Date: September 4, 20192Attorney: William S. Barrett, CEO and Casey Gocel

September 4, 2019

Even though cannabis remains illegal at the federal level, many states have legalized its use for medicinal and/or recreational purposes. The rise in state legality of cannabis use has led to the increase of cannabis users, and health care providers need to be aware of the potential rise in cannabis use by their patients. With the marijuana industry projected to grow to $22.6 billion by 2020, it is imperative that dentists are knowledgeable about the implications of widespread cannabis use.

The Australian Dental Journal states, “[c]annabis abusers generally have poorer oral health than non-users, with an increased risk of dental cavities and periodontal diseases. Cannabis smoke acts as a carcinogen and is associated with dysplastic changes and pre-malignant lesions within the oral mucosa. Users are also prone to oral infections, possibly due to the immunosuppressive effects. Dental treatment on patients intoxicated by cannabis can result in the patient experiencing acute anxiety, dysphoria and psychotic-like paranoiac thoughts. The use of local anesthetic containing epinephrine may seriously prolong tachycardia already induced by an acute dose of cannabis.” In addition, there are many common oral ailments that are prevalent with constant cannabis use such as: gingival inflammation, gingival hyperplasia, and alveolar bone loss. In a study conducted by the Journal of Dental Hygiene, the sample population exemplified that the number of decayed teeth among cannabis users was two and a half times higher than that of a non-user. It is known throughout the dental community that tobacco and alcohol have direct negative effects on soft tissue in the mouth, but this issue is also highly prevalent in cannabis users. One of the main effects of cannabis use is dry mouth, which reduces the production of saliva. Saliva is imperative for the prevention of periodontal issues, which has led to an increase in periodontal disease in cannabis users. Similar to tobacco, cannabis also poses an increased risk for oral cancer. Cannabis contains multiple types of carcinogens, which has shown in studies to lead to an increased risk of head and neck cancer.

It is important for dental providers to understand and be able to recognize the signs of cannabis use, so that they can safely and effectively treat their patients. The first step to ensuring the safety of your patients is to encourage the disclosure of cannabis use in their health history, which can be difficult seeming as cannabis is still classified as a Schedule I drug on the federal level. One of the easiest ways to encourage the disclosure of cannabis use is to use adjusted medical history forms that include a section about cannabis use. In a study produced by The University of Tokyo, it was found that participants were much more likely to disclose their cannabis use on a form, than when confronted about their use face to face. Once this information is revealed, it is important for dentists to react professionally and responsibly. Patients should be informed that their cannabis use is confidential, and that all communication regarding the issue will only be shared with the patients consent. This will create a deeper trust between the dentist and the patient, which will lead to better care in the long run.

As a dental professional, it is very likely that you will encounter cannabis, due to the popularity of the drug and the increase in state legalization. It is important that you implement a plan on how to handle this issue in your practice and be aware of the elevated oral health risks of cannabis users.

Attorneys: William Barrett, CEO and Casey Gocel

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