Cannabis
Cannabis
Cannabis is known by many “names including marijuana, weed, dope, and pot” (Canadian Public Health Association, 2018). The American Dental Association describes the effects of cannabis “as a mild sedative and mood enhancer for recreational users and is used for its analgesic and antiemetic properties in clinical applications” (2020). Cannabis was legalized in Canada back in 2001 for medical purposes and since October 17, 2018, recreational use cannabis has also been legalized, causing an increase in cannabis users in Canada (Anastasopoulos, 2018). This blog will elaborate on the oral adverse effects of smoking cannabis.
Figure 1
Smoking Cannabis
From “A joint a day keeps the doctor away!,” by Zayan, A. (2020). https://unsplash.com/photos/4msfw7Pe1iU
THC vs CBD
To start it is important to distinguish the difference between THC and CBD. Delta-9-Tetrahydrocannabinol or more commonly known as THC is mostly used for recreation, and provides the psychoactive effect of marijuana or the “high” individuals seek (Holland, 2020). It stimulates appetite, helps with sleep and can reduce muscle spasms and pain (Holland, 2020). Cannabidiol or CBD is used for medicinal purposes and does not provide the “high” effect. It contains anti-inflammatory and analgesic properties, helps with anxiety and depression and is commonly used as seizure medicine (Holland, 2020). There are many different ways of consuming cannabis including, ingestion, inhalation, oral-mucosal, and topical, but in this blog, we will be talking about inhalation, more commonly known as smoking (CPHA, 2018). There are different methods of smoking cannabis such as joints, bong, pipe, vape and hookah.
Adverse Effects of Cannabis
Cannabis has effects on the cardiovascular, respiratory and central nervous system and has the potential to reach the brain within seconds depending on the consumption; however, today we will be elaborating on the oral adverse effects (Anastasopoulos, 2018). There is a large range of oral adverse effects relating to smoking cannabis such as periodontal disease, high caries risk, xerostomia (dry mouth), leukoplakia (wrinkled white lesion), bone loss, oral cancers (Anastosopoulos, 2018) and erythroplakia (red patches) (American Dental Association, 2020).
The Relationship between Cannabis and High Prevalence of Caries and Periodontal Disease
There are many side effects when smoking cannabis, but the most prevalent being xerostomia or dry mouth, and the relationship it has with increased caries risk. Furthermore, THC stimulates appetite that is better known for the “munchies'' and can lead to ingestion of cariogenic foods like sweets, chips, bread and sugary beverages (Anastosopoulos, 2018). The frequent snacking of cariogenic foods results in frequent acid attacks resulting in demineralization and destruction of the enamel that leads to caries (de la Barra, 2018). Xerostomia is a reduction of salivary flow or change in the nature of the saliva that results in the pH of the oral cavity to become more acidic and reduce the mouths ability to buffer, especially when combined with food and oral biofilm, leading to an increased risk of caries (Darby &Walsh, 2014, p 208). Dental caries can result in tooth destruction and tooth loss and dental hypersensitivity (Darby & Walsh, 2014 p 208)
Frequent cannabis use has also been linked to periodontal disease in many recent studies, where there was a significant increase in pocket depths equal to or deeper than 4mm, attachment loss, and alveolar bone loss (ADA, 2020). Research has also concluded that cannabis users may present periodontitis earlier in life than non-users (Anastosopoulos, 2018).
Fungal Infections and Oral Health Implications
THC creates an immunosuppressive effect to the cannabis user, and when combined with poor oral hygiene it allows for higher risk of bacteria and infections to thrive in the mouth known as oral candidiasis (ADA, 2020). There are studies that link the hydrocarbons of cannabis providing energy sources for the Candida albicans that increase the number and the density of colonies (ADA, 2020). In addition, smoking cannabis is linked with “gingival enlargement, erythroplakia and chronic inflammation of the oral mucosa with hyperkeratosis and leukoplakia sometimes referred to as “cannabis stomatitis,” which can develop into malignant neoplasias” (ADA, 2020). There is also an increased risk of neck and oral cancers especially in younger cannabis users; with the immunosuppressive effect increasing the risk of papillomavirus (ADA, 2020).
To conclude; cannabis users are continuously growing in numbers in Canada and it is important to be educated on the systemic and oral health impacts it poses. This blog focused on the most important oral adverse effects; however, it is extremely important to review and educate yourself on the systemic impacts cannabis may have to the rest of the body. If you or someone you know is addicted to cannabis or is ready to quit please contact the following numbers, reach out to your family physician or watch the vlog “Cannabis Cessation”.
