Live Webinar Q&A
Katelynn Ritchie and Zaid Qaryaqos
Are there any medications commonly prescribed by dentists that may interact negatively with medical marijuana? Or that medical marijuana may lessen the effects of?
Sandra StramoskiRDH, MSDH
Potentialdrug-drug interactions with medical marijuana are numerous, and include interactions with drugs which affect the CNS, including antidepressants and anxiolytics, sleep aids and other psychoactive compounds. If a dentist prescribes an antianxiety premedication, such as a benzodiazepine (Valium, Xanax), or an opioid-containing analgesic, a full drug-use history is always in order. Cannabinoids can cause short-term CVS effects (HBP, tachycardia), as well as respiratory depression, so epinephrine may be used with caution, depending upon the dose and timing of medical marijuana use, but this may be a relative contraindication. Anticholinergics (such as for dry mouth), can also cause additive tachycardia. Specific agents should be investigated on an individual basis.
Kaitlin Fong
Do Dental Hygienists qualify as HCPs who would have the ability to authorize? Or would it have to be the DDS?
Anna MatthewsRDH, MS
Which health care providers can become certified to recommend/authorize medicinal marijuana depends on the laws and regulations of the particular jurisdictions. In some states, dentists, as well nurse-practitioners and other HCPs, can authorize its use. Whether RDHs can recommend/authorize medicinal marijuana use, would be defined by the scope of practice, which may differ from state to state.
Tania Cruz and others
Can nitrous oxide can be used on a patient that takes medicinal marihuana?
Sandra StramoskiRDH, MSDH
Nitrous Oxideis form of conscious sedation used to decrease anxiety, as well as for its analgesic properties. It is also mood-altering, so may be contraindicated for patients who take other drugs which can affect mood, such as barbiturates, antidepressants and sleep aids, whether prescribed or self-administered, as effects may be additive. If they are taking any form of medicinal marijuana which has psychoactive effects, evaluation of the particular drug preparation they are using, including the FDA-approved synthetics, should be done prior to administration. When doubt exists, the prescribing physician should be consulted. If patients admit using marijuana recreationally, or as a self-administered premedication, evaluation of possible intoxication which may reduce their ability to properly consent to treatment, is advised. There has not been specific research to date which considers only medicinal marijuana and nitrous oxide sedation/analgesia.
Howardjay Kirschner, Olivia Lieblong and Others
Does cannabis use intrerfere with our local anesthetics?
Sandra StramoskiRDH, MSDH
Michaela Speckmann
Are there comparison studies between the effects of marijuana versus tobacco smoking on oral health?
Sandra StramoskiRDH, MSDH
The considerations for the use of local anesthesia for a patient who is using medical marijuana should include a complete medical and drug history, blood pressure, pulse and respiratory monitoring, as well as investigation of the specific agent which has been authorized by the patient's physician, its therapeutic and potential adverse effects, including intoxication and dysphoria. There are no absolute contraindications for marijuana and vasoconstrictors in local anesthesia as there are with other drugs such as cocaine and methamphetamines, but if marijuana dosing was acute, blood pressure and tachycardia are a consideration as well. The acute effects lessen with time since administration.
Lynne Alva
Should I talk to my patients that are using medicinal marijuana about cessation as I do smoking tobacco?
Anna MatthewsRDH, MS
No. If medicinal marijuana was recommended by their physician, we should investigate the reasons for such treatment, how effective it is, and whether the patient has any adverse general and oral effects. We should not advise the patients to discontinue any treatment, including using medicinal marijuana, that is outside of our scope of practice. This should be the decision by their authorizing physician.
Amanda and Nada Hammond
I am confused, I know it was a question from previous, however, so there is no FDA plant - derived cannabinoid drugs in the United States?
Sandra StramoskiRDH, MSDH
That is correct, there are no FDA marijuana plant-derived drugs approved in the U.S.
Janelle Petty
Can physicians prescribe the synthetic FDA-approved drugs? Only the botanical form of marijuana cannot be prescribed, only authorized, correct?
