Cannabis Use and Risk of Periodontitis and Adverse Oral Health Outcomes: A Systematic Literature Review

Cannabis is widely consumed globally. Common methods of consumption include smoking, vaping, and consuming edibles. Despite its increasing use, the impact of cannabis consumption on the treatment and management of oral health disorders remains poorly understood. Cannabis has been associated with adverse oral effects such as periodontitis, xerostomia, caries, and gingivitis. These adverse oral effects complicate dental care. A systematic literature review was conducted, searching PubMed, EMBASE, and Cochrane databases from inception to May 31, 2024, to evaluate the effects of cannabis use on oral health, including its association with periodontitis and other adverse outcomes relevant to the treatment and management of oral health disorders among current or former adult users compared with never users. Eligible studies included randomized controlled trials (RCTs), quasi-RCTs, cohort studies, case-control studies, and cross-sectional surveys involving cannabis users and never users with diagnosed dental disorders; articles including synthetic cannabinoids were excluded; relevant articles were restricted to English-language studies on human subjects. The review protocol was registered with PROSPERO (CRD42024558418). Abstract and full-text reviews were conducted by two independent reviewers, with conflicts resolved by a third adjudicator. Crowe Critical Appraisal Tool (CCAT) Version 1.4 was used to assess the risk of bias within the included articles. The included studies were thematically analyzed and presented in descriptive tables.  A total of 6,535 records were identified; after abstract and full-text review, 23 articles were included and underwent data extraction. The most prevalent condition was periodontitis, consisting of 11 studies, of which nine identified a negative relationship between cannabis use and periodontitis. Overall, cannabis use appears to be associated with an increased risk of adverse health outcomes like periodontitis, highlighting the need for patient screening. Other studies addressed health disorders such as cancer, dental caries, xerostomia, and altered anesthesia requirements. The interpretation of study results was limited by variability in study methodologies and reported outcomes. This work was supported by the Touro College of Pharmacy Student Summer Research Fellowship.