Stain Prevention

Many dental patients want to keep their teeth white.  To prevent stain, especially for 48 hours after teeth whitening1, don’t let the following food and drinks touch your teeth: Tea2, coffee, red wine, tomato sauces, and strongly-colored fruit3.  When drinking staining liquids, periodically swish some plain water around your mouth to rinse your teeth off.  Some people drink coffee through a straw.  The company Hot Straw™ makes a straw that is safe to use with hot liquids5.  If you smoke, avoid smoking for 48 hours after whitening4.

Try to brush after every meal, to remove food debris that may become stained.  Many people mistakenly brush their teeth too hard, thinking it is more effective.  Harder toothbrushing may cause abrasion (tooth wear), especially if you eat or drink acidic products6.  It may also cause the gums to recede, exposing dentin, the more fragile tooth layer underneath.  These fragile teeth surfaces are more susceptible to being stained8, as well as getting cavities and being sensitive.  It is more effective to brush with lighter pressure and to tilt your toothbrush at a 45 degree angle, so that the toothbrush bristles go slightly underneath your gumline.

Almost all toothpastes have ingredients that remove stain7.  However, the ingredient hydrated silica may microscopically wear down your tooth enamel.   The following ingredients remove stain, but are less abrasive:  Dicalcium phosphate, sodium bicarbonate and calcium carbonate9.  In addition, the following ingredients remineralize your teeth, which may prevent stain10:  Fluoride, CPP-ACP, and nano carbonate apatite11.

If you are unable to brush after every meal, at least periodically swish some water around your mouth to rinse your teeth off.  Chewing sugarless gum after meals stimulates saliva9, whose remineralizing effects can prevent stain13,14.

With these tips, your bright smile will be preserved for a long time.



1,3,4Al Quran, F., Al Wahadni, A., Al-Hyari, S., Mair, L., & Mansour, Y (2011). Efficacy and persistence of tooth bleaching using a diode laser with three different treatment regimens.  The European Journal of Esthetic Dentistry, 6(4), 1-10.


2,10, 13Chand, P., Ram, S., Shetty, O., Singh, R. Yadav, R. (2010).  Efficacy of casein phosphopeptide-amorphous calcium phosphate to prevent stain absorption on freshly bleached enamel: An in vitro study.  Journal of Conservative Dentistry, 13(2), 76-79.

5Hot Straw™ corporate Internet website.  Retrieved on February 3, 2014 from

6Attin, T., Egert, S., & Wiegand, A. (2008).  Toothbrushing before or after an acidic challenge to minimize tooth wear? An in situ/ex vivo study.  American Journal of Dentistry, 21(1), 13-16.

7Joiner, A. (2010).  Whitening toothpastes: a review of the literature.  Journal of Color and Appearance in Dentistry, 38(2), e17-e24.

8Addy, M. & Watts, A. (2001).  Tooth discolouration and staining: a review of the literature.  British Dental Journal, 190, 309-316.

9Moore, M, Putt, M., & Schemehorn, B. (2011).  Abrasion, polishing, and stain removal characteristics of various commercial dentrifices in vitro.  The Journal of Clinical Dentistry, 22(1), 11-18.

11Kim, B., Kim, Y., & Kwon, H. (2011).  Effect of nano-carbonate apatite to prevent re-stain after dental bleaching in vitro.  Journal of Dentistry, 39(9), 636-642.

12Ly, K., Milgrom, P. & Rothen, M. (2008). The Potential of Dental-Protective Chewing Gum in Oral Health Interventions.  Journal of the American Dental Association, 139, 553-563.

14Grandini, S., Perra, C. & Porciani, P. (2010).  Effect on dental stain occurrence by chewing gum containing sodium tripolyphosphate–a double-blind six-week trial.  The Journal of Clinical Dentistry, 21(1), 4-7.

Teaching Kids Dental Health with Puppets

Dental hygiene is not just practiced in dental offices and doesn’t always consist of cleaning teeth.  At its conception, the dental hygiene profession was created as a profession of prevention.  Cleaning teeth, was part of this, but dental hygiene education was the most important part.  Today dental hygienists work in many areas practicing prevention, but it is with children that this education is the most beneficial.  Early dental education can get kids started out on the right track for a healthy mouth for a lifetime.

