Volume 2 - Issue 3 (May-Jul)

Review Article
mucous membranes of the oral cavity, including the
tongue. It often occurs as a pre-cancerous growth), oral
cancer and other oral infections. Oral cancer related
to cannabis usually occurs on the anterior floor of
the mouth and the tongue. 14,15 Marijuana smoke is
associated with dysplastic changes within the epithelium
of the buccal mucosa (anucleated squamous cells,
immature cell forms, increased nuclear pleomorphism
and increased mitotic activity and abnormalities).
Although smoking marijuana is associated with oral
premalignant lesions, including leukoplakia and
erythroplakia but results of a large population based
study found no association between marijuana use
and development of oral squamous cell carcinoma. 16
The increased incidence of intraoral candidiais in
persons who smoke cannabis may be because of the
hydrocarbons present in marijuana, which act as an
energy source for certain types of Candida species.
Additional factors such as compromised immune
response due to chronic use of marijuana, poor
denture hygiene and nutritional factors should also be
considered. 17
Cannabis Use and Dental Caries
The hypothesis that cannabis increases the risk of
caries was not confirmed according to a study report. 1
However, the difference between groups in the
incidence of decayed surfaces was highly significant.
Cannabis users had considerably more open carious
lesions than those who did not use cannabis. Shortterm
xerostomia and consumption of cariogenic food
and beverages after using cannabis may be responsible
for the high incidence of caries on smooth surfaces.
The cariogenic diet, reduced frequency of oral hygiene
and rare dental control visits indicate that the lifestyle
of cannabis users makes an important contribution to
the incidence of caries. Therefore, the combination of
cannabis use and an unhealthy lifestyle increases the
risk of caries on smooth surfaces. 1,13
Cannabis and Periodontal Disease
Smoking cannabis can affect the nerve endings in the
mouth, masking any sensitivity that may be occurring.
Various effects like fiery-red gingivitis, alveolar
bone loss, gingival inflammation and hyperplastic
gingiva are reported in cannabis smokers. 13,18 Current
knowledge on the effects of cannabis on periodontal
health is inadequate. Controlled epidemiologic studies
are difficult to undertake as the frequency, amount,
duration and mode of administration of cannabis
differ amongst individuals. Personal risk factors
including age, oral hygiene, general health, concurrent
tobacco smoking and poly drug use make it difficult
to identify the specific influence of cannabis abuse on
susceptibility to periodontitis.
The Legal Regulation of Cannabis Use
Cannabis is a controversial drug; debate continues
over its illegal nature and whether or not it should be
legalized. This has become more problematic in recent
years with the emergence of cannabis as a potential
therapeutic agent for some medical problems (such as
multiple sclerosis). Significantly, the issue of the longterm
health effects of cannabis use remains unresolved.
Much of the scientific debate has become entangled
with the wider social question of whether its use should
remain illegal or not. 19 The difficulties with cannabis
prohibition have been noted in a number of reviews,
which have pointed to the difficulties and injustices of
attempting to criminalize the use of a substance, which
is widely used. 20,21
An important legislative issue that requires attention
is the issue of the supply of cannabis to young people
under the age of 18. There is increasing evidence to
suggest that this age group is the most vulnerable to
the effects of cannabis 22,23 and accordingly there are
grounds for suggesting that sentencing in cases of the
supply of cannabis should take into account the ages
of the individuals to whom cannabis is being supplied
with supply to adolescent populations attracting more
severe penalties.
Drug Education in Schools
One approach that has been widely advocated has been
the use of drug education in schools. In particular it
has been argued that by educating young people about
the harms of drugs including cannabis, risks of future
drug use and abuse may be reduced. 24,25 However, the
evidence in support of school-based drug education
is not strong. In general, studies of drug education
programs have found these programs to be most
effective in increasing knowledge about the risks of
drug abuse. 26 Evaluations have found that the program
is effective in increasing student knowledge but that
Indian Journal of Multidisciplinary Dentistry, Vol. 2, Issue 3, May-July 2012
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