Sandra StramoskiRDH, MSDH
Yes, the FDA-approved drugs may be prescribed appropriately. Authorization of botanical preparations are subject to state laws and regulations.
Ashley Carey
What was the reason that marijuana suddenly became illegal after all the prior evidence of positive use cases?
Sandra StramoskiRDH, MSDH
Many pharmaceutical preparations were not regulated prior to vigorous scientific research for therapeutic and adverse effects, including abuse potential. This has changed with the Controlled Substances Act of 1970.
Susan Lorenz
Can children use medical marijuana? Are there any age restrictions??
Sandra StramoskiRDH, MSDH
In some cases, children have been allowed to be part of clinical trials associated with cannabinoid based products. Epidiolex is currently under investigation in several trials on infant-onset severe epilepsy syndromes, as discussed in presentation, as well as available under the "compassionate use" program under their medical doctor and with FDA supervision.
Susan Davie and Amanda
Are there any certain exceptions with professionals using medical marijuana and working?
Sandra StramoskiRDH, MSDH
Laws regarding the use of medical marijuana and the workplace are dependent on several factors. Firstly, the individual workplace must have a policy regarding both workplace intoxication which is generally unacceptable, and mandatory drug testing, which is employer-specific. Next, if the employer is the Federal Government, they have a zero-tolerance policy under the Drug Free Workplace Act, and marijuana is currently illegal under Federal Law. Some states which allow the use of medical marijuana exempt federal employers from accommodating their employee's marijuana use. Further, a landmark case in Colorado, which went to their Supreme Court, upheld an employee's termination due to a marijuana- positive random drug test..
Victoria Fox Miller
Why is marijuana classified Schedule 1? Does that have to change before research can be conducted?
Anna MatthewsRDH, MS
Marijuana is classified as C-I since 1970 because it was determined at that time that it had no accepted medical use and had high abuse potential. Although research can be conducted under the existing classification, it is more difficult for the researchers than it would be if it was in a less-restrictive schedule (II-V).
Sharon Simons
Is it true the government has a patent on cannabis which dictates the research?
Anna MatthewsRDH, MS
The FDA, a federal agency, regulates all pharmaceutical research, including that on cannabis. As a C-I controlled substance, marijuana is subject to additional regulatory controls, as we discussed in the presentation.
Howardjay Kirschner
Is cannabis available on Medicaid?
Anna MatthewsRDH, MS
Medicaid is a federal program and medicinal marijuana is prohibited under the current federal law.
Victoria Fox Miller
Is there a group whom is fighting to keep marijuana on Schedule 1 to prevent research?
Anna MatthewsRDH, MS
The Drug Enforcement Administration (DEA), a federal agency, is responsible for designating the drugs according to their medical use and abuse potential in schedules I-V. At this time, the DEA continues to consider marijuana a drug with "no accepted medical use" and a "high abuse potential".
Alejandra Mederico
As Marijuana is in the Schedule I, it means it is not still accepted to use it in medical use?
Anna MatthewsRDH, MS
On a federal level, this is correct.
Cheri Beard
Does the class status change state by state?
Anna MatthewsRDH, MS
No, it is the same in all states according to the federal law.
G. William Walker
How is it approved for medical use AND be a Schedule 1?
Anna MatthewsRDH, MS
Marijuana is approved for medical use at the state levels but not at the federal level where medicinal marijuana use remains illegal.
Alejandra Mederico
So in some states the Marijuana is NOT in Schedule I? Like you say in NY and CT
Anna MatthewsRDH, MS
No, marijuana is C-I in all jurisdictions according to federal law as determined by the DEA.
Victoria Fox Miller
Can a pt. using medical marijuana in their home state use that license in another state?
Anna MatthewsRDH, MS
Patients have to reside in states where medicinal marijuana is approved, receive authorization from the DOH- registered physicians, and obtain the medicinal marijuana preparations in the state-approved dispensaries. Patients should consult their state DOH websites for more information regarding use in other jurisdictions.
Evelyn Becerra
If the patient is approved and prescribed medicinal marijuana, how long is the process for the patient to obtain the ID?