Kathy Moreno is a dental hygienist in Iowa who does some amazing dental hygiene education for children.  She works in public health dental hygiene and travels outside of dental practices to bring an educational puppet show to her young patients.  This is her story.

“We (Siouxland District Health Department) bought the puppets back in 2000 when I started working in public health. I thought they would be great tools to use in teaching kids how to brush along with helping to “break the ice” since I was going to be working with such young children ages 0-5.

We bought the puppets from a company called Paragon and they sent a couple of puppet show scripts along with the puppets. I used to love acting in high school so this was right up my alley. I tweaked a few things to make it my own, along with using a hand puppet of my own as one of the characters, and it took off from there.

When I go back to schools and see kids that have seen the puppet show the previous year(s), they always remember “Sparkly Sue” and that the only thing that is ok for them to drink at bedtime, after they’ve brushed their teeth, is WATER!”

Please take a moment to watch Kathy share her message with a group of children.  If you have kids, share it with them, and by all means share this with your local dental hygienist.  Thank you Kathy for making dental hygiene fun to a whole new generation!

The Tooth Fairy

In the last month the tooth fairy has been visiting my home rather frequently.  My 6 year old daughter, Gennavieve, who was once afraid of losing teeth, is now excited when the come out (although she refuses to wiggle them and allows them to just dangle until they fall out.)  I remember the excitement of placing my tooth under my pillow and checking under the pillow in the morning for my quarter.  I’m pretty sure that inflation has hit the tooth fairy because she seems to be giving out much more money than when I was a kid.  Genna and I have had quite a few conversations about the tooth fairy.  During one conversation we decided that the tooth fairy must use all those teeth to decorate her house, which is why she likes clean teeth.  Nobody would want a house full of dirty teeth, right?  Now whenever she has a loose tooth she keeps it super clean.

Ever wonder where this tradition came from?  I did, so I did a little research.

Like many traditions this one has its roots in superstition.  Long ago, when people feared witches taking control of them, body parts like nail clippings, hair trimmings and even teeth were thought to be ways a witch could take control of a person.  To protect their children parents would burn or bury the lost teeth.  They told the children that this was like planting a seed, which would allow their adult tooth to grow in the place of the missing tooth.  The tradition followed immigrants to America where it changed to the more commonly know tradition of placing a tooth under the pillow.  The change may have happened because more people lived in cities and had less farmland to bury teeth.  Parents began to tell the story of a fairy who took the teeth away.  Popularity of the tooth fairy has gotten greater since the 1950′s.

This may have been because the tooth fairy began to be promoted by products, like tooth fairy banks and other merchandise.  A quick search for Tooth Fairy on Amazon and you will see how popular she has become.  I personally really enjoy the movie with Dwayne Johnson.

The Smithsonian has an amazing tooth fairy exhibit as well.  You can see more about it here.

I think this is really cute.  If you have little kids you should show them the site.  Well, for now I guess I just need to make sure I keep cash on hand just in case and watch in wonder how amazing children are.  I wish I still had the wonder that I had when I was little.

Whitening and Damage

enamel rods

Microscopic view of enamel

Occasionally, a patient will ask me if whitening can damage their teeth.  Damage may be prevented with certain precautions.  Before whitening, have your dentist repair any cavities or fractures you may have, or whitening might make them worse.  The main ingredient in whiteners is either hydrogen peroxide or carbamide peroxide (another form of hydrogen peroxide). They come in varying percentages. The higher the percentage, the quicker the whitening process, but the higher the incidence of teeth sensitivity. [Read more...]

Implants: When Bacteria Attack

implant tooth comparisonDental implants have become an increasingly popular way to replace missing teeth and anchor dentures in place.  When an implant is used to replace a single tooth it can be one of the most natural feeling replacement options.  You can floss around an implant, just like your natural tooth.  This is much easier to do than flossing around and under a dental bridge.  An implant is anchored into the bone, just like the root of a tooth so it stays in your mouth all the time, unlike a partial denture which is taken out at night.  For a patient who wants the most realistic replacement option an implant may be the way to go.  Unfortunately, bacteria can cause bone loss around implants, just like with natural teeth.  This destruction around a natural tooth is called periodontal disease, around an implant it is called peri-implantitis.

