Up in Smoke: Will Cannabis Replace Analgesics in Dental Pain Management?

Episode #332 with Dr. Tom Viola, R.Ph., C.C.P.

You might know that one person who really loves their mints. But it turns out, those could be edible cannabis, not Altoids or Tic Tacs! And because so many different forms are available today, it’s almost impossible to know who could be using cannabis. So, why is this important to dentistry? To answer that question, Kirk Behrendt brings back Dr. Tom Viola to explain some of the direct and indirect impacts, as well as some of the ethical dilemmas of cannabis. To learn what dental school didn't teach you about cannabis, listen to Episode 332 of The Best Practices Show!

Main Takeaways:

Cannabis is still an unknown, and its use has an impact on dentistry.

There are many myths and misconceptions about cannabis.

Cannabis actually raises your blood pressure and heart rate.

In high enough doses, cannabis can increase anxiety.

Cannabis can cause immunosuppression and increased risk of infection.

Patients who use cannabis are more resistant to the effects of anesthetics.

Because cannabis isn't standardized, we don't know how much a patient may be taking.

Cannabis can span any age group. It’s not just younger people taking it.  

Always ask patients about their cannabis use.

Quotes:

“Cannabis is an unknown. I didn't learn about it in school, you didn't learn about it in school, because at the time, cannabis was still a Schedule I substance under the federal law, which meant it was illegal, like heroin, like LSD. So, we didn't learn much about it, and we really didn't anticipate that cannabis was going to get such widespread political and social acceptance — and medical acceptance — as it has now. Honestly, it’s still a quagmire. It’s still illegal, Schedule I, at the federal level, but approved in, if you want to call it that, or legalized or decriminalized in 35 states throughout the country. So, it leaves everybody in a quandary because, again, your patients have never had such widespread access to a drug that we, in our education, never really learned much about.” (07:50—08:37)

“The first thing you need to know as a dental professional is that what your patient is smoking, consuming as a gummy, vaping, is probably not one of the three original strains but some hybrid of those three strains that specializes in a specific THC or CBD content that the patient is demanding or the patient expects.” (14:57—15:17)

“The next thing to realize is that many people believe that cannabis, marijuana, mellows you out. And therefore, by logical extension of “mellows you out,” that means it must lower your blood pressure, lower your heart rate, make you calm and less anxious. Actually, that's not true. Actually, cannabis raises blood pressure and raises heart rate, and in high enough doses can actually cause paradoxical effects of dysphoria, anxiety, agitation.” (15:21—15:54)

“From our perspective as dental professionals, it’s like, ‘Yeah, you're right. If you can use cannabis, why do we need to prescribe an opioid? I'm good with that too.’ But if you look at the legislation in all these states where opioid education is mandatory, what's one of the primary things that’s central to all of those education programs? Did you educate the patient? Did you ask an at-risk patient one question: do you have, or have you had, an issue with substances in your past? And guess what? Cannabis is a substance. Your patient may not agree with it. Heck, you may not agree with it. But at the end of the day, it is. So, all of a sudden, it’s easy for the patient to say, ‘Hey, don't worry about it, doc. I had a gummy an hour ago. I'm good.’ But is that substance abuse?” (18:39—19:28)

“The big question is about how to take a good medical history. The fourth...