At the stroke of midnight on October 17th, it became legal in Canada to buy, possess and use recreational marijuana. The impacts of the new laws may be considerable for the economy, the criminal justice system, the workplace, health and healthcare. It may still be too soon to say whether the new laws will have any significant impact on rates of consumption among Canadians. In addition, while research has already confirmed harmful short and long term health effects of recreational cannabis use 1, we can expect further scientific research in the years to come, possibly identifying additional harmful effects or even benefits.
An important subject often ignored in the debates surrounding recreational marijuana usage is the impact of cannabis on oral health. The American Dental Association (ADA) has identified possible links between the regular smoking of marijuana and a number of oral health issues including a significantly increased rate of caries (cavities) than non-users; staining; dry mouth and more serious conditions including gingival enlargement, periodontal disease and oral cancer2.
With the advent of legalization, we spent a few minutes with Dr. Shirzad and asked her for her perspectives on the issue as well as the ADA’s report:
E: How do you think the legalization of recreational cannabis is going to impact on the types of oral health issues you see among your patients?
Dr. S: Cannabis has been used for a long time and we certainly have treated patients who use it both recreationally as well as for medical reasons. I don’t expect to see new issues arising or even increased usage.
E: So what will be the impact of legalization?
Dr. S: I really hope that legalization will allow for better communication between patients and dentists. In the past, patients have sometimes been reluctant to share the fact that they use cannabis. With legalization, I hope that patients feel more comfortable disclosing this sort of information, whether they are new to marijuana or use it regularly. In our practice, we treat the information as confidential and we don’t make value judgments. Our interest is the patient’s health.
E: Why is disclosure so important?
Dr. S: For many reasons. Some patients consume marijuana before visiting the dentist. This isn’t a good idea. Marijuana affects people differently. Some people may become more relaxed, but others become extremely agitated or even paranoid. It’s not the state you want to be in during a dental procedure. So, if I know a patient uses marijuana, I will discourage them from using it before an appointment.
E: What if marijuana has the effect of relaxing the user? Isn’t that a good thing?
Dr. S: Actually it is not. It can be dangerous. The problem with the patient who relaxes under the effects of marijuana is that they become difficult to properly sedate. If a dentist is unaware the patient has used marijuana, it’s possible to place them in a deeper state of sedation than what is clinically safe. Again, whatever the effect marijuana has on the patient, they shouldn’t use it before an appointment.
E: So patient disclosure is important.
Dr. S: It’s critical. But for other reasons as well. Like with many drugs, using cannabis can have impact on your oral health. Patients need to be aware of the risks, the most immediate of which are tooth decay and gum disease. If I know that a patient uses cannabis, I’m certainly going to keep my eye on those sorts of issues. For those patients, I also advise them about steps they can take to mitigate the effects of smoking marijuana on teeth and gums, like drinking water. Patients also need to be aware of the risks that cannabis presents for oral cancer.
E: Is it possible to detect oral cancer early?
Dr. S: Yes. Fortunately, we have the technologies that make early detection possible. Again, if the patient discloses information to us about their consumption habits, we gain a more complete understanding of risk for disease and are better able to catch problems early.