Cannabis and Dental Caries
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- Published: Tuesday, 18 February 2025 09:30
- Written by Peter Ingle
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A new study from the University of Buffalo published in the Journal of the American Dental Association has linked frequent recreational cannabis (FRC) use with caries and severe tooth loss.
As part of the intake questionnaire at the public clinic where Dr Ellyce Clonan worked, patients would often answer “no” when asked if they smoked. However, when she gave them home instructions following a tooth extraction such as, “no fried foods and no smoking,” an important truth often would be revealed.
“They’d tell me, ‘Well, I do smoke cannabis,’” she said. Clonan, who joined the faculty in spring 2024 as a clinical assistant professor in the Department of Pediatric and Community Dentistry, spotted the association between cannabis and tooth decay while completing her Dental Public Health Residency Programme in New York.
To explore the possible connection, Clonan, who is also a consultant for the ADA, used a cross-sectional study analysing data obtained from 5,656 adults, ages 18-59 who participated in the National Health and Nutrition Examination Survey (NHANES), sponsored by the Centers for Disease Control and Prevention (CDC) between 2015 and 2018.
It revealed that people smoking cannabis at least once a month for more than a year had a 17% higher chance of having untreated coronal caries, 55% higher odds of root surface caries and 41% higher odds of severe tooth loss, compared with patients who did not smoke it. This was after controlling for age, sex, race or ethnicity, education, income and alcohol consumption.
“The surveys only focused on smoking cannabis, not other use such as edibles,” Clonan said. “When you smoke cannabis, you’re literally putting fire near your mouth, which is never good. It causes dry mouth, which can lead to tooth decay. Saliva protects you from dental caries.”
Two particular factors were identified that may contribute to cavities and tooth loss — the high-fat snacks, sugary foods and drinks people typically consume when they use cannabis, and poor brushing habits while under the influence.
The effect of cannabis use on oral health has been on Clonan’s radar for a while, she said, since numerous states, including New York, have legalized marijuana, and recreational use has increased.
The available data was self-reported, so Clonan suspects frequent recreational use is higher than the surveys reveal. Location of respondents was another factor: “Someone in New York might be more forthcoming compared to someone in Alabama who might worry about who is looking at the survey.”
While the average age of the study’s respondents was 39, cannabis use in adults 65 and older jumped by 75% over a three-year period, according to a recent report in the Journal of the Medical Association (JAMA). Meanwhile, according to a 2023 study by the National Institute on Drug Abuse, the percentage of young adults (ages 19-30), who reported past-year marijuana use and daily marijuana use reached their highest ever levels.
While smoking cannabis may lead to oral health problems, Clonan said that she doesn’t want to convey that the drug is inherently bad and patients shouldn’t use it. Cannabis, she pointed out, can serve as a therapeutic agent for numerous diseases and disorders — from cancer to anxiety: “Yes, we want to educate our patients about the dangers of smoking, but we want to treat their use with kindness and understanding. The results of the survey also indicate we need to tailor our advice.”
“For instance, a person smoking either cigarettes or cannabis needs to drink a lot of water afterwards. If their appetite increases after smoking cannabis, it’s preferable that they eat all in one sitting versus snacking over time. I’d also tell them to avoid sugary, sticky foods and remember to brush after eating, even while under the influence of cannabis.”
These lifestyle changes should decrease the chances of cannabis smokers losing their teeth. Clonan also suggests that dental practices can help by making their patient questionnaires more specific.
“In addition to asking about tobacco use, they could ask, ‘Do you use cannabis and How often?’” she said. “Knowledgeable providers will be better equipped to identify and address the adverse outcomes associated with frequent recreational cannabis use, and in turn, give better advice to their patients.”
Those looking for a tick box approach in dental practices to patients with unhealthy habits might want to reflect on another part of Professor Clonan’s advice: “Yes, we want to educate our patients about the dangers of smoking, but we also want to treat their use with kindness and understanding."
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