Oral health implications of increased cannabis use among older adults: Another public health concern?

The Effect of Marijuana-Smoking on Dental Caries Experience

OBJECTIVE

This cross-sectional study aims to examine the effect of marijuana-smoking on dental caries experience and to explore the potential combined effects of tobacco and marijuana cigarette-smoking.

METHODS

We used data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES). We examined demographics, tobacco- and marijuana-smoking, dental examination, and dietary intake. Caries was measured as decayed, missing, filled teeth (DMFT). Data analysis included univariate, bivariate analyses, and linear regression model (LRM) to examine the association between marijuana-smoking and DMFT.

RESULTS

Mean DMFT score was lowest for nonsmokers (8.72) and highest for current marijuana smokers (9.87) (P < .0001); however, LRM results revealed that marijuana-smoking was not associated with caries. Adjusted DMFT was the highest for current tobacco and former marijuana smokers (β estimate = 1.18; 95% CI, -0.27 to 2.62), but the relationship was not statistically significant.

CONCLUSIONS

After controlling for potential confounders, there was no significant association between marijuana-smoking and dental caries experience. However, when marijuana and tobacco were smoked concurrently, there was a notable increase in DMFT, although the difference was not statistically significant. Future research should be directed towards exploring the effects of different forms of marijuana consumption, such as edibles and drinkables, on caries development. Health promotion programmes should be aimed at educating the public regarding the combined health impacts of smoking both marijuana and tobacco, considering the potential heightened caries risk.

The need for cannabis education in dental hygiene programs

PURPOSE/OBJECTIVE

Cannabis and the endocannabinoid system (ESC) are rarely included in training programs for healthcare providers. Knowledge within the medical and dental health professionals is lacking regarding the treatment of patients using medical or recreational cannabis. Patients are unaware of the risks associated with cannabis use, and healthcare providers should be prepared to assess, educate, and treat the patients who use cannabis. With the increased legalization and use of cannabis for medical and recreational purposes across the US, this study demonstrated the lack of cannabis education provided in dental hygiene programs.

METHODS

In 2021, an online survey was conducted with 327 dental hygiene program directors. Respondents were asked to answer 26 questions.

RESULTS

With a 21% response rate and 100% completion rate, 60% of the participants responded that cannabis content was provided in their dental hygiene program, 38% responded with a "no," and one responded with "I do not know." No significant difference was found regardless of whether cannabis was legal in the state for medical or recreational use and whether the cannabis content was included in the dental hygiene curriculum.

CONCLUSIONS

The results indicate that every dental hygiene program should provide cannabis content, and each patient should receive a cannabis assessment at every dental hygiene appointment. Further research is required to identify standardized educational content on cannabis and the ESC, which will enable educators to teach students. The development and implementation of a standardized cannabis use assessment and the creation of standardized recommendations for patients who use cannabis to alleviate adverse oral health effects are important.

Cannabis Perceptions and Patterns of Use Among Older Adult Cancer Survivors

Objectives: To descriptively assess cannabis perceptions and patterns of use among older adult cancer survivors in a state without a legal cannabis marketplace. Methods: This study used weighted prevalence estimates to cross-sectionally describe cannabis perceptions and patterns of use among older (65+) adults (N = 524) in a National Cancer Institute-designated center in a state without legal cannabis access. Results: Half (46%) had ever used cannabis (18% following diagnosis and 10% currently). Only 8% had discussed cannabis with their provider. For those using post-diagnosis, the most common reason was for pain (44%), followed by insomnia (43%), with smoking being the most common (40%) mode of use. Few (<3%) reported that cannabis had worsened any of their symptoms. Discussion: Even within a state without a legal cannabis marketplace, older cancer survivors might commonly use cannabis to alleviate health concerns but unlikely to discuss this with their providers.

Dental students' knowledge, attitudes, and perceptions about marijuana and its effects on patients' oral health

PURPOSE/OBJECTIVES

This article seeks to determine dental students' knowledge, attitudes, and perceptions toward patients' marijuana use and whether dental students would like additional marijuana education.