Sandra StramoskiRDH, MSDH
These are state by state processes that can vary. Please consult your state DOH website, which has very specific and detailed information Nearly all states with medicinal use have websites.
Lawrence Endo
What does THC stand for?
Anna MatthewsRDH, MS
Tetrahydrocannabinol
Meena Priya B.
Does it modify the host immune response?
Anna MatthewsRDH, MS
Cannabinoids can bind to CB2 receptors that are found on the immune cells. There is some evidence of the immunosuppressive effects of cannabinoids and marijuana.
G. William Walker
How long does THC stay in your system?
Anna MatthewsRDH, MS
It depends on the route of administration and tissue in question. Half-life can range from 30 min following cannabis inhalation, to 20-30 hours following oral ingestion. Ultimately, cannabinoids that are not eliminated from the body, are stored in adipose tissue where they can stay for longer periods of time.
Janelle Petty
Where specifically is benzopyrene chemical found? Is it found in THC or CBD? Or in the leaves of the plant?
Anna MatthewsRDH, MS
Benzopyrene is one of the over 400 chemicals found in marijuana. It is different from the phytocannabinoids that include THC, CBD and over 60 other cannabinoids.
Sharon Bauer
Is the spray considered an endocannibidial?
Anna MatthewsRDH, MS
The oral mucosal spray Sativex (nabiximols) contains a combination of plant-derived THC and CBD. They are phytocannabinoids because they are obtained from the Cannabis plant. Endocannabinoids are substances produced and circulating in the human body.
William Weissman
Please differentiate between medicinal marijuana (otherwise also known as cannabis) and industrial hemp which is CBD and is not categorized as medicinal cannabis or medicinal.
Anna MatthewsRDH, MS
Industrial hemp contains very low amount of phytocannabinoids (less than 0.3%). Medicinal marijuana contains varied amounts of THC, CBD, or both, depending on the specific preparation and plants.
Sharon Simons
Can you please elaborate on the THC levels in the recreational vs. medicinal. I saw a documentary saying medicinal had such low levels of THC that the "hippies don't want it" because you do not get high
Anna MatthewsRDH, MS
It is quite possible that the same marijuana product can be used recreationally and medicinally where both uses are allowed by the states. In jurisdictions where only medicinal use is allowed, approved products and their potencies vary.
Stanley Levsky
What are the implications of cannabis emesis?
Sandra StramoskiRDH, MSDH
Cannabis hyperemesis syndrome has unknown causes, is associated with chronic cannabis use and is reversible, often with hot baths. Because of the long half-life and storage of cannabis compounds in fatty tissues, it is thought that stress may contribute to the release of stored chemicals into the circulation, contributing to this effect. Occurrence during medicinal use is dependent on many factors, including the individual agent used, dose, dose form, and frequency.
Christine Oakes and Calvin Brown
Are there any studies determining the long term effects of marijuana? and the side effects on the lungs?
Sandra StramoskiRDH, MSDH
Studies on long term effects of marijuana to date have focused on recreational use. Chronic, heavy use has been associated with some lung diseases, such as COPD. There is no evidence of association with lung cancer to date. There are other adverse effects, as described in the presentation and the literature. Long term effects of the newer preparations remains to be shown. REPORT LINK
Fabricio Chaves Rojas
Can people do exercise while on medical marijuana?
Sandra StramoskiRDH, MSDH
Since medical marijuana is a general term, and numerous agents and dosages may be used, it is dependent upon many factors. Authorizing physicians should provide guidance on this.
Olga Vaughn
Are there any restrictions for driving while a pt. under cannabis?
Sandra StramoskiRDH, MSDH
Both recreational and medicinal marijuana preparations can have intoxicating effects. User discretion and physician guidance are advised.
Komal Kamath
In which cases are medical marijuana contraindicated?
Sandra StramoskiRDH, MSDH
Medicinal marijuana is prohibited where not allowed by law. Medically, specific contraindications, comorbidities and drug interactions should be discussed with the authorizing physician.
Ashley Carey
Are the FDA-approved synthetic THC drugs considered "artificial marijuana", and are there adverse effects?
