Cannabis use disorder

Oral health effects

• Xerostomia ('cottonmouth')

  Cannabis reduces salivary flow, which together with increased snacking raises caries risk.

  Mechanism: Cannabinoid-receptor (CB1) effects on salivary glands reduce secretion.

  Clinical management: Saliva substitutes, xylitol gum, high-fluoride toothpaste, and dietary counseling on snacking.

• Gum disease (periodontitis)

  A meta-analysis found cannabis use associated with a higher prevalence of periodontitis.

  Clinical management: Periodontal screening and maintenance, and address co-use of tobacco.

• Mucosal changes with smoked cannabis (leukoedema, candidiasis, leukoplakia)

  Smoked cannabis is associated with leukoedema, increased oral Candida albicans, cannabis stomatitis, and leukoplakia-type lesions; the smoke contains many of the same carcinogens as tobacco smoke.

  Clinical management: Soft-tissue examination at each visit, biopsy or refer persistent white/red lesions, and treat candidiasis.