Recently I saw a patient with moderate periodontal disease and two implants, one showing signs of peri-implantitis.  She had a 6  mm probing depth on one implant, with bleeding.  Bone loss around the implant was also visible on the x-rays that were taken.  The patient was treatment planned for scaling and root planing with locally applied antibiotic therapy.  While I frequently use locally applied antibiotics in practice for patients with periodontal disease I was not sure what the science said about using it around implants, so I decided this would be a great time to find out.



They type of locally applied antibiotic that I like to use is Arestin, which is minocycline, a member of the tetracycline family.  I spoke to the company representative to ask her opinion.  I was told, that Arestin is not FDA approved for the treatment of peri-implantitis.  FDA approval is given to a drug based on research on the drug for a specific purpose.  The company must submit research to the FDA that shows the drug is safe and effective for that specific purpose.  The FDA reviews this evidence and decides if the benefits outweigh the risks.  They don’t test the drug itself.  If they approve the drug is allowed to be sold.  Use of a drug for a purpose other than that specifically tested is called off label use.  Doctor’s and dentists are allowed to use a drug for an off label use, many drugs are used this way.  A good example is the use of antidepressant drugs as drugs to help patients sleep. (Example: Trazadone)  I did learn from the representative that dental professionals have used this drug for peri-implantitis based on research that is currently available.  I was also told that the company is also doing its own studies on Arestin and peri-implantitis.

Off label use of medications is not a new concept to me.  I worked for many years in the field of psychology, and a lot of drugs used to treat psychiatric illnesses were developed for other reasons.  Also, most of these medications were only approved for use in adults, but they are commonly prescribed to children and adolescents.

Before I began to research, or speak to reps from the company this was my thought process:

1.  A bleeding pocket indicates bacteria, regardless if it is surrounding a tooth or an implant.

2. While research on teeth with periodontal pockets indicates an increase of attachment and reduction in pocket depth, it may not be the same with implants, so I need to do some research.

3.  Scaling an implant is much more difficult than scaling a natural tooth because of the shape of the implant, and the instruments that can and can’t be used.  Implants can only be scaled with plastic or titanium instruments.  Only special plastic covered ultrasonic instruments can be used.  This reduces the likelihood of removing all bacteria.  I would feel much more comfortable placing an antibiotic in order to continue to kill any leftover bacteria.

The Research

  1. Bacteria load, 40 types including the one most commonly associated with peri-implantitis,  in pockets around the implant was reduced for 180 days. 5
  2. Another study found similar results, but thought that it wasn’t a specific bacteria that was causing the peri-implantitis, rather it was the combination of all bacteria present as well as the amount of bacteria.4
  3. Greater reduction in probing depth and bleeding was found in patients who had Arestin placed, than those who used a chlorhexidine gel for treatment.6
  4. Patients with a history of smoking, periodontal disease, poor oral hygiene, exposed implant threads or implants that were placed into areas of reduced bone are at increased risk of peri-implantitis.  These conditions should be under control before placing implants for best results.  Failure rates are higher for smokers and patients with active periodontal disease.  Controlling periodontal disease through a maintenance program is required to keep bone healthy.  In fact, peri-implantitis progresses faster than periodontal disease, more destructive and harder to treat so proper maintenance and assessment at regular intervals is needed.  When bone loss around implants are found aggressive treatment is needed.  Which may include mechanical debribement, flushing with antimicrobials and antibiotic placement, possibly even surgical intervention.2
  5. Another study found that adjunctive photo-dynamic therapy had comparable results to locally delivered antibiotic therapy.1  Photo-dynamic therapy uses a photo-active dye which is activated by a certain wavelength of light which breaks down components  of cells, including the bacteria which cause the destruction in periodontal disease and peri-implantitis.3  Unfortunately this treatment is not commonly used in practice, so you may not find a dental office that performs this therapy.

So what am I going to do for my patient?  I am going to place localized antibiotic.  I would like for more research to be completed so I can have stronger evidence to support the treatment, but I can’t take a chance at not doing something that will be beneficial to my patient while waiting for research to be completed.  As medical professionals sometimes we have to make a call, and after doing my research and discussing it with the dentist I work with I think this is the best call for my patient.


1 Bassetti, M; Schär, D; Wicki, B; Eick, S; Ramseier, CA; Arweiler, NB; Sculean, A; Salvi, GE.  Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy: 12-month outcomes of a randomized controlled clinical trial.  Clin Oral Implants Res, 2013.

