By Anne Blythe
The thought of going to the dentist’s office and having tartar scraped off your teeth might send chills through you similar to those caused by the screech of fingernails on a chalkboard.
There’s a word for that: dentophobia.
Here’s something dentists want their patients to know as they try to calm those fears: It’s best not to smoke a joint or down a gummy or use other products containing tetrahydrocannabinol, or THC, to try to chill out before an appointment.
As more states legalize marijuana for medicinal or recreational use, oral health care providers are seeing more patients under the influence, the American Dental Association says.
Still, let’s say you had no idea it was ill-advised to smoke, ingest or consume THC, the psychoactive compound that causes that altered state or cannabis “high,” and failed to refrain before your appointment.
“It’s usually thought of as innocuous, safer than alcohol, safer than opioids — ‘What’s the big deal?’,” Bill Claytor, executive director of North Carolina Caring Dental Professionals, told NC Health News in a phone interview.
Don’t hide it, providers say. Be sure to let your dentist know — whether the product is legal or not.
Being high on marijuana in the dental chair can limit the kind of care the dentist can safely deliver. There can be unexpected consequences — higher blood pressure, racing heartbeat or other cardiovascular issues, and airway issues for sedated patients.
Products also might be laced with fentanyl, an extremely potent synthetic opioid becoming widely available on the streets and dark web.
“The issue is not to get someone in trouble,” Claytor said. “The marijuana today is not your mother’s weed of the ’70s.”
Will N.C. legalize marijuana use?
As of Nov. 8, 2023, 24 states and the District of Columbia had enacted laws for recreational marijuana use, and 14 more allowed for medical use of cannabis products, according to the National Conference of State Legislatures.
The North Carolina General Assembly has debated for years whether to legalize marijuana for medicinal use, but it has yet to get enough votes in both chambers to move forward with legislation. Last year, the N.C. Compassionate Care Act passed the state Senate easily, but it got bogged down in the House of Representatives.
The issue is likely to come up this year, Claytor said, and he questioned whether the North Carolina dental profession is ready for what might follow.
In November 2022, the American Dental Association issued a news release with this headline: “Half of Dentists Say Patients Are High at Dental Appointments: Marijuana Use May Affect Oral Health and Treatment.”
“When talking through health histories, more patients tell me they use marijuana regularly because it is now legal,” Tricia Quartey, a dentist in New York and ADA spokesperson, said at the time. “Unfortunately, sometimes having marijuana in your system results in needing an additional visit.”
“Marijuana can lead to increased anxiety, paranoia and hyperactivity, which could make the visit more stressful,” Quartey added. “It can also increase heart rate and has unwanted respiratory side effects, which increases the risk of using local anesthetics for pain control. Plus, the best treatment options are always ones a dentist and patient decide on together. A clear head is essential for that.”
Cannabis and oral health
The ADA has a webpage listing key points about cannabis and oral health effects.
- Smoking or ingesting cannabis can lead to dry mouth.
- Cannabis smoking is associated with periodontal complications, such as malignant patches of skin the tongue, as well as potentially increased risk of developing mouth and neck cancer.
- A number of studies have suggested a direct relationship between cannabis use and periodontal disease.
- One 2023 study reported that cannabis users required more IV anesthesia medications than non-cannabis users during ambulatory oral surgery procedures, such as extractions.
‘On our radar’
Bobby White, chief executive and legal counsel for the North Carolina State Board of Dental Examiners, said he’s aware of the issue, but it hasn’t risen to an urgent level in North Carolina yet.
“It’s on our radar, but it’s not something we have been getting a lot of complaints about,” White told NC Health News.
Claytor, whose organization offers professional training for dentists to help them recognize and address substance use and addiction in their patients and themselves, would like to hear more discussion on the topic.
As more states legalize marijuana for medical and recreational use — and Democratic members of Congress urge the Biden administration to “deschedule,” or remove, marijuana from the controlled substance list — Claytor acknowledges that his opinion might not be popular. He’s a proponent of more study before legalization in North Carolina.
Nonetheless, Claytor sees the momentum moving toward legalization, and he hopes the profession lays out best practices for safe care.
“We’re on the cusp for this,” Claytor said. “We’re not there yet, but it’s going to affect dental practices.”
As they take personal histories, dentists should be asking their patients about substance use just as they do about prescribed medicines and other health-related issues, Claytor said.
Heads up in Davidson
At Davidson Cosmetic and Family Dentistry, patients get guidance about marijuana use on the practice’s website.
“Recently, we have been finding more people who are using marijuana,” the site says. “We are not here to judge anyone, but as part of your medical team, we need to know about your drug use for your safety and comfort. Marijuana can increase the risk for complications and pain during and after surgery, and we suggest discontinuing its use at least 72 hours before your scheduled treatment.”
“While it might be tempting to use marijuana before surgery to relax, this can lead to more complications,” the site continues.
The practice underscores how cannabis use can raise the heart rate and lower blood pressure, and it can lead to “an increased risk of airway sensitivity and heart problems, including heart attacks, when using anesthesia.”
“Before coming in for any treatment that requires anesthesia or sedation, we recommend that you avoid all types of marijuana for at least 72 hours (although depending on your particular procedure, we might recommend a longer period),” the practice instructs. “This includes not smoking, eating edibles or using synthetic substitutes. Our goal is to keep you safe and well cared for.”
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