METHODS

Predoctoral dental students were invited in 2021 to complete a questionnaire regarding marijuana's oral health effects, their comfort discussing marijuana with patients and their interest in additional training.

RESULTS

Among participants (n = 206, 32.7% response rate), most were familiar with smoked, smokeless and edible methods, but only 39.3% were familiar with topical applications. Only 29.6% of preclinical and 32.2% of clinical Doctor of Dental Medicine students agreed that smoking marijuana was detrimental to one's health, compared to 64.6% of internationally trained Advanced Standing students. Significantly more clinical students (70.6%) could identify how often they treat patients having used marijuana compared to the estimates of preclinical students (36.7%), although 44.2% of all students indicated they were unsure. Not surprisingly, more preclinical students were uncomfortable treating patients during routine dental procedures (45.6% preclinical vs. 32.8% clinical) and when administering local anesthesia (45.6% preclinical vs. 38.8% clinical) due to not yet providing direct patient care. A majority of both preclinical (92.2%) and clinical (89.7%) students agreed they would benefit from more marijuana education. Clinical students preferred adding a brief introductory seminar while preclinical students preferred multiple lectures throughout the curriculum.

CONCLUSION

As states legalize medical and recreational marijuana use, dental schools need to evaluate marijuana education in their curriculum and develop resources so students can feel comfortable and confident in their ability to identify and safely treat patients who use marijuana.

Associations between Oral Health and Cannabis Use among Adolescents and Young Adults: Implications for Orthodontists

Cannabis use is prevalent among adolescents and young adults in the US. Virtually all modes of cannabis consumption involve the oral cavity, and previous studies have linked cannabis use with poorer oral health. We sought to identify associations between cannabis use and various oral health outcomes and behaviors among individuals 12-25 years of age, and to discuss implications for orthodontists who largely interact with this age group over an extended period of treatment time. We examined data from patient electronic health records (N = 14,657) obtained between 2015 and 2021. Associations between lifetime and current self-reported cannabis use and several oral health outcomes or related behaviors that reflect periodontal health, caries status, oral lesions, and physical integrity of tooth structure and restorations were examined in a bivariable and multivariable manner, controlling for patient age, sex, and self-reported tobacco and alcohol use. Reporting lifetime cannabis use was associated with higher risk for having oral lesions (aPR = 1.41, 95% CI: 1.07-1.85), bruxism (aPR = 1.31, 95% CI: 1.09-1.58), and frequent consumption of sugary beverages and snacks (aPR = 1.27, 95% CI: 1.12-1.41). Reporting current cannabis use was associated with higher risk for oral lesions (aPR = 1.45, 95% CI: 1.03-2.06) and frequent consumption of sugary beverages and snacks (aPR = 1.26, 95% CI: 1.07-1.48). Cannabis users aged 12-25 are at increased risk for bruxism, oral lesions, and frequent consumption of sugary beverages and snacks. Orthodontists and other dental professionals should probe for drug use and be cognizant of increased risk for oral health problems in patients that report actively using cannabis.

Considerations for Cannabinoids in Perioperative Care by Anesthesiologists

Increased usage of recreational and medically indicated cannabinoid compounds has been an undeniable reality for anesthesiologists in recent years. These compounds’ complicated pharmacology, composition, and biological effects result in challenging issues for anesthesiologists during different phases of perioperative care. Here, we review the existing formulation of cannabinoids and their biological activity to put them into the context of the anesthesia plan execution. Perioperative considerations should include a way to gauge the patient’s intake of cannabinoids, the ability to gain consent properly, and vigilance to the increased risk of pulmonary and airway problems. Intraoperative management in individuals with cannabinoid use is complicated by the effects cannabinoids have on general anesthetics and depth of anesthesia monitoring while simultaneously increasing the potential occurrence of intraoperative hemodynamic instability. Postoperative planning should involve higher vigilance to the risk of postoperative strokes and acute coronary syndromes. However, most of the data are not up to date, rending definite conclusions on the importance of perioperative cannabinoid intake on anesthesia management difficult.