Sandra StramoskiRDH, MSDH
Lab-manufactured synthetic THC cannabinoids carry many of the properties of plant-based cannabinoids, and can exert both the desired effects as well as similar adverse effects. The FDA-approved synthetic pharmaceuticals discussed here are not to be confused with the street drugs, such as K-2 or "spice" which are often referred to as "synthetic marijuana"
Amanda Pirrone
Is it true that anti-depressants medications will not work when combined with marijuana usage? I have heard this before.
Sandra StramoskiRDH, MSDH
There has been some evidence of drug interactions with tricyclic antidepressants (TCIs) and selective-serotonin reuptake inhibitors (SSRIs), where marijuana use has either decreased or increased the drugs' antidepressive effects, as well as other negative interactions in both the cardiovascular and central nervous systems.
Donna Ferari
Can medicinal marijuana be used instead of premedicating with Rx valium
Anna MatthewsRDH, MS
The two currently FDA-approved cannabinoid-based drugs dronabinol and nabilone (both synthetic) are not approved as anxiolytics. In states where medicinal use is allowed, authorizing physicians may recommend medicinal marijuana preparations for specific patients' condition depending on their clinical judgement.
Ashley Carey
Is non-psychoactive CBD oil recommended for use in-office?
Sandra StramoskiRDH, MSDH
CBD oils are not approved by the FDA, and just last year, they issued 8 warning letters regarding the sale and advertisement of these products, and 6 letters in 2015. Consumers were also advised not to buy or use these products.
Donna Ferari
Can the dentist prescribe Marinol and would it be something for pain management with TX.
Anna MatthewsRDH, MS
As an FDA-approved drug, Marinol can be prescribed by a physician or a dentist, within their scope of practice. However, Marinol (dronabinol) has not been approved for pain relieve.
Jessica Harrington
Dentists can not prescribe this at this time for any reason correct?
Anna MatthewsRDH, MS
It depends on the jurisdiction. Please refer to your state's DOH for state-specific information.
Howardjay Kirschner and Karen Lightner
Can a dentist/dental provider write a prescription for cannabis?
Anna MatthewsRDH, MS
In some jurisdictions where medicinal marijuana is allowed, dentists and other health care professionals can be certified to authorize its use. For example, in Maryland, in addition to physicians, dentists, nurse-midwives and nurse practitioners can authorize medicinal marijuana under a state bill passed in 2016. According to the bill, providers would be required to have an active, unrestricted license to practice in their fields; be in good standing with their respective boards; and have a state controlled dangerous substances registration.
G. William Walker
Is Marinol an oil and if so does it have an odor when used in the currently popular vaping devices?
Sandra StramoskiRDH, MSDH
Marinol (dronabinol) is one of the two FDA-approved synthetic cannabinoid-based drugs. It is available in capsule form only, and is a C-III scheduled drug. There are other cannabis products (not FDA approved) which may be vaporized, but dronabinol is only supplied in capsule form.
Juli Byard
A patient recently told me he and his significant other use THC in a vape device. Have you seen any research on this? He also mentioned this is something they have done since quitting smoking tobacco.
Sandra StramoskiRDH, MSDH
THC is one of the psychoactive compounds in marijuana. Since it is extracted as an oil, vaping is possible, but I am unsure if you are asking about medicinal or recreational use.
Jill Loewen
It doesn't seem appropriate to support use of marijuana via "smoked". Anything that burns and is inhaled can't be a good thing. Is it justified to suggest people use an oral or edible form?
Anna MatthewsRDH, MS
Patients using medicinal marijuana should be advised to follow the recommendations of their authorizing physician regarding the dose, frequency and route of administration of medicinal cannabis. Oral health professionals should access and monitor oral adverse effects and provide relevant information to our patients.
Cynthia Johnson
If a patient smokes or eats marijuana how does that make a difference in the way it was used? Thank you!
