Several studies endeavor to relate oral cancer with marijuana use and smoke, with mixed results.23 In one study described by Hall, Zhang found a 2.6 times more likely association of primary squamous cell carcinoma of the head and neck in marijuana users after adjusting for cigarette smoking, alcohol use and other risk factors.24 The mechanism by which marijuana may act as a carcinogen is unclear, and the reported cases of marijuana use with squamous cell carcinoma cannot adjust other risk factors in other studies.25 In a case control study included in an epidemiologic review of marijuana use and cancer risk, increased risk to oral cancer is suggested, but the difficulty exists when measuring the use of marijuana, tobacco, alcohol and other drugs in this population of patients.24
Cognitive impairment of patients using marijuana, either for recreational or medicinal purposes must be considered when recording informed consent for treatment.20 With widespread use of marijuana and the inability of providers of care to distinguish impairment, the challenge lies in treatment for that patient.26
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