The effects of cannabis use on oral health

Cannabis Uses in Dentistry: A Bibliometric Analysis

Background: This bibliometric review seeks to understand metrics of papers, authors, journals, and universities, about the benefits of the therapeutic application of Cannabis sativa (CS), as well as the most harmful effects associated to its use. Methods: The main search strategy applied to the topic was conducted in Web Of Science Core Collection on February 2024. A crossmatch of the number of citations was performed in Scopus and Google Scholar. The analyses were carried out in VOSviewer and Altmetric for PubMed and Google Scholar. Results: Of a total of 196 records, 53 articles were included for analysis. There were 25 publications on either therapeutic or harmful effects. In the ranking of subjects, those of greatest interest were general oral health and periodontics, with 53% of the total. The most cited paper was authored by Thomson et al. (2008) with 85 citations, allowing the University of Otago to be the most cited. Although JAMA was the most cited journal, in the dental field this corresponded to the Journal of Clinical Periodontology. In relation to the distribution by country, the United States received the largest number of citations and New Zealand second. Related to dentistry, in the cluster analysis, keywords more occurrent were "periodontal disease" and "periodontitis". Conclusions: In the past 4 years, there has been a superlative growth in CS papers related to oral health effects. This growth follows the social and political events related to CS legalization in some countries and reveals that the use of CS in dentistry is an emerging research field.

Comparative effects of methamphetamine, cannabis, and polysubstance use on oral health

Introduction

This study aimed to compare the clinical oral health status of individuals with Methamphetamine (MA), Cannabis (THC), and Polysubstance (PS) use disorders to healthy controls, and assess the impact of substance type, usage duration, quantity, and oral health behaviors on dental health outcomes through comprehensive oral examinations.

Methods

This cross-sectional clinical study was conducted at İzmir Democracy University Buca Seyfi Demirsoy Education and Research Hospital between April 2024 and August 2024. A total of 190 individuals with substance use disorders (MA, THC, and PS users) and 91 healthy controls participated. Sociodemographic data, substance use history, and oral health behaviors were collected using a researcher-developed questionnaire and the Turkish version of the Hiroshima University Dental Behavior Inventory (HU-DBI). Oral health status was assessed through clinical oral examinations using the Decayed, Missing, and Filled Teeth (DMFT) index. Statistical analyses were performed using SPSS 26.0, applying t-tests, ANOVA, Chi-square tests, and Pearson correlation to evaluate group differences and relationships between variables. A p-value of < 0.05 was considered statistically significant.

Results

The study revealed significant differences in oral health among substance users compared to the control group. MA users had the highest DMFT scores (11.04 ± 5.56), followed by THC users (9.49 ± 5.87), and PS users (8.40 ± 4.52), with the control group showing the lowest scores (6.08 ± 4.18) (p<0.001). The study also found a moderate positive correlation between MA use and DMFT scores, indicating that longer and higher usage leads to poorer oral health, while no significant association was observed between THC use and DMFT scores. Additionally, significant disparities in education levels were observed, with substance users having lower education compared to controls (p=0.001). HU-DBI scores indicated poorer oral health behaviors in substance users, though the difference was not statistically significant (p=0.053).

Discussion

The study reveals that all substance use groups, including MA, THC, and PS users, exhibit significantly poorer oral health outcomes, with higher DMFT scores and worse oral health behaviors compared to the control group, highlighting the critical need for comprehensive dental care interventions for individuals with substance use disorders.

Clinical Trial Registration

https://clinicaltrials.gov/study/NCT06640712, identifier NCT06640712.

