Cannabis Use in Ontario

With some forms of marijuana use now legal in Canada, and with the individual provinces setting specific regulations, it’s a good time to review this changing landscape. In Ontario, legality entails restrictions on the quantities of marijuana legal for possession, permissible sites for cannabis consumption, restrictions regarding mixing driving with cannabis, and age restrictions, among other things.

As of October 17, 2018 certain forms of cannabis are permitted for sale: marijuana in fresh form, dried bud, oil, plants, and seeds. The initial introduction of cannabis products to the market in Ontario was through online sales, but as of April 1, 2019 limited storefront sales are also allowed. Not permitted for sale until later in 2019 (with the exception of oils) are edible cannabis products and concentrates (although these are permitted in private production for personal use). Also, vaporized THC is not permitted for sale at present (this refers to products for electronic cigarettes and other types of vaping).

The legalities have not changed for medical marijuana.

Without getting into far into the specifics of the legalities of marijuana use in Ontario, it is nonetheless possible to identify the aspects of this new legal structure that relate to dental concerns.

Smoking Cannabis

Smoking marijuana leaves and the other products that come from marijuana plants, while a newly legal activity, is not in itself new. However, the new legalities mean that it’s likely that more people will participate in this activity than in the past. The important point is that smokers of marijuana products, whether the product is bought legally, home grown, or illegally purchased, will all face the same oral health implications.

Oral Cancer

All of the means of smoking marijuana products are fundamentally the same in that the delivery of the cannabinoid products is through a process of combustion that produces a wide range of byproducts. With that, there is a risk of oral cancer from carcinogens in the smoke. Additionally, marijuana is also combined with tobacco as an accompanying combustible, and so all the carcinogenic dangers of smoking are then added to the mix.

Infections

Marijuana use has been connected with weakening of the immune system, affecting gum health and possibly leading to tooth infections. In addition, smoking leads to dryness of the mouth, which in turn leads to thrush, or yeast infections (candidiasis).

Xerostomia (Dry Mouth)

Apart from the increased risks of oral infection arising from a dry mouth just described above, dry mouth is a leading contributor to gum disease and cavities—remember the mechanism! Bacteria in the mouth, feeding on sugars from foods in the mouth and around the teeth, produce acids as a consequence of their digestion. That acidity demineralizes the teeth and irritates the gums, facilitating tooth decay.

Damage to Tooth Enamel

As well as the damage to tooth enamel caused indirectly through the mouth-drying effects of smoke, the combustion products from smoke have other directly negative effects: first, the smoke will stain the enamel of the teeth, and second, the smoke itself has a chemistry that combines with water in the mouth to generate acids that contribute to demineralization: yes, you can have acid rain inside your mouth.

Stomatitis

Just when you thought you had heard enough deleterious effects of marijuana smoking, you can add one more: stomatitus. This is an inflammation of the mouth and lips, or an overgrowth of the gums.

Edibles

After that long and perhaps depressing list of the oral and dental problems that smoking marijuana can cause, you might be thinking that the alternative might be taking your cannabis as edibles. It is possible to put cannabinoids into tasty foods, such as sweet baked goods or candies. At the moment in Ontario, edible marijuana products are strictly in the realm of personal manufacture; however, they will be soon legalized as smoking has been.

Consequently, the oral health implications of cannabis edibles need to be considered. In the simplest terms, oral and dental problems exist with “edibles” but they are really just the same problems as those foods would present without the cannabis included. Therefore, bear in mind sugar content: sugars are one of the fundamental dangers to oral health.

In addition, cannabis consumption can lead to snacking habits that are bad for oral health, as well as forgetting to brush the teeth. Rinsing, while also important, can be too easily overlooked.

Therefore, while the dental and oral problems of smoking cannabis are reduced, cannabis edibles are not perfectly innocent: they still introduce risks to oral health.

Interacting with Your Dentist

Dentists may well see the evidence of cannabis use when looking onto your mouth, but don’t assume so: it’s important to keep your dentist in the loop (at least, these days you will likely be less reticent to do so). But you and your dentist will need to consider marijuana use as far as the planning and timing dental visits.

Therefore you should tell your dentist if you use cannabis. Using cannabis (in any form) before a dental procedure can negatively affect the type and amount of medication or sedation you require, increase bleeding, and complicate your ability to heal. The effects of the cannabis use pertain to the strength of the cannabis, the duration of its effects, and whether one has smoked cannabis or consumed edibles.

The Canadian Dental Association Position on Cannabis Legalization

By now, you can probably guess that the Canadian Dental Association does not look favourably on cannabis use, and has produced a position paper on the topic. They “strongly advise against the use of tobacco products and smoking of cannabis because of the unacceptable risks posed to general and oral health” and realistically “acknowledge that despite the already known risks, patients may still choose to use these products”.

They therefore recommend that:

1. patients review their use with their dentist;
2. dentists review with patients the known and potential risks of exposure and consumption and recommend measures that promote cessation and reduce harm;
3. governments endorse action to reduce the potential harm to Canadians through
   1. banning all advertising and promotion;
   2. strictly enforcing regulations prohibiting sale to minors;
   3. continuing bans on public smoking (to reduce second hand effects);
   4. prohibiting exports of cannabis products, especially to developing nations.

These recommendations by the CDA amount to an admission to the fact that the change in the legal status of marijuana and cannabis generally is not a good thing for dental health. At this point responsibility for cannabis use becomes a personal decision, best made by informed users, should they choose to use cannabis.

Sherway Gardens Dental Centre can advise you on the best strategies for managing your dental health. Reducing or eliminating your mouth’s exposure to smoke—tobacco or marijuana—is an excellent first step. Now that we are living in a legal context that permits cannabis use, it’s important to manage this new element in our lives keeping in mind our dental health. Contact us for more information.