Anna MatthewsRDH, MS
Absolutely. Speed with which the drug reaches systemic circulation and the amount of drug in the system, referred to as bioavailability, are higher when cannabis is inhaled and absorbed through the lungs. Additionally, hepatic processing of the drugs - 'first-pass effect', including cannabis, after oral ingestion, can substantially reduce the amount of drug in the general circulation.
Michelle Larose
Smoking the substance creates combustion which is wasteful not to mention hard on the lungs. From what I learned from a physician, it is best prescribed in an oil or vaporized.
Anna MatthewsRDH, MS
In addition to cannabinoids, marijuana smoke contains many chemicals, including known carcinogens, such as those contained in tobacco smoke. Vaporization can deliver phytocannabinoids while reducing the amount of other compounds. The decision on which form and route of administration of the medicinal marijuana is best for the patient's condition will be made by their physician.
Susan Lorenz
What about using medical marijuana oil form in a diffuser?
Sandra StramoskiRDH, MSDH
Patients are advised to follow the authorizing physician's recommendations. Some preparations are vaporized when used, decreasing the combustibles.
Brenda Smulewicz
What about other autoimmune diseases such as Crohn's or colitis?
Sandra StramoskiRDH, MSDH
Research involving cannabis and immune disorders is generally based on reports of anti-inflammatory effects observed in tissue studies. NHANES data reveals that persons with inflammatory bowel diseases are more likely to use cannabis products (authorized or not), but little evidence to date of effectiveness in fighting the disease itself. Documented pain reduction may be the reason for its popular use.
Anibal Torres and Autumn Adams
RA is autoimmune disease so is Lupus. Has THC been studied to treat Lupus
Sandra StramoskiRDH, MSDH
Lupus can have severely debilitating episodes, characterized by pain and inflammation, especially in the joints. Like for other autoimmune diseases, cannabis products may provide symptomatic relief, and appear in popular literature and weblogs. Evidence-based research to date for this indication is scarce.
Laila Bonner
Has medicinal marihuana been recommend on children with cancer or other conditions usually found on adults?
Sandra StramoskiRDH, MSDH
Certain childhood diseases and conditions, such as the intractable seizures associated with infantile onset conditions, such as Dravet syndrome or Lennox-Gastaut are under investigation on children. Epidiolex®, the drug under study, is also available through an M.D. with permission from the FDA under the "Compassionate Use" program for children suffering from these rare, but serious conditions.
Komal Kamath
Can it be given for 'ALS'?
Anna MatthewsRDH, MS
One of the FDA-approved cannabinoid-based drugs, dronabinol, has been studied in ALS and the evidence so far is considered insufficient. Cannabis in other forms/routes of administration has not been studied yet.
Colleen Timmons and Harriett Rosenbaum
Are there any studies for Parkinson's disease?
Anna MatthewsRDH, MS
Both synthetic oral cannabinoid-based drugs and inhaled cannabis were studied in Parkinson's disease. The evidence of ameliorating effects of tremors, dyskinesia and overall severity of PD to date remains inconclusive. While inhaled marijuana showed some effectiveness in improving outcomes, the study was observational and without the control group. Investigators proposed a larger, longer, double-blind, randomized controlled trial.
Amanda
Would this help with Huntington's diseases'?
Anna MatthewsRDH, MS
Two small studies investigated the effect of synthetic cannabinoids (nabilone and cannabidiol) in Huntington disease. Nabilone showed some benefits in reduction of chorea (abnormal involuntary movements) while cannabidiol was not different from placebo. However, due to small sample sizes and short duration of the studies, their results are considered insufficient evidence. The effects of cannabis have not yet been studied.
Karen Wookey
Any information on use with severe autism?
Anna MatthewsRDH, MS
Autism is a neuro-developmental disorder that can be associated with many neurological and behavioral symptoms/manifestations. Any benefits of cannabinoids and marijuana would have to be evaluated in their effectiveness based on individual symptoms. There is evidence of effectiveness of cannabinoid-based drugs in reduction of seizures and tics (such as in Tourette syndrome) that can be associated with autism.
Eileen Becker
Does it help Sjogrens pts?
