ISSN: 2469-5734 Singh et al. Int J Oral Dent Health 2019, 5:098 DOI: 10.23937/2469-5734/1510098 Volume 5 | Issue 3 International Journal of Open Access Oral and Dental Health SYSTEMATIC REVIEW ARTICLE Impact of Cannabis on the Port of Entry-Oral Tissues: An Overview Harpreet Singh*, Joseph Katz, Wafaa Saleh and Seunghee Cha Check for Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, USA updates *Corresponding author: Dr. Harpreet Singh, Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL 32610, USA, Tel: 352-273-6685, Fax: 352-846-0588 predominance of marijuana abuse among the elderly Abstract population in the USA (matured ≥ 65) shows uprising, Objective: While there is a recent surge in the publications and developing association is evident of complications describing the beneficial effects of cannabis in chronic pain control and anti-seizure effects there is a dearth of reporting in oral cavity due to cannabis abuse [3]. In the current on the potential side effects of marijuana particularly in the scenario, cannabis use in on the rise with legalization in oral cavity. Since the oral cavity is the main port of entry a few states, and pending enactment in others. Ample of cannabis, the aim of this review paper is to inform and evidence has been reported in the literature supporting educate importance to the dental professionals and public the advantages of cannabinoids for an extensive variety about the negative effects of chronic cannabis use in the oral cavity. of medical conditions for pain and agony for specific dis- eases, such as AIDS, glaucoma, and treatment of neuro- Literature search: Studies published in the English lan- guage on PubMed, Web of Science, Wiley Library and logical ailments including epilepsy, however, concerns Springer reported from 1978to 2018 including human stud- have emerged with respect to the potential abuse and ies, animal studies, and case reports. additionally hazardous utilization of cannabinoids. Results: The continuous use of cannabis was associated The fundamental driver of the antagonistic impacts with adverse effects on oral tissues such as increased xero- caused by 9-tetrahydrocannabinol (THC) a synthet- stomia and caries incidence, periodontal and gingival prob- lems, oral cancer and candidiasis. The compound 9-tetra- ic compound found in cannabis [4]. The mechanism hydrocannabinol was implicated with most of these adverse through which this active component signal is through effects. cell-surface receptors specific to cannabinoid receptors Conclusion: The literature review has identified a wide 1 (CB1) in the cerebrum, lungs, liver, and kidneys and range of detrimental effects in the oral cavity when cannabis cannabinoid receptors 2 (CB2) in the immunity system is used chronically. and hematopoietic cells [5]. The cannabinoids contrarily Keywords influence the immunity reaction and harm the host de- Cannabis, Marijuana, Xerostomia, Oral cancer, Caries, Peri- fense against microbial infections [6]. odontal diseases Literature Search Introduction The following search keywords were used: (Canna- bis), (Cannabinoid), (Marijuana), (Hash oil), and its im- The use of cannabis is very common in the western pact on (Periodontal), (Gingival) tissues, (Dental caries), world and in the USA in particular®. The source of can- (Xerostomia) and (Oral) or (Oropharyngeal cancer). The nabis sativa (C. sativa) a plant from the cannabaceae search was done in August 2018 on PubMed, Web of originally from Central and Eastern Asia. Marijuana is Science, Scopus, Wiley online library and Springer li- the most common psychoactive medication utilized in brary and included human studies, experimental stud- America and around the globe [1]. Current data shows ies, and case reports written in English and published that roughly 147 million individuals (2.5%) on plan- from 1978 and 2018. No filters were applied amid the et earth utilize cannabis for various reasons [2]. The search procedure and, subsequently, any published Citation: Singh H, Katz J, Saleh W, Cha S (2019) Impact of Cannabis on the Port of Entry-Oral Tissues: An Overview. Int J Oral Dent Health 5:098. doi.org/10.23937/2469-5734/1510098 Accepted: September 02, 2019: Published: September 04, 2019 Copyright: © 2019 Singh H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Singh et al. Int J Oral Dent Health 2019, 5:098 • Page 1 of 5 • DOI: 10.23937/2469-5734/1510098 ISSN: 2469-5734 study qualified for incorporation in this paper. ibles” in which person takes cannabis as an ingredient in edible products [7]. The other methods of marijuana Results consumption are inhaling vaporized