Antifungal susceptibility profile of Candida species and uncommon yeasts from drug abusers with oral candidiasis

In Iran, there is limited information regarding the species distribution and antifungal susceptibility profiles of yeast isolates from drug addicts suffering from oral candidiasis (OC). In this study, 104 yeast isolates, including 98 Candida species and 6 uncommon yeasts, were collected from 71 drug abusers with OC. The susceptibility profiles of Candida spp. and uncommon yeasts to amphotericin B (AMB), itraconazole (ITC), nystatin (NYC), fluconazole (FLC), and caspofungin (CAS) were evaluated using the CLSI broth microdilution method. The prevalence of OC in the sampled population was found to be 29%. The susceptibility profile of Candida spp. revealed remarkable sensitivity, with 100% and 99% of isolates susceptible to NYC and AMB, respectively. However, concerning levels of resistance or non-wild-type minimum inhibitory concentrations (MICs) were observed, with 13.2% of Candida isolates showing resistance to FLC, 13.2% to ITC, and 16.3% to CAS. Notably, 35.2% of patients showed mixed yeast species, while 5.1% of Candida isolates exhibited multidrug resistance. The analysis of the uncommon yeast species showed that the overall frequencies of the highest MICs were observed for CAS. Furthermore, within the six non-Candida species identified, Hanseniaspora opuntiae and one isolate of Pichia kluyveri exhibited resistance to FLC and ITC, respectively, while all non-Candida species were susceptible to AMB and NYC. Additionally, one isolate of Pichia kluyveri exhibited simultaneously high MICs to two drugs ITC and CAS. Furthermore, the Hanseniaspora opuntiae isolate showed high MICs to CAS and FLC. The findings from the present study suggest that AMB and NYC can be suitable choices for empiric treatment of both common Candida species and uncommon yeast infections in substance abuse patients.

The Effects of Recreational and Pharmaceutical Substance Use on Oral Microbiomes and Health

Oral health remains one of the most taken for granted parts of human body health, even though poor oral health has now been linked to various diseases, such as cancers, diabetes, autoimmune complications, neurological disorders, and cardiovascular disease, just to name a few. As we review in this paper, substance use or abuse, including alcohol, smoking, recreational drugs, and pharmaceutical drugs can have significant implications on oral health, which in turn can lead to more systemic diseases. In this paper, we show that oral microbiome dysbiosis and inflammatory cytokine pathways are two of the most significant mechanisms contributing to oral health complications from substance use. When substance use decreases beneficial oral species and increases periodontopathogenic strains, a subsequent cascade of oncogenic and inflammatory cytokines is triggered. In this review, we explore these mechanisms and others to determine the consequences of substance use on oral health. The findings are of significance clinically and in research fields as the substance-use-induced deterioration of oral health significantly reduces quality of life and daily functions. Overall, the studies in this review may provide valuable information for future personalized medicine and safer alternatives to legal and pharmaceutical substances. Furthermore, they can lead towards better rehabilitation or preventative initiatives and policies, as it is critical for healthcare and addiction aid specialists to have proper tools at their disposal.

Cannabidiol and its application in the treatment of oral diseases: therapeutic potentials, routes of administration and prospects

Cannabidiol (CBD), one of the most important active ingredients in cannabis, has been reported to have some pharmacological effects such as antibacterial and analgesic effects, and to have therapeutic potential in the treatment of oral diseases such as oral cancer, gingivitis and periodontal diseases. However, there is a lack of relevant systematic research and reviews. Therefore, based on the etiology and clinical symptoms of several common oral diseases, this paper focuses on the therapeutic potential of CBD in periodontal diseases, pulp diseases, oral mucosal diseases, oral cancer and temporomandibular joint diseases. The pharmacological effects of CBD and the distribution and function of its receptors in the oral cavity are also summarized. In order to provide reference for future research and further clinical application of CBD, we also summarize several possible routes of administration and corresponding characteristics. Finally, the challenges faced while applying CBD clinically and possible solutions are discussed, and we also look to the future.