2  Ho, Christopher CK; Tang, Teck.  Failing implants, maintenance, recall.  Australasian Dental Practice.  January/February, 2011.

3  Konopka K, et al.  Photodynamic therapy in dentistry. J Dent Res. 2007 Aug;86(8):694-707.

4  Persson, GR; Salvi, GE; Heitz-Mayfield, LJ; Lang, NP.  Antimicrobial therapy using a local drug delivery system (Arestin) in the treatment of peri-implantitis. I: Microbiological outcomes.  Clin Oral Implants Res, 2006 vol. 17(4) pp. 386-93.

5    G.R. PERSSON.  Microbiological Outcomes of Peri-implantitis Therapy with an Adjunctive Local Antibiotics.  University of Berne, University of Washington, Seattle, WA, USA, G.E. SALVI, University of Berne, School of Dental Medicine, Switzerland, L.J.A. HEITZ-MAYFIELD, University of Berne, Cottesloe, Australia, F. DOHERTY, Orapharma Inc, Huntingdon Valley, PA, USA, and N.P. LANG, University of Bern, Berne, Switzerland.

6  Renvert, S; Lessem, J; Dahlén, G; Lindahl, C; Svensson, M.  Topical minocycline microspheres versus topical chlorhexidine gel as an adjunct to mechanical debridement of incipient peri-implant infections: a randomized clinical trial.  J. Clin. Periodontol., 2006 vol. 33(5) pp. 362-9.

Baby Teeth

Baby teeth are important.  The are not just there to chew until your adult teeth come in.   The pretty pearlies hold the place for the adult teeth that will take there place in the future.  For this reason, they are phenomenally important.  We have all had them, and we never gave them the proper respect.  Since they are not permanent most people don’t really care what happens to them, but why should we love those babies?

deciduous lateral incisorPlace Holders for Adult Teeth

Baby teeth hold the place for our future.  Yes, it is true, without those babies the adult teeth that follow wouldn’t have the space to grow that they need.  Without the baby teeth the adult teeth would have a much harder time becoming the beautiful smile that we all want.  Kids don’t think about the future, so it the parent’s job to realize that the choices that they make for their kids’ teeth can effect their future smiles.  Parent’s need to realized the importance of these teeth and take care of them for their children.  A cavity on a baby tooth is a BIG deal.  If these teeth are not preserved the adult teeth can suffer.  Kids are not the best brushers and adults should not blame them for this.  It is the parents’ responsibility to make sure the kids’ teeth are brushed properly.  You wouldn’t expect them to be in charge of eating a proper diet would you?  Well, the same thing goes for tooth brushing.  A cavity starts small, but once it passes through the enamel it grows quickly.  If left untreated it can cause pain to the child, and even infect the adult tooth below.  Some baby teeth stay in the mouth until the children are 12 years old.  If a dentist recommends treating a cavity in a baby tooth it is because the tooth will be around for a while and needs to be protected.  In advanced cases of decay baby teeth may require a pulpotomy (a root canal on a baby tooth) or an extraction.  If an extraction is necessary the child may need a space maintainer placed to hold the place of the adult tooth.  This will be removed by the dentist when the adult tooth begins to come in.

Stem Cells

Baby teeth also contain stem cells, which are cells that can turn into any cell.  Stem cells have been associated with a lot of controversy because the most commonly known source is embryos.  Baby teeth are a much more acceptable source for stem cells.  The baby teeth can be removed, shortly before they are due to fall out on their own and be banked for future stem cell use.  Baby teeth need to be healthy to be banked for stem cells.  Stem cells have been used to treat many diseases, and it is possible that more uses will be discovered in the future.


You Could Have Them Longer Than You Think

Some people are born without the adult teeth that will replace these baby teeth.  At the dental office we can see if the adult teeth are present below the baby teeth through x-rays.  At home there is no way to know.  The best thing you can do is treat all these teeth like they are going to be with your child forever.  Keep the teeth clean and healthy by making sure your child brushes properly.  Proper brushing for young children includes parental help.  Children 8 and under should have adult help to be sure they are brushing properly.  Using a disclosing rinse to be sure no plaque is left behind is a fun way to make sure kids brush well.  Once they are about 6 they can start using a fluoride rinse to keep the teeth strong.  Missing adult teeth is often a hereditary condition, so if you know someone in your family who still has baby teeth it is possible that your kids may have this condition as well.



