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Is Smoking Marijuana Bad For Your Teeth?

Smoke may not be the best for your pearly whites.

As more states across the US are legalizing marijuana, its consumption is becoming less taboo and more people are talking with their dentists about the risks of smoking in regards to gum and tooth health. This has caught the oral health experts largely off guard, as very few studies have been done in this area, unlike with other products such as tobacco. Of the studies currently published, most were poorly conducted or rely on epidemiological data rather than more robust clinical trials. However, according to a 2008 review paper on the subject, it was concluded that common side effects of marijuana smoking include xerostomia (chronic dry mouth), leukoedema (white, filmy mucous layers), increased incidence of periodontal disease, increased prevalence and density of the fungus Candida albicans, and oral cancers.

The short answer to is smoking marijuana bad for your teeth is, of course, yes. As it would be for smoking anything. Most physicians would suggest that if you are going to use marijuana then you should consume it orally or vaporize it to get the beneficial effects with less health risk. However, that’s not to say that vaping is risk free (in this case, we’re referring to vaping oil, not dry flower.) Some have actually found that vape oils containing glycol or glycerin may have cariogenic properties. While most studies conducted are looking at vaping tobacco, a lot of cannabis oil vape cartridges include these two ingredients as cutting agents in order to make their concentrate more vape-able, so the risk is still present in the absence of nicotine. If you want to avoid vaping any harmful cutting agents, you will probably want to try switching to a full-spectrum extract instead.

However, this is also a matter of personal choice, so it is relevant to maybe rephrase the question to “how bad is smoking for your teeth?” To investigate this question further, we have summarized several scientific studies and reviews regarding marijuana use and oral health to get an idea of just how bad it can be for frequent users.

The Side Effects Of Marijuana Smoking On Oral Health

A comprehensive review from 2005 in the Australian Dental Journal concluded that marijuana abusers generally had poorer overall oral health than non-users. This included an increased risk of tooth decay, periodontal disease, and oral infections as well as higher plaque scores and less healthy gums. The study also cited a condition unique to marijuana smokers known as ‘ cannabis stomatitis,’ in which the thin lining of cells around the mouth undergoes changes. This process can lead to small, chronic lesions in the tissues, and increase the risk for oral cancers. However, it should be noted that the same study concluded that “current knowledge on the effects of cannabis on periodontal health is inadequate.”

A more recent study from the Journal of Periodontology (2017) looked at data from 1,938 dental patients who were asked about marijuana use and corrected for tobacco, age, and alcohol use. The study looked at probing depth (an indicator of periodontal disease) and tooth decay and concluded that both were significantly higher among frequent users than non-users. A mechanism was not proposed in the study, and although multivariate analysis did rule out many lifestyle-related factors it is difficult to imply causation based on the methods of the study.

How Serious Is The Threat?

Both studies discussed above concluded that marijuana smoking could be tied to decreased oral health and tooth decay, and with what is known about tobacco smoking this seems intuitively plausible. However, not all studies agree. A small 2009 study in Chile looked at adolescents who admitted to smoking marijuana regularly and found no evidence of increased periodontal disease. Similar conclusions were made in a 2011 study on the effect of several different drugs on oral health, and found that only opiates were significantly associated with any decrease in oral health over a 1-year study period.

What About Oral Cancers?

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Another major concern regarding smoking any substance is oral and throat cancers. The causative effects of smoking tobacco and developing cancers are well documented, and the mechanisms have been well described. However, for marijuana causation is harder to prove at this time due to a lack of data and trials. Many studies have indicated that frequent marijuana smokers are more prone to several types of cancer, primarily of the mouth and neck.

The 2005 review from Australia quoted earlier also discussed oral cancers, stating that chronic marijuana smokers have an increased risk of both leukoplakia (white patches on the gums and tongue) and oral cancers. They sited carcinogenic compounds found in the smoke, including aromatic hydrocarbons, benzopyrene, and nitrosamines, all of which are about twice as abundant in marijuana smoke than cigarette smoke. The study also implicated the different methods used to smoke marijuana than tobacco as more harmful, including not using filters, breathing in more deeply, and holding the smoke in. However, due to limitations in the studies that were reviewed, the authors could not make any strong conclusions, primarily because the effects of smoking marijuana and tobacco could not be separated in the study population.