THC oil common- From 5638 query items, eighteen investigations ly called as “shatter” and “wax” with a process called were qualified including five experimental studies, elev- “dabbing” [8]. Medical cannabis is also well known for en case-control studies, two prospective cohort, and its anti-nociceptive and antihyperalgesic effects in the 5 case reports were added due to the limited number peripheral and central nervous system [9]. The port of of published eligible studies. The research revealed an entry for all forms of cannabis which are volatile, ed- aggregate of 5638 publications in databases and dupli- ible, medicinal, non-medicinal is the oral cavity which cated articles were removed. These investigations and may be affected in an adverse way. The purpose of the research papers demonstrated the chronic utilization present review is to summarize the short term and long of cannabis lead to antagonistic impacts in the mouth, term adverse effects of recreational marijuana on the for example, gingival and periodontal issues, oral can- oral cavity. The limitation of this review is that based cer, xerostomia, dental caries, and candidiasis. All these on literature search we are not able to establish that clinical studies and their finding are briefly incorporated adverse effects of cannabis are most commonly related in Table 1. to which form of cannabis as there is not much of litera- ture available on the individual cannabis forms and their Discussion adverse effects. Since ages, the most traditional and common meth- od of marijuana use is smoking of dried leaves of can- Impact on Periodontium nabis sativa. In recent times other methods are also As reported by López R, et al. cannabis smoking is a becoming quite popular for instance “vaping” which is hazard factor for the periodontal disease that is inde- inhaling vaporized dried flowers or cannabis oil and “ed- pendent of the use of tobacco [10]. Studies conducted Table 1: Showing adverse effects with chronic use of cannabis in the oral cavity. Impacts with chronic use of cannabis in the oral cavity. Oral Clinical findings Authors & References conditions Oral cancer Oral papilloma, leukoplakia and erythroplakia, Darling and Arendorf [11] cannabis stomatitis, HPV-positive oropharyngeal Aldington, et al. [23] cancer. Feng, et al. [24] Liang, et al. [29] Tashkin, et al. [25] Wu, et al. [26] Gillison, et al. [28] Flygare and Sander [30] Periodontal Fiery red gingivitis, gingival leukoplakia, gingival Lopez and Baelum [10] diseases inflammation, and alveolar bone loss. Darling and Arendorf [11] Greater probing depth, Attachment loss, High risk of Nogueira-Filho [15] developing periodontitis. JA Shariff, KP Ahluwalia and PN Papapanou [17] Severe periodontitis. Gingival Blazing gingivitis, gingival overgrowth, Rugged Baddour, et al. [19] enlargement gingiva, Attachment loss. Rawal, et al. [20] Momen-Heravi and Kang [21] Xerostomia Oral dryness, bad taste, loss of teeth. Versteeg, et al. [2] Reduced parotid salivary flow. Kopach, et al. [34] Darling and Arendorf [22] Schulz-Katterbach, Imfeld and Imfeld [35] Pikkarainen, et al. [36] F Di Cugno, CJ Perec and AA Tocci [37] Dental decay Higher DMF index or plaque score. Darling and Arendorf [8] Schulz-Katterbach [35] Silverstein S [38] Candidiasis Increased prevalence, higher risk with Darling, Arendorf and Coldrey [39] immunosuppression, poor denture cleanliness and Warnakulasuriya [40] nutrition. Darling and Arendorf [22] Singh et al. Int J Oral Dent Health 2019, 5:098 • Page 2 of 5 • DOI: 10.23937/2469-5734/1510098 ISSN: 2469-5734 by Darling MR, et al. [11,12] have demonstrated that ations from the normal [11]. Smoking cannabis was antagonistic impacts are not only limited to fiery red related to premalignant lesions in the oral cavity such gingivitis but also seen as gingival leukoplakia, gingival as leukoplakia and erythroplakia. Chronic smoking and hyperplasia, and alveolar bone loss [11,12]. In 1992, chewing may also result in abnormal oral epithelial Darling and Arendorf also stated that a greater plaque changes, namely “cannabis stomatitis”, which includes index; and poorer gingival health is more prevalent in buccal mucosal leukoedema along with hyperkeratosis. cannabis users than in healthy controls [11]. The mech- “Cannabis stomatitis” was reported as the constant ag- anism by which cannabinoids negatively affects the gravation of the epithelial cells in the oral cavity result- periodontium is very well explained by Nakajima, et al. ing in leukoplakia, which may advance to neoplasia [11]. [13] According to the author’s presence of CB1 and CB2 Marijuana smoking