Research confirms an association with poor oral health and alcohol dependence and marijuana use due to a number of reasons: hygiene habits, poor diet choices, attitudes about care or limited access to care.18 Marijuana use induces salivary reduction causing xerostomia along with an increased appetite after marijuana use, in particular for cariogenic foods, which in turn can increase the risk for caries.19 A higher level of DMFT (decayed, missing and filled teeth) scores has been documented as described by Cho.16 In addition, a trend analysis by Ditmyer et.al. has supported these findings over an eight year span looking at the effect of tobacco and marijuana use in adolescents residing in Nevada with “an increased prevalence and severity of caries.”20
Additional effects of marijuana on oral health involve the periodontium. Oral mucosa and gingival tissues exhibit changes such as leukoedema, which may be in part due to the irritants in the marijuana smoke. Gingivitis and alveolar bone loss are documented with chronic inflammation and gingival hyperplasia.21 The risk of periodontal diseases may be related to this inflammation and the “increased prevalence of opportunistic infections.”24 The suppression of the immune regulatory system with the “inhibition of lymphocytic proliferation, antibody production, natural killer cell activity and macrophage activity” are the major mechanism of action to reduce resistance to bacterial or viral infection.25 Furthermore, an increased prevalence of Candida albicans can be demonstrated with this diminished immune response and the ability of C. albicans to use the hydrocarbons from cannabis as an energy source.23
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