Sandra StramoskiRDH, MSDH
There have been no studies to date which examine the effects of cannabis on syndrome symptoms, except in general pain relief. No existing reviews contain studies which address Sjögren's.
Michelle Bilodeau
Any help for scleroderma?
Sandra StramoskiRDH, MSDH
To date, there have been no human studies for scleroderma. Tissue studies have shown some effectiveness in reducing skin fibrosis.
Wilma Olazo
Can cannabis be used in conjunction with chemo and radiation to patient w/ cancer?
Anna MatthewsRDH, MS
Since the potential uses of cannabinoids and medical marijuana focuses on general cancer symptoms and associated with chemotherapy (pain, anorexia, nausea, weight loss), the studies evaluated the benefits of cannabinoids and marijuana specifically in cancer patients undergoing chemotherapy. Nabilone in particular, was also evaluated as an anti-emesis agent in patients with radiation-induced emesis and post-surgery nausea and vomiting.
Caroline Florov
What type of cancer is it used? Thank you
Anna MatthewsRDH, MS
Cannabinoids as anti-tumoral agents are under investigation in pre-clinical studies of glioma, hepatocellular carcinoma, prostate cancer, lung cancer, cholangiocarcinoma, breast cancer, and melanoma. A phase 1 clinical study in patients with glioma is underway.
Harriet Rosenbaum
Is there a specific strain or brand that is better than the other for myopathy? or concentration of THC or DMT that is better?
Sandra StramoskiRDH, MSDH
There is limited research on cannabis use in myopathy, which is a symptom of numerous conditions and diseases. Because cannabis has been associated with immune response and possible anti-inflammatory effect, it may hold promise when properly controlled clinical trials are carried out, which will assist in determining the most effective formulation. Our presentation did not address other compounds, such as DMT.
Rebekah Hargrove
Can medical marijuana be used similarly to nitrous in a dentist office?
Sandra StramoskiRDH, MSDH
Currently FDA-approved cannabinoid-based drugs are not indicated for anxiety or acute pain relief. Medical marijuana has not been shown effective for pain associated with dental procedures.
Faith Ryan and Willard Ferrell
Will the use of marijuana decrease the efficacy of local anesthetic?
Sandra StramoskiRDH, MSDH
There is no evidence of marijuana use increasing or decreasing the physiological effects of local anesthetics.
Laila Bonner
Patients who take medicinal marihuana, are they considered under the influence?
Anna MatthewsRDH, MS
It would depend on the presence or absence of psychoactive symptoms.
Amy Rankin
Can people drive a car while on medicinal marijuana?
Anna MatthewsRDH, MS
Adverse effects of medical marijuana are similar to those of the approved cannabinoid-based drugs as well as recreational marijuana, depending on the dose form, amount, and route of administration of the substance. In general, patients should be advised not to drive or operate machinery, but they should consult their authorizing provider and information specific to their recommended drug/product for more guidance regarding ability to drive.
Audrey Torres and Sheila Campbell and others
What is considered recent use in deciding if ok to treat?
Anna MatthewsRDH, MS
It depends on several factors including dose form in which cannabinoids or marijuana were administered and its route of administration (oral, topical, smoked or vaporized), as well as the amount/concentration of active ingredient, THC. The other main cannabinoid, CBD, doesn't have psychoactive properties. Oral ingestion results in low bioavailability (6-20%) and longer duration of action (peak plasma concentration 1-6 hrs., half-life 20-30 hrs.) than that resulting from inhalation: peak plasma concentrations are achieved in 2-10 min and rapidly decline within 30 min. However, traces of THC can be still present in the brain up to 24 hours after administration.
Gail Childs
Should a medical consult be sought for patients on medically recommended marijuana when the treatment plan includes surgical procedures?
Anna MatthewsRDH, MS
A consultation with the authorizing provider would probably be beneficial in planning/provision of all dental/DH procedures, including surgeries.
Juli Byard
Under what circumstance would we deny treatment if the patient is actively using or high? Is the primary concern ability to consent to treatment?