Other reviews have found no clear association between marijuana and oral cancers. However, most studies have some degree of confidence that marijuana smoking will lead to higher rates of oral and throat cancer, especially in young adults. However, although more evidence is needed, early findings suggest that smoking cannabis may have a lower risk of causing cancer than tobacco. That being said, some issues with current studies and data include:

    • A significant amount of cannabis consumers also consume tobacco.
    • The typical tobacco smoker consumes a greater quantity of tobacco than the quantity of marijuana smoked by the average cannabis consumer.

What Can I Do To Limit Health Concerns?

So, although the science regarding marijuana and the health of your teeth and mouth is far from conclusive, there is enough data to indicate that it is wise to be cautious. Based on current research, we have developed this short list of ways to keep yourself protected while still enjoying the benefits of marijuana use.

  • Consider other methods of consumption such as edibles, vaporizers (remember that this isn’t a completely risk-free option either), tinctures, or oils.
  • Avoid adding tobacco to joints, or consider stopping using tobacco altogether.
  • Be sure to maintain better than average oral hygiene.
  • Use Biotene®, or other dry mouth products to prevent chronic dry mouth which can lead to tooth decay.
  • Ask you doctor about oral probiotics, which have been shown to improve ‘good bacteria’ in the mouths of smokers.
  • See you dentist yearly, or more frequently is you suspect anything is wrong.
  • Talk to your doctors and dentists about your marijuana use (even if you live in an illegal state) so they are aware of the additional health risks or precautions necessary.

While many studies have been conducted proving a link between smoking tobacco and poor mouth health, is the same true of smoking cannabis?

Is cannabis ruining your teeth?

In 2016, a major study from Duke University measured the health of 1,000 New Zealanders who’d consumed cannabis for more than 20 years. What researchers found was surprising—especially when it came to the participants’ mouths.

One cannabis study found no effect on blood pressure, cholesterol, or body mass index. But smoking wasn’t good for teeth and gums.

While cannabis seemed to have no adverse effects on physical health indicators like lung function, cholesterol, blood pressure, and body mass index, researchers found that regular cannabis use did have a significant impact on the health of teeth and gums.

“While study participants who had used marijuana to some degree over the last 20 years showed an increase in periodontal disease from age 26 to 38, they did not differ from non-users on any of the other physical health measures,” they reported.

Increased risk of periodontal disease

Researchers were careful to account for confounding factors like tobacco smoking, alcohol abuse, and poor hygiene in their analysis. Still they noticed a significant oral health effect from cannabis, especially an increased risk of periodontal disease.

Taking this study and several others into account, the American Dental Association’s (ADA) official position is that cannabis smoking “is associated with periodontal complications, xerostomia, and leukoplakia as well as increased risk of mouth and neck cancers.” Xerostomia is a chronic dry mouth condition. Leukoplakia is a condition that causes white patches or spots to appear on the inside of the mouth.

As a result, the dental community is ramping up its educational efforts about the impact of cannabis on the mouth and adjusting clinical recommendations for regular cannabis consumers. Meanwhile, the cannabis industry is developing new products that could lessen the adverse effect on oral health.

The ecosystem called your mouth

The human mouth is a complex ecosystem. It’s made up of many interconnected parts, and requires a variety of organic materials to keep it in balance. Saliva, in particular, is one of the most vital components. It’s responsible for a myriad of functions, like breaking down food and maintaining a moist environment. Most importantly to cannabis users, saliva clears and breaks down bacteria and other substances from the teeth and gums, preventing cavities—or worse.

When you smoke cannabis, research shows that saliva production decreases. Most cannabis smokers will recognize this as the familiar sensation of dry mouth.

This happens because THC mimics one of the body’s natural endocannabinoids, anandamide, which binds to the CB1 and CB2 receptors in the submandibular gland in the mouth to decrease saliva production. So when a person consumes THC-rich cannabis, it signals those receptors to decrease the mouth’s saliva production.

Dry mouth isn’t just annoying

Excessive dry mouth is the biggest cannabis-related issue for oral health because it contains antibacterial compounds (in addition to water, mucus, electrolytes, and enzymes). A mouth without saliva creates an ideal environment for bacteria to build up, which can cause cavities and fungal infections. If left for too long, severe infections in the structures around the teeth, also known as periodontal disease, can develop. This can mean tooth and bone loss, and the risk is compounded by the munchies.

