Does Regular Cannabis Use Lead to Gum Disease and Tooth Loss?
A while back I recall reading an article on ‘meth mouth’, the end result of chronic dry mouth from methamphetamine addiction. It’s a condition called xerostomia where, due to a significant depletion of salivary secretions, those afflicted eventually may lose all of their teeth. The common ‘cottonmouth’ that cannabis smokers experience is in some ways a scaled down version of this condition. So, what do you think happens to someone who smokes marijuana every day and experiences a dry mouth for many hours every day? Will the decrease in salivary secretions lead to gum disease?
In the past people thought of cottonmouth as just a nuisance more than anything else, but new evidence is emerging which suggests that heavy cannabis users may be at increased risk for gum disease and eventual tooth loss.
WHY IS SALIVA SO IMPORTANT?
Well, one of the reasons is because saliva protects the oropharynx, gums and esophagus from drying out. Although it’s 99.5% water the remaining 0.5% is teeming with biochemistry. This tiny percentage contains about 11 main categories of numerous enzymes, electrolytes, mucus, growth factors and antibiotics. It’s all there as a protective measure. The average person will generate and secrete anywhere from 0.75 to 1.5 liters per day. Without normal salivary function the frequency of dental caries, gum disease (gingivitis), and other oral problems increases significantly. Not only that but saliva allows you to taste things. It is the liquid medium in which chemicals are carried to taste receptor cells. Persons with little saliva often complain of dysgeusia (i.e. disordered taste, e.g. reduced ability to taste, or having a bad, metallic taste at all times).
Now that we have established why it’s so important to maintain salivary output let’s see why cannabis decreases it. It appears that saliva and cannabinoids are intimately connected.
In 2003 an Italian study revealed that a certain tick from Texas was secreting its own endocannabinoids 2-AG and anandamide, the same two that we make. The reasons for this odd finding is that the tic uses the potent antiinflammatory effects of these endocannabinoids to cloak the parasite from discovery. In other words, most people do not recall receiving a tick bite since the effects of itching and or pain are eliminated. Pretty remarkable.
Several other studies revealed that rats have cannabinoid receptors on their salivary glands, and that high levels of anandamide caused a reduction in the output of saliva secreted by these glands.
In humans we have the same setup. Cannabis smoking increases levels of THC which acts like anandamide, stimulating endocannabinoid receptors located on salivary glands, leading to a reduction in saliva; and eventually producing a dry mouth that has earned the nickname ‘cottonmouth’ because of the sometimes surprisingly powerful desiccation which renders your oropharynx as parched as midsummer cotton ball.
Some cannabis varietals are more drying than others but most still produce some degree of cottonmouth. If you have a genetic susceptibility to gum disease, or you smoke tobacco, you may want to consider stopping tobacco since this is one of the biggest risk factors for periodontal disease and tooth loss.
DOES CANNABIS CAUSE AN INCREASED RISK FOR PERIODONTAL DISEASE IN CHRONIC USERS?
Let’s look at the evidence against cannabis. Everyone seems to be hanging their hats on a well-publicized trial from New Zealand which went to print in 2008. From WebMD:
Heavy pot use was found to be strongly associated with gum disease at age 32 in a study published in the Feb. 6 edition of The Journal of the American Medical Association.
After controlling for other risk factors for gum disease, including tobacco use, the 32-year-old study participants who smoked the most marijuana were 60% more likely to show evidence of [mild] gum disease than 32-year-olds who had never smoked pot.
Almost one in three people had some evidence of gum loss.
“We found that about a fifth of the participants actually had adult gum disease in their mid-20s and by age 32 the number was just under a third,” researcher W. Murray Thompson, PhD, tells WebMD. “It is clear that smoking — whether it is tobacco or cannabis — damages the gums.”
“With the gums there is a constant fine balance between destruction and repair,” he says. “Smoking tips the balance toward destruction, and if you don’t smoke the balance is tipped back toward repair.”
Thomson and colleagues conclude that smoking may prove to be the “primary behavioral risk factor” for early gum disease.
The author goes on to state that early gum disease may be a canary in a coal mine foretelling early onset heart disease or diabetes or an unhealthy lifestyle since periodontal disease contributes to endothelial inflammation and atherosclerosis.
However, a study like this cannot prove causation, that cannabis actually causes gum disease. But there is a strong association between smoking marijuana and higher risk for early gum disease. The problem lies in the difficulty separating tobacco smoking from cannabis smoking in this study group, and in any others of this type. Scientists adjust for these ‘confounders’ but that only goes so far. It’s interesting that this study also suggests that once again, cannabis smoking does not appear to contribute to other more serious diseases, even after examining heavy, chronic smokers.
