75% of dentists don't talk about cannabis -- here's why you should

By Theresa Pablos, DrBicuspid.com associate editor

August 9, 2019 -- Do you discuss cannabis use with your patients? Researchers from the University of California, San Francisco (UCSF) hope the answer is yes. They outlined the oral health considerations of marijuana and other noncigarette products in a recent study.

"Any product that involves breathing in smoke, including cannabis, is likely to exacerbate periodontal disease and impair wound healing," lead author Benjamin Chaffee, DDS, MPH, PhD, told DrBicuspid.com. "Smoked tobacco and chewing tobacco both increase the risk of oral cancer."

Dr. Chaffee and fellow researchers from the UCSF School of Dentistry asked hundreds of California dentists and hygienists about their tobacco and cannabis counseling behaviors with their patients. They published their findings in JDR Clinical & Translational Research (July 19, 2019).

The majority of dentists and hygienists said they didn't discuss electronic cigarettes (e-cigarettes), smokeless tobacco, or other types of nontobacco products. Only 25% reported talking with patients about cannabis use, significantly lower than almost any other type of product.

Percentage of dental professionals who discuss cannabis and tobacco products

Dr. Chaffee was somewhat discouraged by the findings since dental professionals should discuss tobacco use with every patient. Tobacco products have known oral health consequences, and while less is known about e-cigarettes, he maintains they are not harm-free.

It's also important for dentists and hygienists to discuss cannabis use, Dr. Chaffee noted. Smoking marijuana, including in water pipes, is the main concern for dental professionals, but other types of cannabis may still have a detrimental effect.

Benjamin Chaffee, DDS, MPH, PhD
Benjamin Chaffee, DDS, MPH, PhD.

"As for vaping or edibles, the research is insufficient to understand possible oral health effects," he said. "That said, there may be other relevant considerations, like patients who are self-medicating with cannabis for dental anxiety, perhaps becoming too impaired to drive safely to or from dental visits."

Talking about cannabis is not something Dr. Chaffee only recommends for California dentists, either. California is often an indicator of future countrywide trends, and dentists in other states should be prepared to ask about marijuana use.

"California is somewhat unique, given the low prevalence of tobacco smoking and liberal attitudes and policies around cannabis," he said. "Historically, smoking levels and policies seen first in California have later become the norm in other states."

“There's no need to feel uncomfortable talking about something that is directly related to oral health.”
— Benjamin Chaffee, DDS, MPH, PhD

In fact, Dr. Chaffee believes not talking with patients about cannabis and tobacco use could be a disservice, especially because cannabis can interfere with optimal healing after an extraction, graft, or implant.

"Dental professionals are trained to be great communicators," he said. "There's no need to feel uncomfortable talking about something that is directly related to oral health."

Finally, Dr. Chaffee urged dental professions to learn more about local tobacco cessation resources and refer patients to cessation programs when necessary. In the study, only 35% of hygienists and 16% of dentists offered patients a referral -- percentages the authors deemed low.

"It is vital that dental professionals are well informed and comfortable with the available tobacco cessation resources near them so that they can connect patients with evidence-based support to quit," Dr. Chaffee said. "Compensating dental practices for time spent delivering tobacco cessation counseling would both motivate providers and signal that this service is important."

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Last Updated np 8/9/2019 3:13:54 PM

1 comment so far ...
4/20/2020 1:52:16 PM
Regarding discussing use of cannabis with dental patients:  when I wrote my textbook regarding preventing medical emergencies by asking the most relevant questions during the medical history review there was an item on the American Dental Association Medical History 2 page form for cannabis use. I searched the literature for dental implications of cannabis use and found only a few studies. One study on the pharmacology of cannabis and local anesthetics with epinephrine as a vasoconstrictor reported a drug interaction of cannabis increasing dangerous cardiovascular effects. The study authors advised dental professionals to ensure cannabis had not been used in recent past if a local anesthetic/vasoconstrictor was planned for use. I have searched the literature for other studies on cardiovascular effects of cannabis and there are not many studies. My guess is that since cannabis was in Schedule 1 of DEA abused drugs, that it was not easily available to study. However, since cannabis is lawful to buy in several states, this prohibition is no longer relevant. Hopefully someone will study the effect of cannabis and use of a normal dose of local anesthetic/epinephrine. This would be very relevant to dentistry. If anyone knows of a study on this issue (which I must have missed), please provide a reference and thank you. Frieda Pickett, RDH, MS