Ontario Resources
Addiction, mental Health and Problem Gambling Services. (ConnexOntario)
1-866-531-2600 (24 hours chat services)
Good2Talk- For post-secondary students between 17-25
1-866-924-5454 (24 hours)
Nationwide (Canada) Resources
Wellness Together Canada
1-866-585-0445 (24 hours, free service in other languages, chat Service)
Kids Help Phone (For Youth)
1-800-668-6868 (24 hours chat service)
References
Anastasopoulos, R. (2018). Cannabis Legalization and Oral Health— what dental hygienists
need to know. Milestones, (3), 8-11. [PDF] Retrieved from http://www.cdho.org/docs/default-source/pdfs/milestones/milestones_201803.pdf
American Dental Association [ADA]. (2020). Cannabis: Oral Health Effects. Retrieved from:
https://www.ada.org/en/member-center/oral-health-topics/cannabis-oral-health-effects
Canadian Public Health Association [CPHA]. (2018). Cannabasics. [PDF] Retrieved from:
https://www.cpha.ca/sites/default/files/uploads/resources/cannabis/cannabasics2018-fact-sheets-e.pdf
Darby, M.L., Walsh, M.M. (2014). Dental Hygiene: Theory and Practice (4th Edition) [Texidium
version]. Retrieved from http://texidium.com
De La Barra, S. (2018, January 29). Dental plaque biofilm and its microbiological significance.
[PowerPoint slides]. Brightspace Algonquin College.
https://www.algonquincollege.com/brightspace/
Government of Canada. (2021). Get help with problematic substance use. Retrieved from
Holland, K. (2020). CBD vs. THC: What’s the difference? [Medical review of the article CBD
vs. THC: What’s the difference?, by D.R Wilson.] Retrieved from: https://www.healthline.com/health/cbd-vs-thc#medical-benefits
Zayan, A. (2020). A joint a day keeps the doctor away!. Retrieved from
https://unsplash.com/photos/4msfw7Pe1iU
Hi Anabelle, I’m Brianna Smith and I just read over your blog and I think it provides lots of very useful information. There are often many people who think that smoking cannabis is fine since there is not as much information out there as to what it may due to our oral health. While doing some research I found a chart and questions that a dental hygienists or dentist should ask to clients smoking marijuana (RCDSO, 2019). I think that asking questions to the clients in regard to their habits and providing them with the resources to learn more can positively impact their oral health.
ReplyDeleteHere is the link for the table and questions I was referring to: https://www.rcdso.org/en-ca/rcdso-members/dispatch-magazine/articles/5167
RCDSO. (2019, August 23). Cannabis and dental health: What dentists should know. Retrieved April 8, 2021, from https://www.rcdso.org/en-ca/rcdso-members/dispatch-magazine/articles/5167
Thank you, Brianna, I took a look at the table of questions you provided and I believe these are great questions to ask to better indicate the oral effects the client may present due to cannabis. I agree that there is a lack of education in regards to the oral health impacts of Cannabis and it is important to share these with our clients in clinic. I found a great fact sheet to provide to clients from the Ontario Dental Associations highlighting some important facts the client should know.
DeleteHere is the link to this https://oda.ca/docman-categories/documents/122-cannabis-fact-sheet
Reference
Ontario Dental Association. (n.d.). Now that cannabis is legal, don’t let it all go to your head….
or mouth. [PDF]. Retrieved from https://oda.ca/docman-categories/documents/122-cannabis-fact-sheet
Hey Anabelle, my name is Hailey and I really enjoyed your post. I think you did a good job at explaining all the adverse oral effects that can come along with cannabis smoking. It is very important to educate clients on this as many people think because cannabis is a plant, there is no harm done when you smoke it. Unfortunately, many people are not educated on the fact that it does still pose harmful risks to your body, especially the oral cavity, just like cigarettes do. According to The American Lung Association, “Smoke from marijuana combustion has been show to contain many of the same toxins, irritants and carcinogens as tobacco smoke”. It also states that smoking cannabis can lower the immune system, which can increase the risk for infections, especially in the oral cavity. (American Lung Association, 2020).
ReplyDeleteThanks for all the great information!!
American Lung Association (2020 December 17). Marijuana and Lung Health. Retrieved from: https://www.lung.org/quit-smoking/smoking-facts/health-effects/marijuana-and-lung-health
Hi Hailey,
DeleteThank you for your comment. I do agree that we must educate clients on the harmful effects of cannabis, especially due to the misconception that it is a plan therefore there is no harm to smoking it. The truth is that there are many harmful effects to not only the oral cavity but also the overall body. As you mention it can lower the immune system increasing the risk of infections more specifically fungal infections due to cannabis containing fungal pathogens, and “they can result in substantial illness and even death, particularly in immunocompromised persons.” (Benedict et al., 2016).
Reference
Benedict, K., Thompson, G. R., & Jackson, B. R. (2020). Cannabis Use
and Fungal Infections in a Commercially Insured Population, United States, 2016. Emerging Infectious Diseases, 26(6), 1308-1310. https://dx.doi.org/10.3201/eid2606.191570.