ANOTHER NEW ZEALAND STUDY
Not to confuse you, but there was yet another New Zealand study published this year (2016) that reinforced the previous study. It too found an association between cannabis use and gum disease. But not to any other morbidity such as decreased lung function, abnormal metabolic function as in for example, higher cholesterol and increases in fasting blood sugar: risk factors for heart disease and diabetes. They also tested for increases in systemic inflammation and found no association.
The lead author had this to say:
“(I was) somewhat surprised to see that cannabis use was not associated with reduced lung function. Disentangling cannabis and tobacco use is challenging.”
“In New Zealand, cannabis is not typically mixed with tobacco, but most participants who used cannabis also smoked cigarettes. Although we controlled for tobacco use, imperfect control might bias the results toward finding spurious associations between cannabis use and poor health. We note, however, that all poor health outcomes, apart from periodontal disease, were unrelated to cannabis use,”
Richard Saitz, MD, MPH, chair and professor, Department of Community Health Sciences, Boston University School of Public Health, Massachusetts, who was not involved with the study, had several comments that were noteworthy:
…he…pointed to several limitations [of the study], the most important being in terms of the kinds of health effects that were being examined. Dr Saitz highlighted that one of the issues with interpreting the data is that the overlapping proportions of cannabis and tobacco users in the current analysis are unknown.
“We do tend to have this wish and belief that we can isolate factors in studies that are not experiments, like this one, where people choose their behaviors. We think we can identify one risk factor, and the way that we come to that belief is by using sophisticated epidemiological methods.
“We study prospectively, and we use statistical techniques to adjust for things, and that’s all great, but in the real world…the fact of the matter is that any one risk factor or any one behavior is usually done in the context of many others, and the clear one that overlaps here is tobacco. So I would definitely worry about their ability to isolate just the effects of cannabis,” he said.
In other words, we need to view this study as one which suggests that marijuana use can increase the risk for gum disease but that it may not be entirely due to cannabis (or to cannabis use at all) because it may not be statistically possible to separate the effects of tobacco from the effects of marijuana in this particular study.
The lead author Dr. Meier (an assistant professor of psychology at Arizona State University) stated that “Unlike tobacco smoking, cannabis smoking is associated with few physical health problems in midlife, with the exception of periodontal disease.”
She also mentioned that although the study cannot prove that cannabis smoking causes gum or periodontal disease, physicians should still inform their patients that cannabis use puts them at risk for tooth loss.
Except that they cannot pinpoint the actual cause or mechanism:
Dr Meier, “Our analyses show that this association was not explained by tobacco smoking, alcohol abuse or less tooth brushing and flossing.”
She concluded her study with this quote:
Cannabis use for up to 20 years is associated with periodontal disease but is not associated with other physical health problems in early midlife.
Paul Armentano, deputy director of NORML, which advocates for the legalization of marijuana said the study results bolster arguments in favour of legalized marijuana in the United States.
The association between long-term marijuana use and gum disease is likely caused by dry mouth, which is common among marijuana smokers, he said.
SUGGESTIONS FOR PREVENTION OF EARLY PERIODONTAL DISEASE
This dry mouth effect has plagued cancer chemotherapy patients too. The condition of xerostomia is not curable but it can be helped. I have a Master’s degree in traditional Chinese medicine as well as an MD. I have found a half-dozen Chinese herbal formulas that one can take daily as an effective counterforce to dry mouth. I developed these treatments for many cancer chemotherapy patients desperately needing help.
So, in the end, if periodontal disease is caused by cannabis’ actions on salivary CB receptors, and not due to some other smoke related toxicity in the combustion product, we have many Chinese herbs that can help generate fluids and offset this condition. With continued use of these herbs we could perhaps entirely prevent early gum disease and eventual tooth loss. In addition to Chinese herbs, using coconut oil for ‘pulling’ may also be a good preventive measure.
Cannabis Can Help Fight Alcoholism
I grew up in an era when Nancy Reagan’s “Just Say No” campaign proliferated through the airwav…
Patients often substitute medical marijuana for opioid pain medications and other drugs
Medical marijuana patients tend to reduce their use of prescription opioid pain medications, accordi…
Cannabinoids used in Sequence with Chemotherapy are a more Effective Treatment for Cancer
New research has confirmed that cannabinoids - the active chemicals in cannabis - are effective in k…
Cannabis Extracts Associated With Reduced ADHD Symptoms
The administration of whole-plant cannabis extracts is associated with improvements in cognition and…
Cannabidiol reverses the mCPP-induced increase in marble-burying behavior
Cannabidiol (CBD), one of the main components of Cannabis sp., presents clinical and preclinical anx…
Cannabidiol reverses MK-801-induced disruption of prepulse inhibition in mice
Cannabidiol, a nonpsychoactive constituent of the Cannabis sativa plant, has been reported to act as…