Is your state of practice any shade of green?
If so, you may be seeing more and more patients who are (legally!) using cannabis products in the dental practice, and that means it’s time to bone up on the potential effects of smoked, vaped, edible, and topical cannabis products on oral health.
With medical use now legal in 33 American states and recreational use legal in another 10, the United States is seeing a clear, broad-based trend toward state-level decriminalization of marijuana, even though the plant remains illegal (classified a Schedule I substance) at the federal level.
The American Dental Association has prepared a thorough, evidence-packed primer for dentists and hygienists, summarizing the current state of knowledge about long-term, chronic recreational use of cannabis. From well-known effects such as xerostomia (“cottonmouth”) and its associated higher rate of caries (cavities) to higher rates of poor overall oral hygiene, recreational cannabis smokers are known to experience higher rates of oral health complaints and conditions:
- Gingival enlargement
- “Cannabis stomatitis,” a precancerous chronic inflammation of the oral mucosa with features including leukoplakia and hyperkeratosis
- Higher rates of periodontitis, at earlier ages, with more sites and deeper pockets
- Alveolar bone loss
In addition, as cannabis makes its way into the mainstream, general healthcare practitioners and emergency room physicians are reporting an uptick in patients presenting with symptoms associated with a rare but troubling condition associated with long-term use of marijuana products: Cannabinoid hyperemesis syndrome (CHS).
CHS is, as its name implies, as distressing as it is violent. For reasons not yet understood, in some longtime daily chronic cannabis users, CHS causes repeated, intense, severe bouts of vomiting—which, due to the acidic nature of stomach acid, has obvious implications for oral health, including teeth and oral mucosa. Initially, patients suffering from CHS find relief by taking repeated hot showers throughout the day to relieve their severe nausea, but to date, the only known permanent resolution for CHS is for those susceptible to the syndrome to cease using cannabis completely.
While the history of the legal status of cannabis in the United States is lengthy and complex, it is the ethical and medical duty of health care providers to provide comprehensive care, education, and advocacy. In states with some form of legalized use of cannabis, that includes asking about cannabis use and counseling patients about ways to adapt their oral care regimens to mitigate potential negative effects of marijuana products, whether those may simply come from choosing too many sugary snacks during “the munchies,” or from potentially serious complications like cannabis stomatitis or CHS.