Anna MatthewsRDH, MS
There are currently no guidelines regarding provision of dental and DH treatment to patients using medical or recreational marijuana. The decision would depend on the patient's level of intoxication, if any, urgency of treatment, as well as our confidence in the safety of treatment. Patient's ability to provide informed consent is one of the important considerations.
Christine Henley
Is there any need for concern as far as bleeding if a pt. has smoked just before an appointment?
Anna MatthewsRDH, MS
Cannabis smoking has not been shown to increase bleeding.
Amanda
Would you want to postpone any procedures if the pt. has admitted smoking marijuana?
Anna MatthewsRDH, MS
The decision would depend on several factors, as we discussed in the presentation. Urgency of treatment, patient's intoxication and their ability to consent to treatment, as well as to undergo any necessary procedures safely, will need to be evaluated on an individual basis.
Fabricio Chaves Rojas
Can we treat a patient with any of the kind of effects on the dental office?
Anna MatthewsRDH, MS
Audrey Torres and Harriet Rosenbaum
How can a provider know if a patient using marijuana is ok to give valid informed consent to treatment or considered too impaired to consent?
Anna MatthewsRDH, MS
There are no specific guidelines about such an evaluation. Providers would need to use their judgement, perhaps similarly to alcohol intoxication.
Adrienne Yap
If a patient tells you they have smoked cannabis prior to appt that day, are we as an office supposed to make sure that patient doesn't drive home? Is there impairment when driving?
Anna MatthewsRDH, MS
If we consider that patient's intoxication can make their driving unsafe, we may advise them not to drive and assist in getting an alternative transportation. In general, patients should be advised not to drive or operate machinery when using marijuana.
Christine Henley
Wouldn't informed consent be invalid if the pt. is actively using marijuana opening up for legal action against the clinician?
Anna MatthewsRDH, MS
If a patient exhibits signs of impairment, this may invalidate proper informed consent. The provider's judgement of the patient's level of intoxication may include physical and behavioral manifestations, including tachycardia, redness of the eyeball, confusion and restlessness. The use of a measure of cognitive ability, such as the Mini-mental State Examination may prove helpful.
Amanda
Is there any sort of effects that needs to be considered when a pt. indicates staff that they have smoked marijuana with dental procedures?
Anna MatthewsRDH, MS
Yes, of course. As we discussed in the webinar, patient's degree of intoxication has to be evaluated regarding their ability to consent to the necessary treatment as well as the safety of the planned dental/DH procedures, including anesthesia if necessary.
Heather Weeks
Do dentists need to clear with patients PCP before authorizing marijuana?
Anna MatthewsRDH, MS
If dentists are authorized by the state, where it is allowed, to recommend medicinal marijuana to their patients within the appropriate scope of practice, they would have to follow a specific protocol according to their jurisdiction's laws and regulations. Providers are advised to consult their state DOH for guidance.
Maria Serbanescu
Can we tell marijuana stains on teeth from tobacco stains?
Anna MatthewsRDH, MS
Probably not when marijuana is smoked as the extrinsic stain will result from inhalation of smoke.
Sharon Bauer
Are the sores shown similar to other oral cancers?
Anna MatthewsRDH, MS
No. The mucosal plaques associated with the use of an oral mucosal Sativex spray are reversible once the drug is discontinued.
Shelley Peters
Do marijuana plant tinctures taking sublingually cause similar results as the synthetic sores you showed?
Anna MatthewsRDH, MS
Only one cannabinoid-based drug, Sativex, is approved in many countries and is under investigation currently in the US, as an oral mucosal spray. The mucosal plaques shown in the presentation may be an adverse effect of this spray and there are no other medicinal cannabis tinctures that are used on the oral mucosa.
Annabelle Adriano
How does marijuana effect someone getting an implant, and what is the failure rate?
Anna MatthewsRDH, MS
There are no studies examining this currently.
Maria Teresa
Any oral mucosa effects?
Sandra StramoskiRDH, MSDH
Cannabis smoking is associated with increased vulnerability to oral infections, hyperplastic changes similar to tobacco smoking, and oral candidiasis. These are mostly recreational use reports. One drug currently under study, Sativex® (nabiximols) oral mucosal spray. has caused reversible white lesions at the area of administration.
