The Dental ‘High’
By: Dr. Ketki Gadge
Tags: Dentistry, Cannabis, Oral Health, Marijuana, Dental

Cannabis is a flowering plant found all over the world, with a widespread past of consumption for industrial, recreational, and medicinal purposes. It acts as a mild sedative, narcotic and mood enhancer for recreational users and is used for its pain-relieving and anti-emetic (regulation of vomiting and nausea) properties in medical uses. Pharmaceutical administration in tablet or capsule form is more common among individuals who are not accustomed to smoking recreationally, and most studies do not show a significant difference in effectiveness among modes of administration.

The evidence base for cannabis use as a medicinal drug is in its infancy. There is some suggestion which supports cannabis as an anti-emetic and as an appetite stimulator for patients with Cancer and AIDS, as well as a pain and spasm reducer for several chronic conditions. Some findings have proposed that cannabis has anti-inflammatory or anti-bacterial properties, as well as having effectiveness as a therapy for glaucoma because of its properties in relieving intraocular pressure. Therapeutic cannabis can be given in botanical (i.e., smoked) form, added as an ingredient in food, inhaled as a vapor/mist, applied topically, or ingested as a pharmaceutically manufactured medication.

The practice of cannabis, chiefly marijuana smoking, has been linked with reduced quality of oral health, but identifying the root cause has been difficult by several accompanying influences with regular users, comprising of parallel use of tobacco, alcohol abuse, and other drugs; poor oral hygiene practices; and irregular appointments to dentists. It also leads to xerostomia (dry mouth), which can add to numerous oral health ailments. Further, the main component, THC (phototropic drug which works by adjusting the brain chemicals or neurotransmitters), is an appetite stimulant, which frequently leads users to eat snack foods which cause dental caries. Consistent cannabis consumers are identified to have considerably greater numbers of caries than non-users, mainly on the easy-to-reach smooth surfaces.

Smoking marijuana is linked with gingival swelling, Erythroplakia (thick red patches located inside the cheek) and chronic inflammation in the oral cavity with hyperkeratosis and leukoplakia (thick white patches located inside the cheek), occasionally indicated as “Cannabis Stomatitis,” which can advance into a cancerous growth. It has been studied that a collaborative influence between tobacco and cannabis smoke may escalate oral and neck cancer threats for individuals who smoke both. The danger and hostility of cancer cells connected with cannabis seem to be higher in younger (i.e., <50 years old) users. The immunosuppressive properties of cannabis may add as well to a greater incidence of oral candidiasis compared to non-users. Considerably greater percentages of periodontitis were detected amongst the everyday users as compared to non-users, with suggestively higher statistics of areas with high pocket depths (≥4 mm) and attachment loss.

A present intoxicated (i.e., “high”) consumer may present numerous problems for the dental practitioner. Added unease, fear and hyperactivity may increase the trauma of a dental appointment. Increased heart rate and other properties of cannabis make the practice of local anaesthetics (for pain control in dental procedures) possibly life-threatening. Patients may be reluctant to self-report marijuana habits or incapable to answer reliably, but identification of inebriation may be achieved through the routine cardiac risk assessment. It is because of the threats of dispensing epinephrine or drugs comprising of alcohol to a ‘high’ patient, totalling to amplified apprehension and fear, that dentists may reject to treat the inebriated patient or contemplate rescheduling of any non-emergency treatment for at least 24 hours. Moreover, there may be legal consequences concerning the rationality of informed consent with intoxicated patients, principally with permanent procedures like extractions.

If the patient seems to be a consumer, it may be supportive to know if the use is medicinal, as this may propose significant co-ailments. Confirmation of cannabis use may be an occasion to converse with other health concerns and advise the patient of the significance of fluoride, good oral hygiene practices, and healthy snacking. It is also recommended to ask the patient to finish a detailed oral checkup examination which contains questions about cannabis use and an in-depth dental and medical history, stress the significance of routine dental appointments and oral care, recommend nourishing, wholesome snacks over sweet, cariogenic snacks, discuss using preventive procedures, such as topical fluorides, discuss treatment for xerostomia, while avoiding alcohol-containing products.