The Power of a Smile

Working in the dental field I see patients every day who do not smile, they are acutely aware of imperfections and hide their smile from the world. A smile is a powerful thing, and patients who don’t smile are at a disadvantage.

There are few things in the world that can transform the behavior of another like a genuine smile. Imagine yourself walking down a crowded street. Everyone is in their own world, oblivious to the other people around them. Now take the time to catch someone of guard with a smile. You may see a bit of surprise in their eyes but they will usually smile back. Now another passerby may see this new smile and catch one of their own. Smiles can be contagious. The physical act of smiling begins to make you feel happier. You just gave an amazing gift to a stranger.

Smiles can make people feel more connected to each other, something today’s technology rich society is lacking.

They make you appear more trust worthy, opening up whole new world of opportunities.

A smile can be a means of encouragement. It can be a pat on the back from across the room. Smiles are beautiful no matter what the mouth looks like.

I challenge you to share the power of your smile today. While you spread smiles you will become happier yourself because smiles have that effect. Break from the norm of avoiding eye contact in public or acting like there is nobody else sitting in the waiting room with you. It only takes a second but the effects are tremendous.

Happy smiling!

What Do Drugs Have To Do With Dental Visits? Methamphetamines and “Meth Mouth”

Methamphetamines also known as meth, crystal meth, ice and speed.  This drug has a major presence in America as well as many other places, with over 35 million users worldwide.3  It is very popular due to its low cost, libido stimulation, appetite stimulation, enhancement well being and energy increasement.5  This drug is very addictive,  it causes wakefulness, increased physical activity, cardiac dysrhythmia (irregular heartbeat), hypertension (high blood pressure), violent behavior and hallucinations.12  It also results in oral problems including rampant caries (dental decay, meth mouth), enamel erosion, xerostomia (dry mouth), bruxism (grinding) and trismus (reduced opening of the jaw due to muscle spasm).9   Surprisingly, intravenous meth use is associated with higher rates of dental problems than smoking or inhaling meth.6, 10  Methamphetamine use contributes a significant number of emergency room visits every year, 10% of these visits are for dental pain.4

“Meth Mouth”

rampant caries from meth use

Methamphetamine users have a much higher rate of tooth decay than the general population.  There are several reasons for this.  Poor eating habits are common among users and their frequent consumption of snack foods and soda contributes to decay. Poor tooth brushing, or complete lack of it results in increased decay as well.  Smoking which is also common among users is another contributor.7

Meth also causes changes in the body, that make it less able to defend against bacteria.  The body has immune cell which are a major defense against invading bacteria.  Using methamphetamines causes cell death in some of these special immune cells.  When these cells die, the harmful bacteria in the mouth that cause periodontal disease and tooth decay begin to overpopulate resulting in rampant tooth decay and periodontal destruction (loss of bone and supporting soft tissues which hold the teeth in place).11













The pH of meth varies depending on how it is made, but studies on various formulations have found and average pH of 5.0 with some as low as 3.2.2 As a comparison a pH of 7 is neutral with lower numbers being more and more acidic as they get lower.  A pH of 3.2 is around as acidic as soda, or orange juice.  In this pH range the teeth begin to soften and enamel erodes.  The saliva of meth users is also more acidic than normal, although quantities are normal.8  This higher pH saliva has a reduced ability to buffer acids, which is a function of healthy saliva.  Without saliva’s protection the user is at a higher risk for tooth decay. 

To reduce the risk to enamel, users should practice good oral hygiene, use fluoride daily, avoid sugary drinks and eat cheese which helps buffer the acids. 2

In the Dental Chair

Dental professionals need to be aware of the oral effects of meth use since patients may not disclose this in their medical history.  While methamphetamines have a reputation for causing dental disease, other drugs can cause severe decay as well.  Dental professionals can’t look into a mouth and know what drug a patient has been abusing.1  While there is a huge difference in the mouth of a non user, compared to a meth user, the difference between that meth user may not be as different from a heroin user.  Visual inspection can be used as a starting point for conversation between the dental professional and the patient.

It is very important to disclose meth use with your dental professional.  The use of local anesthetics with epinephrine can cause irregular heart beat, heart attack or stroke in meth users.4  The only way to truly manage dental diseases resulting from meth use is for the patient to stop using.  Continued use will result in continued disease.