Ulceration and a White Lesion of the Tongue in a Male HIV Positive Patient: A Journey on the Avenue of Differential Diagnoses in Search of a Solution

Oral lesions are early indicator of immunosuppression, leading to HIV new diagnoses. The type of oral lesions can reveal opportunistic diseases that are correlated with the severity of immune depletion. Highly active antiretroviral therapy decreases the incidence of opportunistic oral infections, whereas a large variety of lesions are frequently experienced in people with HIV. Overlapping pathogenic mechanisms and multiple contributing etiologies are related to unusual, atypical oral lesions that are challenging in the clinical practice. We present a rare case of eosinophilic granuloma of the tongue in an older male HIV patient with severe immunosuppression due to the failure of antiretroviral treatment. Differential diagnoses considered squamous carcinoma, lymphoma, viral, fungal or bacterial infections and autoimmune disorders, as well as the influence of HIV immune disfunctions or the influence of cannabidiol use. The histopathologic and immunohistochemistry examination clarified the inflammatory reactive benign substrate of the lesion, although future survey of the oral lesions is essential.

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

BACKGROUND

The past two decades have seen an increase in cannabis use due to both regulatory changes and an interest in potential therapeutic effects of the substance, yet many aspects of the substance and their health implications remain controversial or unclear.

METHODS

In November 2020, the American Society of Regional Anesthesia and Pain Medicine charged the Cannabis Working Group to develop guidelines for the perioperative use of cannabis. The Perioperative Use of Cannabis and Cannabinoids Guidelines Committee was charged with drafting responses to the nine key questions using a modified Delphi method with the overall goal of producing a document focused on the safe management of surgical patients using cannabinoids. A consensus recommendation required ≥75% agreement.

RESULTS

Nine questions were selected, with 100% consensus achieved on third-round voting. Topics addressed included perioperative screening, postponement of elective surgery, concomitant use of opioid and cannabis perioperatively, implications for parturients, adjustment in anesthetic and analgesics intraoperatively, postoperative monitoring, cannabis use disorder, and postoperative concerns. Surgical patients using cannabinoids are at potential increased risk for negative perioperative outcomes.

CONCLUSIONS

Specific clinical recommendations for perioperative management of cannabis and cannabinoids were successfully created.

Cannabidiol Rescues TNF-α-Inhibited Proliferation, Migration, and Osteogenic/Odontogenic Differentiation of Dental Pulp Stem Cells

Strategies to promote dental pulp stem cells (DPSCs) functions including proliferation, migration, pro-angiogenic effects, and odontogenic/osteogenic differentiation are in urgent need to restore pulpitis-damaged dentin/pulp regeneration and DPSCs-based bone tissue engineering applications. Cannabidiol (CBD), an active component of Cannabis sativa has shown anti-inflammation, chemotactic, anti-microbial, and tissue regenerative potentials. Based on these facts, this study aimed to analyze the effect of CBD on DPSCs proliferation, migration, and osteogenic/odontogenic differentiation in basal and inflammatory conditions. Highly pure DPSCs with characteristics of mesenchymal stem cells (MSCs) were successfully isolated, as indicated by the results of flowcytometry and multi-lineage (osteogenic, adipogenic, and chondrogenic) differentiation potentials. Among the concentration tested (0.1-12.5 µM), CBD (2.5 μM) showed the highest anabolic effect on the proliferation and osteogenic/odontogenic differentiation of DPSCs. Pro-angiogenic growth factor VEGF mRNA expression was robustly higher in CBD-treated DPSCs. CBD also prompted the migration of DPSCs and CBD receptor CB1 and CB2 expression in DPSCs. TNF-α inhibited the viability, migration, and osteogenic/odontogenic differentiation of DPSCs and CBD reversed these effects. CBD alleviated the TNF-α-upregulated expression of pro-inflammatory cytokines TNF-α, interleukin (IL)-1β, and IL-6 in DPSCs. In conclusion, our results indicate the possible application of CBD on DPSCs-based dentin/pulp and bone regeneration.

