Can cannabinoids treat gum disease?

By Alvin Danenberg, DDS, DrBicuspid.com contributing writer

October 5, 2016 -- Research is just research. It is information that may make a difference in humans once it has been tried and tested in humans. I see the potential in new research published in the Journal of Neuroinflammation (June 3, 2016) that could enhance the treatment of periodontitis. We as a profession have not adopted this new research yet.

Alvin Danenberg, DDS
Alvin Danenberg, DDS.

The new research revolves around biochemicals that are manufactured by various cells in the body. The specific biochemicals described in the research are called cannabinoids, biochemicals with a recognized anti-inflammatory effect. When cannabinoids are damaged or prevented from doing their work in the body, the body suffers. These biochemicals are also available from external sources and could support those made by the body.

Specifically, cannabidiol (CBD), one of the cannabinoids, is available from the hemp plant. It is not tetrahydrocannabinol (THC), which is another cannabinoid compound that is the active ingredient in marijuana. Cannabidiol has no or minimal psychoactive effects or toxic effects, and it is available as an over-the-counter supplement.

Science and periodontitis

Destruction of the jawbone in periodontitis is related to specific mediators causing inflammation and resorption of bone. Previous animal research has shown that CBD will decrease this inflammation and prevent destruction of the jawbone that is part of the progression of periodontitis (International Immunopharmacology, February 2009, Vol. 9:2, pp. 216-222). A 2006 study posited that it might be possible that supplemental CBD could improve healing following periodontal treatment by reducing these damaging effects caused by advanced gum disease (FEBS Letters, January 23, 2006, Vol. 580:2, pp. 613-619).

In contrast, a 2012 paper suggested that using CBD as a supplement could possibly cause an overgrowth of periodontal tissue, especially if there was existing gum infection (Journal of Periodontal Research, June 2012, Vol. 47:3, pp. 320-329).

Future potential

In the future, clinical trials need to be done to show that CBD would be beneficial in treating periodontal disease. Only then could we consider embracing its potential.

“These questions must be answered before I could recommend CBD as a supplement in periodontal treatment to my patients.”

Other questions that need to be answered include the following:

  • How much CBD would a patient need to consume to improve healing?
  • Since many structural forms of CBD are available, which one would be most biologically available to the body?
  • Are there any side effects from supplemental CBD on the rest of the body?

These questions must be answered before I could recommend CBD as a supplement in periodontal treatment to my patients. However, I do emphasize to them that the best prevention for periodontal disease is a nutrient-dense, anti-inflammatory diet and proper oral hygiene as I described in my series of blog posts.

Unfortunately, science at times has created medicines or supplements processed from natural sources only to learn the intended benefits are not what they should be or the side effects prove to be harmful. That said, I am eager to learn what CBD might be able to do for my periodontal patients.

Alvin Danenberg, DDS, practices at the Bluffton Center for Dentistry in Bluffton, SC. He is also on the faculty of the College of Integrative Medicine and created its integrative periodontal teaching module. He also spent two years as chief of periodontics at Charleston Air Force Base earlier in his career. His website is drdanenberg.com.

A version of this column first ran on Dr. Danenberg's blog. DrBicuspid.com appreciates the opportunity to reprint it.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

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Last Updated np 10/4/2016 12:07:20 PM

5 comments so far ...
10/5/2016 2:24:00 PM
dok
 Answer me this :
 
By altering the inflammatory response are we really treating periodontal disease..... or just masking it ? What is the underlying etiology of periodontal disease ? Could it be the pathogen laden biofilm colonies that lie in inaccessible areas around teeth ? Shouldn't our patients be targeting/disrupting these biolfilm colonies efficiently, effectively and on a daily basis before we go to the trouble of immunotherapy ? We don't treat gingivitis/caries by altering the immune system.........do we ? So why do it for periodontal disease.
 
How is the drug delivered safely and effectively ? Can it be directly targeted to pocket spaces by patients on a regular basis ? If not, will the drug also alter the immune response in other parts of our body especially if it is delivered systemically ( via a pill ).  How long does the individual have to stay on the drug to keep the disease process away if pathogen containing biofilm is not being disrupted in pocket spaces  ??
 
Daily effective targeting of pathogenic biofilm in diseased periodontal pockets is really the answer and it's not rocket science to do so.......just smart engineering.
Dok
 
 
 

10/6/2016 9:06:37 AM
DrJames
dok:
I agree that the questions you've posed would need to be answered, but if they are ultimately found to have satisfactory answers...
Why not both?  The disease theoretically can't progress without the biofilm, and the biofilm is theoretically not destructive without the inflammatory response.
If (and these are big IFs at this point) localized (or systemic) anti-inflammatory treatment can be found to be effective without intolerable systemic side effects, and at a reasonable cost, wouldn't combination therapy be superior to either therapy alone?
 
I believe there's something to be said for research suggesting that a systemic susceptibility to inflammation may predispose an individual to periodontal disease but also a host of other systemic conditions.
(That's not to suggest dentists should begin managing patients' systemic inflammatory response - management of systemic inflammation is obviously beyond the purview of a general dentist or periodontist and would require the involvement of the patient's physician.)

10/6/2016 10:57:27 AM
dok

Hi Dr. James,
Thanks for the reply.
Yes, I agree. Both for short term treatment makes some sense. However, I can't see the immunotherapeutic approach as a long term answer for prevention and maintenance. Still need to disrupt biofilm continously and effectively  regardless of depth or position of pocket spaces around teeth ). Why do we have to brush and floss everyday ??? It is simply because the bugs never give up growth and colonization and a patients genetic susceptibility to pathogens doesn't change, so effective, thorough and regular ( daily ) biofilm disruption is necessary ( even in deep pocket spaces ).
Approaches like cannaboid immunotherpy assumes that all bacterial biofilm cannot be targeted effectively by our patients everyday. It is not that the current crop of drugs are lacking in antibacterial efficiency but instead it is the ability to precisely target the inaccessible biofilm that is lacking.  That limitation is not an issue in my mind.  It is nothing more than a matter of smart engineering to change all that. Cancer researchers have realized this in a big way ( why not look at precise targeting for the treatment of dental diseases in the same way ).
 
Sincerely,
Dok


10/6/2016 11:35:14 AM
dok
Case in point for just one targeting biofilm disrupting product currently in development( there are many others ):
Ever heard of a "photodynamic light enhanced irrigating interproximal  brush" that can both mechanically clean embrasure/interproximal spaces ( where most pockets occur ) as well as target and deliver photodynamically active antimicrobials into deep pocket spaces to disrupt biofilm. This biofilm disrupting technique allows for DAILY, EASY and EFFECTIVE biofilm disruption even in deep pocket spaces. Sounds crazy you say ?? No, it's not really crazy or gimmicky..... just good science and smart engineering.
Dok

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