“People’s behaviors when smoking cannabis—drinking more sugary drinks, eating junk food and not taking good care of their teeth,” are probably more harmful than the THC itself, said Dr. Jared Helfant DDS, a practicing dentist in Florida and president of Sparx, a California-based cannabis purveyor.

Gums don’t like smoke

Additionally, cannabis use has been linked to gingivitis, inflammation of the oral mucosa, and spots on the gums, though it is unclear whether “associated irritants, such as orally inhaled smoke, rather than cannabis itself, may be contributing causes,” according to the American Dental Association (ADA) .

The act of smoking anything is bad for our teeth, according to the federal Centers for Disease Control. Smoking can stain teeth and further dries out the mouth. Because the science is still new, and because tobacco use and cannabis use are often correlated, it’s hard to know whether cannabis or tobacco in particular is worse for the teeth.

How to light up with less harm

For those who choose to light up, health professionals like Dr. Helfant, and Dr. George Anastassov, MD, DDS have a few tips.

To combat dry mouth, Dr. Helfant’s recommendations resemble what you’d usually hear at the dentist: Stay hydrated, use a heavily fluorinated toothpaste to protect against decay, try a microbial mouth rinse to kill excess bacteria in the mouth, and brush and floss more often.

As long as the consumer stays on top of their oral health, Helfant said he remains optimistic about the health benefits of cannabis. He has even recommended CBD products to help his more anxious dental patients relax during their appointments.

Consider… chewing gum?

Dr. George Anastassov is a cranial facial surgeon, dentist, and physician. He also founded AXIM Biotechnologies, a company known for their cannabis chewing gum. Anastassov agreed with many of Helfant’s points, but was more adamant about advising cannabis consumers to quit smoking.

“Any smoke-able substance stains the teeth, unless it’s totally transparent. But I don’t think that’s the main problem with cannabis—the main problem is the effect on the upper airway and lungs,” Anastassov said. What to do instead? “Quit smoking and chew our gum.”

Well, okay, no surprise there—Anastassov is the founder of a cannabis chewing gum company. But he does have a point. Chewing gum has been shown to be beneficial to the mouth. Not only does the act of chewing promote good oral health, but it also stimulates the saliva glands, cleaning the teeth and staving off dry mouth. What’s more, certain cannabinoids can actually be beneficial to the oral cavity, Anastassov said.

Antimicrobial cannabinoids

“It’s known that the oral cavity is the dirtiest place in the human body,” he said. “But certain cannabinoids—in particular CBG and CBD—are actually quite good antimicrobial compounds.” CBG halogenated with fluoride, he said, has been shown to be “extremely active in disrupting the life cycles of certain bacteria—most importantly, MRSA.”

MRSA is an antibiotic-resistant strain of staph bacteria. These common bacteria are generally harmless unless they enter the body through a cut or wound—which is why MRSA tends to both flourish and infect at-risk patients in hospitals.

Talk to your dentist, seriously

Most importantly, experts encourage cannabis smokers to talk with their dentists about their use. Helfant acknowledges that some patients may be wary of divulging use for fear of being judged, and some dentists may be unwilling to have the conversation for fear of legal ramifications.

“I’m 36 years old and in the [cannabis] industry, so I’m probably more comfortable talking about it and more knowledgeable,” he said. “Younger dentists in general might be more comfortable than say, a 75-year-old dentist would be,” because the older practitioner grew up with a heavier degree of stigma around cannabis.

Full disclosure helps

Dentists and the ADA were clear about one point: If you arrive at a dental appointment after consuming cannabis, it’s particularly important to disclose that fact. That’s because there are potentials for adverse interactions with numbing and pain medications used during the appointment.

Be honest with your dentist. Cannabis could interfere with the pain medications used during your appointment.

The practitioners working with you, the patient, will also want to be aware in case any negative side effects of cannabis use arise (dry mouth, paranoia). There may also be complications with the legality of informed consent, which any medical practitioner requires.

In the end, it’s not enough to claim that cannabis ruins teeth, or helps them. A variety of factors go into a cannabis user’s oral health. Some have to do with the chemical make-up of cannabis itself, and some are more dependent on lifestyle choices. Additionally, the science around oral health and cannabis is still preliminary—making it hard to come to any clear conclusions.

For now, practicing these expert tips, finding alternatives to smoking, and keeping your dentist in the loop are the best ways to protect those pearly whites while still enjoying the positive effects of cannabis.

A recent study found that cannabis smoking can lead to oral health issues. Here's what the science says, and how to avoid problems.