in marijuana, oral hygiene and nutrition. 8 Dr. Lança notes that few studies focus on the oral outcomes specifically associated with cannabis use. This is echoed by a 2016 article published in the British Dental Journal : “The combined use of cannabis and tobacco, which is common amongst users, poses challenges for researchers who are interested in identifying the effects of cannabis alone.” 12