Learning Objectives: After completion of this course, the participants will:
- Understand the current state of cannabis access in New Jersey. Discuss the barriers to access, the limitations of research and the potential for future access.
- Describe and list the uses of each major cannabinoids: THC, CBD, CBG, CBN
- Describe & define cannabis as a potential replacement for conventional pain management therapies: opioids, steroids, NSAIDS.
- Analyze the routes and methods of administration for cannabis, including inhalation, topical and ingestion routes.
This course examines the therapeutic potential of the major cannabinoids: THC, CBD, CBG, CBN for the management of acute and chronic pain. Participants will explore the practices of New Jersey Alternative Medicine, a six-office cannabis certification center specializing in the management of pain, anxiety, sleep disorders and more, using cannabis, hemp and the essential oils of cannabis called Terpenes.
Remember the days of everyone from hippie protesters calling for the government to just “legalize it, already”? Well, the days of legalized marijuana are here—and so are the days of cannabis derivatives. According to Governing magazine, 30 states where medicinal and/or recreational marijuana is legal have also legalized the selling and use of cannabidiol (CBD) oil. As dental hygienists and oral health professionals, what should we make of this?
Does it mean anything for our patient’s oral health and their dental treatment?
The answer is yes. According to a 2018 article from the American Dental Association (ADA), there are definite considerations for dental professionals: Cannabis smoking is associated with periodontal complications, xerostomia, and leukoplakia as well as increased risk of mouth and neck cancers.”
Oral Health Implications and Effects:
- The use of marijuana and its isolated components has been shown to have oral health implications.
- These include xerostomia, periodontal disease, and increased risk of oral malignancies.
- Cannabis smoking is associated with periodontal complications, xerostomia, and leukoplakia as well as increased risk of mouth and neck cancers.
- Historically, cannabis has been smoked as marijuana, but is increasingly available in other forms, including edible and topically applied products.
- Cannabis use is increasing, along with state legalization, although it remains federally banned.
- The use of cannabis, particularly marijuana smoking, has been associated with poor quality of oral health, but etiology has been complicated by the number of associated factors with frequent users, including high tobacco, alcohol, and other drug use; poor oral hygiene practices; and infrequent visits to dentists.
- It also leads to xerostomia (dry mouth), which can contribute to a number of oral health conditions. Further, the main psychotropic agent, THC, is an appetite stimulant, which often leads users to consume carcinogenic snack foods. Regular cannabis users are known to have significantly higher numbers of caries than nonusers, particularly on normally easy-to-reach smooth surfaces.
Dental treatment implications:
It’s important to recognize the signs of an intoxicated patient (legally or illegally) prior to treatment, especially when anesthetic is planned.
These signs and symptoms may include the following: euphoria, hyperactivity, tachycardia, paranoia, delusions, and hallucinations.
Other research has noted that dental treatment on patients intoxicated on cannabis can result in the patient experiencing acute anxiety, dysphoria and psychotic-like paranoiac thoughts. The use of local anesthetic containing epinephrine may seriously prolong tachycardia already induced by an acute dose of cannabis.” (4) When suspected, the use of a plain anesthetic is preferred for dental treatment. Lower immunity may compromise healing response following extractions, placement of implants, and surgical and nonsurgical periodontal intervention.
A currently intoxicated (i.e., “high”) user may present several difficulties for the dental practitioner. Increased anxiety, paranoia and hyperactivity may heighten the stress experience of a dental visit. Increased heart rate and other cardio-respiratory effects of cannabis make the use of epinephrine potentially life-threatening. Patients may be unwilling to self-report marijuana use or unable to answer reliably, but determination of intoxication may be possible during the routine cardiac risk assessment. It is because of the dangers of administering epinephrine or products containing alcohol to a “high” patient, in addition to increased anxiety and paranoia, that dentists may refuse to treat the intoxicated patient, or consider postponing non-emergency treatment for at least 24 hours. Additionally, there may be legal implications regarding validity of informed consent with intoxicated patients, especially with irreversible procedures like extractions. Effects of acute intoxication effects are reported to subside within 2 to 3 hours.
The following dental findings may indicate a chronic recreational cannabis user:
- Gingival enlargement/hyperplasia
- Alveolar bone loss
If the patient appears to be a user, it may be helpful to understand whether the use is medicinal, as this may suggest relevant comorbidity.Verification of cannabis use may be an opportunity to discuss other health consequences and inform the patient of the importance of fluoride, good oral hygiene practices, and healthy snacking.
When dental health-care providers suspect cannabis use, it is recommended to:
- Complete a comprehensive oral examination and include questions about cannabis use in a thorough dental and medical history.
- Emphasize the importance of regular dental visits and oral care.
- Encourage healthy, nutritious snacks over sweet, cariogenic snacks.
- Consider employing preventive measures, such as topical fluorides.
- Consider treatment for xerostomia, while avoiding alcohol-containing products.
- Keep advised of current changes in applicable laws on recreational or medicinal cannabis.
Credits: 3 CEU’s [AGD code#: 157]
Instructor: Nicole Greco, R.D.H., B.S., M.A.
Nicole Greco, R.D.H., B.S., M.A.; is a Cannabis Educator with New Jersey Alternative Medicine and a Holistic Dental Hygienist. Nicole spent 15 years as a formal dental hygiene educator, serving as Dean for Baker College of Auburn Hills, Michigan which sadly closed August 2016. She has held Dental Hygiene licenses in four states (NY, NJ, PA, MI) and medical marijuana cards in three states (MI, CA, NJ). Nicole is looking to share the miracles she witnesses in both Holistic Dentistry using microscopy, ozone therapy and probiotics and Alternative Medicine using Cannabis, Hemp and the essential oils of Cannabis called Terpenes. Education: Master of Arts in Health Education, Columbia University. Bachelor of Science in Dental Hygiene, New York University