In vitro evaluation of the effect of the electronic cigarette aerosol, Cannabis smoke, and conventional cigarette smoke on the properties of gingival fibroblasts/gingival mesenchymal stem cells

OBJECTIVE

The current study aimed to evaluate the effect of electronic cigarette (EC) aerosol, Cannabis, and conventional cigarettes smoke on gingival fibroblast/gingival mesenchymal stem cells' (GF/G-MSCs) of never smokers.

MATERIAL AND METHODS

Human GF/G-MSCs (n = 32) were isolated and characterized using light microscopy, flow cytometry, and multilineage differentiation ability. Following the application of aerosol/smoke extracts, GF/G-MSCs were evaluated for cellular proliferation; colony-forming units (CFU-F) ability; cellular viability (using the MTT assay); mitochondrial depolarization using JC-1 dye; and genes' expression of ATM, p21, Oct4, and Nanog.

RESULTS

Colony-forming units and viability (OD 450 nm) were significantly reduced upon exposure to Cannabis (mean ± SD; 5.5 ± 1.5; p < .00001, 0.47 ± 0.21; p < .05) and cigarettes smoke (2.3 ± 1.2 p < .00001, 0.59 ± 0.13, p < .05), while EC aerosol showed no significant reduction (10.8 ± 2.5; p = .05, 1.27 ± 0.47; p > .05) compared to the control group (14.3 ± 3, 1.33 ± 0.12). Significantly upregulated expression of ATM, Oct4, and Nanog (gene copies/GADPH) was noticed with Cannabis (1.5 ± 0.42, 0.82 ± 0.44, and 1.54 ± 0.52, respectively) and cigarettes smoke (1.52 ± 0.75, 0.7 ± 0.14, and 1.48 ± 0.79, respectively; p < .05), whereas EC aerosol caused no statistically significant upregulation of these genes compared to the control group (0.63 ± 0.1, 0.31 ± 0.12, and 0.64 ± 0.46, respectively; p > .05). The p21 gene was not significantly downregulated in EC aerosol (1.22 ± 0.46), Cannabis (0.71 ± 0.24), and cigarettes smokes (0.83 ± 0.54) compared to the control group (p = .053, analysis of variance).

CONCLUSION

Cannabis and cigarettes smoke induce DNA damage and cellular dedifferentiation and negatively affect the cellular proliferation and viability of GF/G-MSCs of never smokers, whereas EC aerosol showed a significantly lower impact on these properties.

Cannabis use outcomes by past-month binge drinking status in the general United States population

Cannabis use and binge drinking are increasingly common in the United States, yet little is known about cannabis use patterns among people who engage in binge drinking. This study explored the relationship between several cannabis use outcomes and past-month binge drinking status. Pooled 2015-2018 National Surveys on Drug Use and Health data (N = 226,632) were used to explore the hypothesis that binge drinking is associated with higher prevalence of cannabis outcomes. Cannabis outcomes included past-month and past-year use, daily/almost daily use, and past-year DSM-IV/DSM-5 cannabis use disorder (CUD). Covariates included age, gender, race, total income, and study year. Separate weighted multivariable logistic regressions assessed associations between binge drinking and each cannabis outcome and provided adjusted prevalences of cannabis outcomes by binge drinking status. Past-month binge drinking was positively associated with past-month (OR: 3.72, 95 %CI: 3.56-3.93) and past-year (OR: 3.90, 95 %CI: 3.74-4.06) cannabis use in adjusted regressions. The adjusted odds of DSM-IV and DSM-5 CUD among people who used cannabis were 15 % and 12 % higher among people who engaged in binge drinking than those who did not, respectively (OR: 1.15, 95 %CI: 1.05, 1.26 and OR: 1.12, 95 %CI: 1.03, 1.21). Conversely, the odds of past-month daily cannabis use among people who used cannabis and reported binge drinking was 18 % lower than those who did not (OR: 0.82, 95 %CI: 0.74, 0.91). Our findings provide evidence of associations between binge drinking and cannabis use. Future studies should explore associations between cannabis and other alcohol use behaviors, including heavy drinking, and simultaneous alcohol and cannabis use.