What You Need to Know About Marijuana: Dental 101

With the impending legalization of marijuana in Ontario, it is important to stay informed. Marijuana can have an effect on both your general health and oral health. Medical marijuana is legal in Canada. Patients often use it for chronic pain among other ailments. It is another tool in the toolbox. However, with its legalization recreationally, your teens must be educated on the health effects before making an informed decision.

The dental world is currently researching into the effects of this drug on dental health and how it can be used. Legalization is helpful for researchers to look at the pain-killing and anti-inflammatory effects for oral and facial pain conditions.

What we know about marijuana

1. Cannabinoids act like Endorphins
   1. The active compound in marijuana which can be ingested directly, in food, dried, smoked or vaporized. Cannabinoids act on special receptors in cells and this can affect the release of neurotransmitters inside the brain. The same receptors also accept molecules called endorphins which are the body’s natural “happy” molecule. This is why you feel relaxed and happy as you consume marijuana.
2. Painkilling effects for chronic temporomandibular joint disorders (TMJ conditions), trigeminal neuralgia and neuropathic pain.
   1. Marijuana has an effect on the neurological pathways in the brain but there is not enough research to prove the exact mechanism yet, nor are there guidelines for the dental community on patient use and prescription. It is interesting to note that some patients see that headaches and migraines caused by anxiety seem to diminish.
3. Negative for the teeth
   1. The main effect the substance has is xerostomia which is dry mouth. The second effect it has is orthostatic hypotension. Read below on why a dry mouth has a negative effect on your dental health
   2. Tar is still present. The average joint (marijuana cigarette) can have a similar amount of tar as 10-20 cigarettes. Although these smokers consume less than cigarette users, it can have bad effects overall. If you smoke regularly, you will develop a dry mouth. Read below on why a dry mouth has a negative effect on your dental health

Dental effects of smoking marijuana

Regular cannabis users have higher rates of missing teeth, gum disease, bone loss, dental cavities and oral cancer.

Dry Mouth:

Saliva contains many protective elements including proteins, immune molecules, water and minerals to build up the teeth after an acid attack. All of these molecules act to wash away the sugars after you eat. Secondly, the molecules help to remineralize the enamel with calcium and phosphorous. Dental enamel—which is the outermost white layer of the tooth is the hardest substance in the human body. This is because dental enamel is made up of crystals which start to break down when sugars are around. The saliva helps to rebuild up these crystals in a cycle. If you have a dry mouth, you do not have your saliva to protect you. This can lead to:

• Dental caries—also known as cavities
• Gingival hyperplasia—the overgrowth and swelling of gums in your mouth. This can be mild or severe and the area depends on the position you place the joint against your teeth. Smoke can be irritating to the gums.

Tooth Loss, Implant Loss and Periodontal Disease

The smoke is irritating to the gums (periodontium) which can cause puffiness, shine and redness. Eventually, certain dental bacteria inhabit your gum and can cause soft tissue and bone loss around your teeth and dental implants. The tobacco affects the attachment between your teeth or implants and bone. This can lead to mobile teeth and dental implants. Smoking in the months following your dental implant placement can also promote failure of the implant to fuse to the bone.

Oral Cancers

Smoking cannabis and even eating it causes changes to the outermost lining of the mouth which can be precancerous. This is cannabis stomatitis. Long term, these inflammatory changes cause permanent destruction of the oral mucosa which is a risk factor for oral cancer. Similar effects can be seen if you hold the smoke inside as you inhale. Your uvula can swell at the back of your throat. Other oral conditions include oral papilloma and leukoplakia which are precancerous conditions.

Warnings of oral cancer include

• Sores that do not go away after 1-2 weeks
• Areas around the mouth that are numb or tingling
• Gums that bleed heavily for an unexplained reason
• Swellings anywhere in your mouth

Dental Cavities

Dry mouth can lead to cavities because the sugars and bacteria bathe your teeth for hours. However, there is also an indirect effect that marijuana can have on your teeth. The use of marijuana increases your appetite for sugars and carbs. Think pizza, chips and sugary sweets. These carbohydrates sit around and immerse your teeth in a layer of bacteria-forming acids and cause cavities. This is especially disastrous if you do not brush your teeth after consuming these types of food.

Bad breath and Halitosis

Smoking marijuana can lead to bad breath. Why? Because having a dry mouth allows for food and plaque to sit at the back of your tongue for prolonged periods of time leading to halitosis and a strong odour.

Is marijuana addictive?

The number of users that become addicted is about 9%. If you started smoking as a teenager, that number increases to 17%! This is because today’s pot contains more THC than in the past.

One of the positive aspects of legalization of marijuana is that more patients will disclose their use of it. As dentists, many have already seen patients who are cannabis users but fail to disclose their use. Legalization opens up a more honest communication stream.

One important thing to note is that the dental profession needs more research into the pain-killing effects of marijuana. We need to know how cannabis and the cannabinoid molecule will affect patients dentally, medically and psychologically.

Overall, there are both positive and negative health effects associated with smoking marijuana. There are potentially some benefits associated with pain relief but the exact mechanism and dosage have not yet been scientifically proven. You should communicate honestly with your dentist about your marijuana use so your provider can properly advise you on protecting your oral health.