1Cretzmeyer, M; Walker, J; Hall, JA; Arndt, S.  Methamphetamine use and dental disease: results of a pilot study. J Dent Child (Chic), vol. 74(2) pp. 85-92.

2Grobler, SR; Chikte, U; Westraat, J. The pH Levels of Different Methamphetamine Drug Samples on the Street Market in Cape Town. ISRN Dent, 2011 vol. 2011 pp. 974768.

3Hamamoto, DT; Rhodus, NL. Methamphetamine abuse and dentistry. Oral Dis, 2009 vol. 15(1) pp. 27-37.

4Hendrickson, RG; Cloutier, R; McConnell, KJ. Methamphetamine-related emergency department utilization and cost. Acad Emerg Med, 2008 vol. 15(1) pp. 23-31.

5Maloney W. The Significance Of Illicit Drug Use To Dental Practice. WebmedCentral DENTISTRY, DRUG ABUSE 2010;1(7):WMC00455

6Mooney, LJ; Glasner-Edwards, S; Marinelli-Casey, P; Hillhouse, M; Ang, A; Hunter, J; Haning, W; Colescott, P; Ling, W; Rawson, R. Health conditions in methamphetamine-dependent adults 3 years after treatment. J Addict Med, 2009 vol. 3(3) pp. 155-63.

7Morio, KA; Marshall, TA; Qian, F; Morgan, TA. Comparing diet, oral hygiene and caries status of adult methamphetamine users and nonusers: a pilot study. J Am Dent Assoc, 2008 vol. 139(2) pp. 171-6.

8Ravenel, MC; Salinas, CF; Marlow, NM; Slate, EH; Evans, ZP; Miller, PM.   Methamphetamine abuse and oral health: a pilot study of “meth mouth”  Quintessence Int, 2012 vol. 43(3) pp. 229-37.

9Rhodus, NL; Little, JW. Methamphetamine abuse and “meth mouth”.   Pa Dent J (Harrisb), vol. 75(1) pp. 19-29.

10Shetty, V; Mooney, LJ; Zigler, CM; Belin, TR; Murphy, D; Rawson, R. The relationship between methamphetamine use and increased dental disease. J Am Dent Assoc, 2010 vol. 141(3) pp. 307-18.

11Tipton, DA; Legan, ZT; Dabbous, MKh.   Methamphetamine cytotoxicity and effect on LPS-stimulated IL-1beta production by human monocytes. Toxicol In Vitro, 2010 vol. 24(3) pp. 921-7.

12Turkyilmaz, I. Oral manifestations of “meth mouth”: a case report. J Contemp Dent Pract, 2010 vol. 11(1) pp. E073-80.

What Do Drugs Have to Do with Dental Visits? Marijuana, Cannabis, Pot

marijuana pot maryjane Marijuana is one of the most well known and commonly used drugs and is known by many names. The scientific name for the plant is Cannabis, but it is better known as marijuana or pot. Medical use of cannabis or medications derived from the drug are becoming more common place. The likelihood of a dental professional having a patient who has recently used this drug is very high. It is common for cannabis smokers to be unaware of the dangers associated with its use. Studies have shown that it has anti-nausea effects, reduces eye pressure and improves symptoms of certain neurological disorders, AIDS and certain cancers.11 Cannabis is sometimes used medically in these cases, it is also used to increase appetite in anorexics. This article is not about why or who can use medical marijuana, this would be a whole other article in itself. This article focuses on how marijuana effects the mouth, since not all of cannabis’ effects are beneficial. It is important to remember that not all users are using the drug illegally, and dental professionals need to know dangers and side effects just as they would for any other medication. Medical marijuana is not always smoked. Oral sprays and pills with the active ingredients have also been created for patients. has a thorough list of these medications and their uses. I recommend all dental professionals take a look at this list so that they recognize them in a patients medical history, as oral side effects are common with these, just as they are with smoked cannabis.

Cannabis and Periodontal Disease

Gum disease and marijuana or pot use.

Periodontal Disease is more common in cannabis users than the general population.

Increased risk for periodontal disease is not just a problem for tobacco smokers, marijuana smokers have an even higher risk of developing periodontal disease than tobacco smokers. Regular use of cannabis has a strong association with periodontal disease,10,2 with both severe gingivitis and bone loss possible. 6
Gingivial hyperplasia (overgrowth of the gums) similar to that seen in patients who take dilantin has also been seen in cannabis smokers.9 This condition can cause painful eating, as well as concerns with appearance.