Investigation of in vitro odonto/osteogenic capacity of cannabidiol on human dental pulp cell

INTRODUCTION

Vital pulp treatment (VPT) maintains tooth vitality with certain dental materials by protecting pulp from noxious stimulation and promoting repair through enhancing cell proliferation/differentiation, migration, and inducing odontogenesis. As a non-psychotropic cannabis constituent, cannabidiol (CBD) possesses the properties of analgesic, anti-inflammation, and osteogenesis. Therefore, we hypothesize that CBD may induce the odonto/osteogenesis of human dental pulp cells (HDPCs), a critical feature using as effective pulp capping agent for VPT.

MATERIALS AND METHODS

In this in vitro study, the cytotoxicity of CBD on HDPCs was determined by MTT assay. Scratch assay was performed to analyze HDPC migration. The biomineralization was examined by collagen synthesis and calcium nodule formation and related odonto/osteogenic and angiogenic genes. Cannabinoid receptor (CB) specificity was evaluated by Western blotting and Von Kossa staining using specific antagonists AM251 for cannabinoid receptor 1 (CB1) and AM 630 targeted at cannabinoid receptor 2 (CB2). In addition, the underlying molecular mechanism of CBD-induced biomineralization were investigated by examining CB-dependent MAPK signaling pathways.

RESULTS

CBD demonstrated bi-phasic effects on HDPC viability in tested concentrations. We found CBD significantly promoted cell migration, enhanced collagen synthesis and mineralized deposits in HDPCs when treated by 1 μM CBD supplemented in the differentiation media. RT-PCR revealed CBD increased the expression of angiogenic and odontogenic genes, such as DSPP, DMP-1, OPN, ALP, Runx2, VEGFR1 and ICAM-1. These effects were via MAPK activation in a manner mainly mediated by CB2.

CONCLUSION

The results from this study suggested that CBD can induce odonto/osteogenesis from HDPCs and has the potential to develop new therapeutics in VPT in dentistry.

Evaluation of Cannabinoids on the Odonto/Osteogenesis in Human Dental Pulp Cells In Vitro

INTRODUCTION

Cannabinoids possess anti-inflammatory, analgesic, and osteogenic effects in different cell types and tissues. The null hypothesis is delta-9-tetrahydrocannabinol (THC) might induce dental tissue repair and regeneration. The aim of this study was to investigate the effect of THC on human dental pulp cell (HDPC) viability and biomineralization as well as the molecular mechanism of THC-induced odonto/osteogenic differentiation of HDPCs.

METHODS

The toxicity of THC on HDPCs was determined by 3-(4,5-dimethylthiazolyl-2-yl)-2,5-diphenyltetrazolium bromide assay. The odonto/osteogenic differentiation marker genes of HDPCs were assessed by real-time polymerase chain reaction with or without THC treatment. HDPC biomineralization was examined by collagen synthesis and calcium nodule deposition. The molecular mechanism of THC on HDPCs was investigated by examining the mitogen-activated protein kinase (MAPK) signaling pathway via blocking cannabinoid receptor type 1 or 2 receptors.

RESULTS

We found that THC had no inhibition of HDPC vitality in the testing concentration (0-100 μmol/L). THC showed biphasic effects on HDPC proliferation. At a low dose (<5 μmol/L), THC considerably increased HDPC cell division. HDPC proliferation reduced with higher THC concentrations (>5 μmol/L). The expression of odonto/osteogenic marker genes were up-regulated in the presence of cannabinoids. These were confirmed by increased collagen synthesis and mineralized calcium nodule formation in the cannabinoid group. The effect of THC-induced odonto/osteogenesis occurred via MAPK signaling.

CONCLUSIONS

THC was biocompatible to HDPCs by promoting their mitogenic division in a biphasic pattern depending on the concentration. THC induced HDPC odonto/osteogenic differentiation through the activation of MAPK mediated by CB1 and CB2 receptors. Cannabinoids may play an important role in the HDPC regeneration process and potentially be used as a pulp-capping agent.