Sinking our teeth into medical cannabis and dentistry

Grin and bear it: Dentistry in the UK

In the UK, almost 40% of the population is unhappy with the appearance of their teeth, and here, taking a trip to the dentist is an extremely common fear, so many choose to not attend unless it's absolutely necessary. 

However, it is also very difficult to secure a dentists' appointment for a lot of people across the UK, due to underfunded and overcrowded NHS services. The Great British Oral Health Report recently found that 70% of Brits have wanted to see a dentist in the last two years - but only 43% have actually managed to do so.  

It was also found that over a quarter of the British population is suffering from untreated tooth decay (27%), and over half have gingivitis (52.9%). Additionally, over the last year, an estimated 6 million adults have experienced long-lasting pain (lasting over two weeks) as a result of a dental issue. 

Because these services are already so overwhelmed, it's imperative that we take proactive steps to take care of our teeth and maintain a high standard of oral hygiene, especially if you vape medicinal cannabis. 

Medical cannabis considerations in Dentistry 

For medical cannabis patients, the thought of what your medication may be doing to your teeth may have never even crossed your mind. But, to properly take care of that smile there are a few things to be aware of, and seeing as it's National Toothache Day, we thought now would be a good time to go over this. 

Unfortunately, the majority of research that analyses how cannabis affects oral health tends to focus on the effects of smoking. But, in the UK, smoking cannabis is always illegal, and it will never be prescribed to be administered in this way because of the serious health risks associated with inhaling combusted materials. 

Cannabis-based treatments can be prescribed to in a variety of different forms which are administered in different ways in the UK, and so, it is hard to make a sweeping statement about medical cannabis treatments affect oral health, but we thought we’d take a look at the two most common forms prescribed: medical cannabis oil, and dried medical cannabis flower. 

Route of administration: sublingual cannabis oil 

Medical cannabis oils are typically prescribed to be absorbed sublingually, in tincture form. Patients hold the oil underneath their tongue for a few minutes so it absorbs into the bloodstream through the mucous membranes that line the mouth. 

Currently, research suggests that the act of administering medicines sublingually does not poorly affect oral health, but, the ingredients in certain conventional sublingual medications like buprenorphine (a semi-synthetic opioid) can have negative consequences in terms of dental health. 

Prescribed medical cannabis oils can either be categorised as either full spectrum, broad spectrum, or isolate oils depending on how many different cannabis components they contain. Cannabis compounds like CBD and THC are known to impact oral health in different ways, and so, the oil’s formulation and the chemical concentrates it contains will dictate how your teeth may be impacted, but the actual route of administration itself, is not believed to have any negative consequences. 

Route of administration: vaped medical cannabis flower

Medical cannabis flowers are prescribed with the instruction of being heated in a vaporiser and then inhaled - not to be set alight and then smoked. So far, research has shown that vaping is a safer alternative to smoking, however there are still health concerns, and dentistry concerns, associated with the use of vaporisers.

For example, the sucking motion that is required to draw vapour through the vaporisers chamber and into your lungs, can cause dry sockets in people who have had a tooth, or teeth, extracted. Almost three quarters of the UK’s adult population have had a tooth removed, and so dry sockets are a common, yet extremely painful and serious dental issue. 

After a tooth has been extracted, blood clots start to naturally form in the empty socket acting almost as a plug, to protect the exposed tissue and start the healing process. But the sucking motion vaping requires, and the heat produced by the vapour, can irritate gums and disrupt this clotting process. This can lead to a dry socket, and extreme pain, so it is always advisable to avoid vaping whilst recovering from a tooth extraction. 

Can CBD help with toothache?

Now that we’ve established how administering cannabis based medicines can affect your teeth, it’s time to have a look at how the components within cannabis, like cannabinoids, can affect your teeth. And, considering it's National Toothache Day, let's start with the evidence that suggests CBD could be an effective option for managing dental pain.

