As medical cannabis continues to make it’s sweeping comeback into mainstream society and modern medicine, the majority of research and clinical data exclusively concerns its effects on the human body. While the practice of dentistry predates all the way to 16th century Renaissance times, modern medicine has largely failed to investigate the potential benefits of cannabis and hemp for oral hygiene and disease prevention 1. Can medical cannabis and/or hemp-derived CBD be an effective tool in preventing bacterial growth, cavities or potentially even oral cancers? Are they helpful in the treatment of these and other various oral pathologies? This scientific review will explore the currently available scientific literature and clinical data to help illustrate the current state of affairs as it relates to medical cannabis, hemp and dentistry.
What is Oral Disease & Why is it Important?
Oral diseases are one of the most common health related ailments facing the modern world 2. While society often impresses upon our youth to brush and floss from an early age, good oral health extends far beyond clean teeth. It involves the gums, palate, lining of the mouth throat, tongue, lips, salivary glands, muscles and nerves and the bones of the upper and lower jaws 3. Recent studies have linked possible associations between chronic oral infections and a host of serious illnesses from diabetes and cardiovascular disease to stroke and premature births 4. Even more importantly is the fact that the most common oral diseases can be prevented and thus, education and oral health literacy is imperative to cultivating a healthy society.
What Are the Most Common Oral Diseases?
Dental caries (cavities), gingivitis (gum disease) and periodontitis are the most common oral diseases, all of which have proven to be preventable5. By understanding the inflammatory and bacterial biological pathways that lead to these illnesses, the medicinal benefits of cannabis and hemp can potentially be applied to treating these conditions.
What Causes Most Oral Diseases & What Are Their Symptoms?
The two biggest causal factors that lead to the aforementioned oral diseases are inflammation and bacterial infection 1. A more accurate depiction of the pathway to oral disease can be seen in Figure 1 (credit: www.principesactifs.org) below. The general mechanism involves poor oral hygiene, bacterial growth, acid production and pH imbalance (creating a beneficial environment for bacterial growth) and demineralization of enamel, finally leading to the most common diseases of Caries lesions, inflammation and infection as well as pain 1. By understanding the mechanism and etiologies of these diseases, we begin to understand how anti-inflammatory and anti-bacterial cannabinoids like CBD and analgesic combinations of CBD and THC can be clinically therapeutic in the scope of oral health 1.
Examining the Potential Role of Cannabinoids in Dentistry:
- Potential Benefits of Cannabidiol (CBD) in Dentistry
The aforementioned biochemical mechanisms behind the pathogenesis of oral diseases and their associated symptoms sets the stage for further investigation of cannabinoid therapy in dentistry. Cannabidiol (CBD), a powerfully medicinal and non-psychoactive component of Cannabis Sativa, shows immense promise in this field due to it’s anti-inflammatory, antimicrobial and anti-nociceptive (analgesic) properties 6. Additionally, a 2017 study demonstrated CBD shows clinical promise in the treatment of oral mucositis 7. Hemp varietals of the cannabis plant are rich in CBD and legal in all 50 states due to containing only trace levels of THC (0.3% or less) and may be a more accessible option for patients around the country. To read more about CBD and Chronic Pain, click here!
- Potential Benefits of THC in Dentistry
THC along with combined formulations of THC and CBD (such as Sativex, a 1:1 whole plant pharmaceutical preparation of cannabis) has already been identified as a clinically effective pain reliever and should be considered more frequently as an alternative to more commonly used opioid pain medicine in dentistry 8,9. The treatment of pain is particularly relevant today at a time when prescription opioid and illicit opioid abuse is a serious epidemiological public health concern.
Other Potentially Effective Cannabinoids in the Treatment of Oral Disease
Cannabis has been dubbed as the plant of one thousand and one molecules due to its diversity of active compounds (cannabinoids) and their interplay with an even greater number of terpenoids 10. Figure 2 (credit: marijuana.com) below presents potential therapeutic targets for various cannabinoids beyond THC and CBD. Special attention should be paid to the anti-bacterial and anti-inflammatory properties and benefits of the cannabinoids as they are one of the most salient qualities needed in dentistry 1.
A Cautionary Note
Unfortunately, the majority of research into cannabis use and oral health revolves around potential adverse or negative effects on oral health instead of using cannabis or hemp as a medicine for treatment. These concerns are primarily tied to the toxicity of smoking and smoke inhalation on oral health 11. While the discussion about the potential dangers of combusting cannabis and inhaling its fumes is another story entirely (which can be found here), its impact on oral health should be more carefully studied as well.
Further Research Into Cannabinoids & Dentistry Is Needed
Currently, there exists very limited clinical data on the role of cannabis in dentistry. Preliminary literature review and analysis, however, suggests cannabis and hemp can be powerful tools in dentistry and the management of oral disease. Currently, it is all too common to receive a prescription for hydrocodone or oxycodone for orthodontic surgery or even bad toothaches. While this may be appropriate for some patients, history has made it abundantly clear that non-opioid alternatives for the management of pain is crucial while dealing with the current opioid crisis. Patients in recovery from opioid abuse may indeed benefit far more from using cannabis or hemp derived pain medication following oral surgery than assuming the risks of using opioids. Furthermore, the anti-inflammatory and antimicrobial properties of CBD are especially promising for the field. With time and adequate research, it may just be a matter of time before cannabis and cannabinoid therapy find their way into the practice of dentistry!
- CBD in Dentistry – Can Cannabis Cure Cavities? Principes actifs (2015).
- Myburgh, N. G., Hobdell, M. H. & Lalloo, R. African countries propose a regional oral health strategy: The Dakar Report from 1998. Oral Dis. 10, 129–137 (2004).
- Benjamin, R. M. Oral Health: The Silent Epidemic. Public Health Rep. 125, 158–159 (2010).
- Health, U. S. D. of & Services, H. Oral Health in America : A report of the Surgeon General. NIH Publ. 155–188 (2000).
- Vodanović, M. [Prevention of oral diseases]. Acta Medica Croat. Cas. Hravatske Akad. Med. Znan. 67, 251–254 (2013).
- Bruni, N. et al. Cannabinoid Delivery Systems for Pain and Inflammation Treatment. Mol. J. Synth. Chem. Nat. Prod. Chem. 23, (2018).
- Cuba, L. F., Salum, F. G., Cherubini, K. & Figueiredo, M. a. Z. Cannabidiol: an alternative therapeutic agent for oral mucositis? J. Clin. Pharm. Ther. 42, 245–250 (2017).
- Hill, K. P., Palastro, M. D., Johnson, B. & Ditre, J. W. Cannabis and Pain: A Clinical Review. Cannabis Cannabinoid Res. 2, 96–104 (2017).
- Russo, E. B. Cannabinoids in the management of difficult to treat pain. Ther. Clin. Risk Manag. 4, 245–259 (2008).
- Cannabis sativa: The Plant of the Thousand and One Molecules. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4740396/. (Accessed: 14th May 2019)
- Significance of cannabis use to dental practice. – PubMed – NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/21735870. (Accessed: 5th June 2019)