Karen Lightner and Erica Webber
Do other routes of consumption beside smoking marijuana cause an increased risk of periodontal disease/adverse oral effects?
Anna MatthewsRDH, MS
Studies evaluated the effect of cannabis smoking on the periodontal health. Oral consumption of cannabis-containing products would result in short duration of contact with oral tissues and would not have the harmful effects of smoke (chemicals, temperature).
Ashley Carey
Is it fair to say there are significantly less adverse qualities to marijuana vs. tobacco use for dental health?
Anna MatthewsRDH, MS
No. Just like tobacco smoke, marijuana smoke contains harmful chemicals and inhalation is accompanied by heat. Further complicating the issue is the possibility that many users of recreational marijuana are also tobacco smokers and so there is combined effect that is not possible to separate and attribute to either cannabis or tobacco smoking.
Heather Weeks
Is oral cancer more prevalent with marijuana usage?
Anna MatthewsRDH, MS
Evidence to date does not show an association of marijuana use and oral cancers.
Judith Dean
Are there any studies following gingival health of patients who use Marijuana as compared to smokers?
Sandra StramoskiRDH, MSDH
A 2016 JAMA psychiatry study on recreational use examined health outcomes, including periodontal health, in cannabis-only users, tobacco-only users, and non-users over a 12-year period. Tobacco users had poorer health in all categories, while cannabis-only users did not have similar adverse outcomes in health categories except for periodontal disease.
Wendi Daniels
Is there a higher incidence of dental caries in medicinal agents that are delivered through oral sprays/ mists and sublingually?
Sandra StramoskiRDH, MSDH
There has been no evidence to this affect. Smoked preparations in general have carried more risk of adverse oral effects,
Alejandra Mederico
How does Marijuana affect the enamel?
Sandra StramoskiRDH, MSDH
Smoked marijuana can produce extrinsic stain, and due to xerostomia, patents are at increased risk fo dental caries.
Katelynn Ritchie
How does the incidence of caries compare between smoking cigarettes and smoking marijuana?
Sandra StramoskiRDH, MSDH
Since both smoked products cause xerostomia, both present risk. No controlled studies to date have compared them for this effect.
Autumn Adams
Smoking affects the gums because of lack of oxygen, does smoking marijuana have the same effect?
Sandra StramoskiRDH, MSDH
Smoking causes vasoconstriction and thickening of the vascular walls, which decreases the blood supply to the gingival tissues. While bleeding is decreased, pocket depth are known to be deeper for smoker, and tooth loss more commons.
Amanda Pirrone
Does marijuana increase the risk of caries for patients?
Sandra StramoskiRDH, MSDH
Marijuana carries a risk of xerostomia, and by extension, caries.
Ashley Carey
How does marijuana use via smoking affect dental health? dry mouth, etc.
Sandra StramoskiRDH, MSDH
Xerostomia is a common adverse effect of smoked cannabis for both medicinal and recreational users. The risks associated with dry mouth, such as caries, are also associated with smoked cannabis.
Amanda Beck-Slumka
Are there increased head and neck cancer risks with smoking marijuana as there is with smoking tobacco?
Anna MatthewsRDH, MS
No. Studies to date have not shown a statistical association of cannabis use and head/neck cancers in general. However, such association should be further investigated for particular types of head/neck cancers.
Bobbie Messick
Should we advise them to stop?
Anna MatthewsRDH, MS
We should educate our patients on the general and oral adverse effects as well as possible interference with dental treatment as applicable and provide helpful educational resources.
Megan Randolph
How do you review with patients that there are chemicals in cannabis so is cancer still a concern because a lot of people think it is safer and more natural?
Anna MatthewsRDH, MS
We should explain that smoke contains harmful chemicals, whether it comes from marijuana or tobacco, and at least one of those chemicals - benzopyrene - is a known carcinogen. We can also reason that since tobacco is also plant-derived, just like marijuana that is derived from Cannabis sativa, it is also 'natural' but nevertheless proven very harmful.