Last November, the results of a double-blind controlled trial involving 61 participants with acute dental pain were released. In this study, CBD (in Epidyolex form) was found to substantially reduce severe dental pain, and improve bite force. After three hours, 85% of those who received CBD said their pain levels had halved, and the median reduction in pain score was 70%. The next step, a phase three trial, is now in the planning stages. 

Other benefits of CBD

Researchers have also investigated the other therapeutic potentials CBD holds, and how these may be able to be utilised within the dental field. Evidence suggests that the cannabinoid’s anti-inflammatory and antimicrobial qualities may be useful in managing or treating periodontal diseases (gum disease), could have a positive influence on gingival fibroblasts, and may promote healing and healthy cell growth. 

Cannabidiol (CBD) has also been praised in respect to its efficacy in treating and managing anxiety, which is often experienced during a trip to the dentist. When CBD is consumed, it has the ability to boost the brain’s production of serotonin, which can in turn decrease stress levels and reinstate a relaxed, calm state of mind. 

Does THC damage teeth? 

There is limited research in respect to how THC affects teeth, however, there are findings that propose the consumption of THC may lead to the development of behaviours that are detrimental to dental health. 

For example, The American Dental Association note, that THC can be an appetite stimulant, and often when a person has consumed cannabis they will then consume cariogenic foods. This food group, which includes sugary and starchy goodies, is the worst food group for your teeth, and they create acid, and promote plaque, in the mouth after being eaten. 

Another area that has been explored is if there is a correlation between poor oral hygiene practices and cannabis consumption. So far, it seems cannabis users are more likely to experience periodontal diseases and tend to develop caries in areas in easy to reach areas of the mouth. Some theorise this could be due to THC’s sedative and memory-altering qualities, and that this can cause cannabis users to forget to clean their teeth as regularly as they should. 

Medical cannabis considerations in Dentistry

It is important that dentists are non-judgemental when medical cannabis patients disclose that they are using cannabis based treatments. Much like in any healthcare profession, dentists have an ethical obligation to treat all their patients with respect, and respect their choices regarding healthcare decisions, while providing the best quality care possible. 

Be open and honest about your use of medicinal cannabis, and ask for extra support from your dentist if you are concerned about your treatment affecting your teeth.  Your dentist may discuss the option of switching the administration method if you currently vape medical cannabis, to using a prescribed cannabis oil, but this should also be discussed with your prescribing clinician before any changes are made. 

Interaction with anaesthesia 

If you are a medical cannabis patient, another thing that you should be aware of, is that your use of medication can alter your typical responses to anaesthesia, because they both affect the central nervous system.

Those who use cannabis regularly (like medical cannabis patients) tend to have a higher tolerance to sedative medication, and therefore, need a larger dose of anaesthetic to put them to sleep. Research suggests those who use cannabis on a daily or weekly basis need around three times as much anaesthetic as those who do not consume cannabis. 

For this reason, it is essential to make sure your dentist is aware that you take cannabis based medicines if you are due to have dental work done, and inform them of your dosing routines and treatment concentration, so their anaesthesiologist can ensure you get the right dose of aesthetic. 

Conclusion

National Toothache Day serves as a timely manner to remember the importance of maintaining a high standard of oral hygiene, especially if you are a medical cannabis patient. Brushing your teeth twice a day with a fluoride toothpaste, flossing daily, and having regular dental check-ups are always advisable, but if you are a medical cannabis patient, they are even more important.

Staying hydrated to prevent dry mouth and staying away from sugary snacks where possible will help to minimise the risk of gum disease and tooth decay, and so this advice is particularly beneficial to medical cannabis patients. As we await further research in this field, taking a proactive approach to dental care is essential. 

Releaf understands the importance of medical cannabis in treating various medical conditions. With our tailored monthly packages, specialist consultations for medical cannabis, and a unique medical cannabis card for protection, you can access the treatment you require without worrying about the stigma.