Cannabis and Soft Tissue Changes

Gingival Leukoplakia

Gingival Leukoplakia

Leukoedema (Thickened white patches of inflammed cells usually seen on the inner cheek) is more common among cannabis users than the general population 4,13, as well as gingival leukoplakia (thickened white patches of hyperkeritinized cells which may become cancerous in the future) 9 and traumatic ulcers.4
Cellular smears taken from patients who smoke cannabis showed more degenerate and atypical squamous cells than cigarette smokers and nonsmokers, as well as koilocytic changes which indicate the presence of the human papilloma virus (HPV)5,2 The combination of cellular changes and HPV are concerning because of their links to oral cancer. In one study, carcinoma of the tongue was found to be more common in cannabis smokers,9 which supports this theory.
Even medications made from cannabis can contribute to oral soft tissue changes. An oral spray created from the active ingredients in cannabis can cause stinging and burns resulting in white lesions in the mouth.12

Cannabis, Xerostomia (Dry Mouth) and Tooth Decay

dry mouth
Xerostomia is strongly associated with cannabis use.4,  13 Cannabis smokers also have higher risk for dental decay than the general population.4 The relationship between dry mouth and cavities is well known. Saliva is the body’s natural buffer against the acids that attack the teeth. Without adequate saliva the teeth are at a much higher risk for decay. The “cotton mouth” feeling associated with cannabis smoking leads people to reach for beverages to counteract the feeling. Often times the beverages chosen may add to the risk for tooth decay. Carbonated sodas, sugary beverages, energy drinks and sports drinks are all dangerous the enamel. Choosing water over these beverages is beneficial for patients who are cannabis smokers.

Cannabis and Oral Flora

candida albicans infection in the mouth

Oral Candidiasis Infection

Cannabis smokers have a higher density of candida albicans in their mouths. This is the fungus that causes yeast infections, in the mouth this infection is known as thrush. While some patients studied did have candidiasis infections, not all did. Surprisingly, they did not have a higher rate of infection, even though they had more candida organisms living in their mouths.3, 13 It is possible that dry mouth associated with cannabis use contributes to this overgrowth, while the natural anti-fungal properties1 of the plant could have kept infection at bay. Oral smears taken of marijuana smokers also contained higher numbers of bacterial cells compared to smears from those who were not marijuana smokers.5 These changes alter the natural balance of oral flora and could contribute to oral infections.

Cannabis Use and the Dental Chair

Psychologically, patients who have recently smoked marijuana can experience acute anxiety, dysphoria and psychotic-like paranoia. 2 Tachycardia (faster than normal heart rate) associated with cannabis use becomes worse with the use of local anesthetics containing epinephrine.2 Even though cannabis usually has anti-anxiety effects, its use prior to dental surgery makes the patient less adaptable to the stress of the procedure.2 This abnormal stress response,6 when added to the increased tachycardia makes its use dangerous prior to dental procedures.7 In fact, the antianxiety effects of cannabis were less than diazapam or placebo (a pill with no active ingredients) when used prior to dental procedures.7
Uvulitis, or swelling of the uvula is another risk associated with cannabis use prior to dental visits. There have been cases of uvulits occurring after the use of dental anesthetics.9 The combination of physical dangers (tachycardia, uvulitis) and psychological dangers (exadurated stress response, paranoia, anxiety) can make a dental visit seriously dangerous to a patient who has recently used cannabis. For these reasons, it is recommended that patients do not undergo dental treatment for 1 week after use of cannabis.


1Charu Arora; Kaushik, R. D. Fungicidal activity of plants extracts from Uttaranchal hills against soybean fungal pathogens. Allelopathy Journal 2003 Vol. 11 No. 2 pp. 217-228.

2Cho, CM; Hirsch, R; Johnstone, S. General and oral health implications of cannabis use. Aust Dent J, 2005 vol. 50(2) pp. 70-74.

3Darling, MR; Arendorf, TM; Coldrey, NA. Effect of cannabis use on oral candidal carriage. J. Oral Pathol. Med., 1990 vol. 19(7) pp. 319-321.

4Darling, MR; Arendorf, TM. Effects of cannabis smoking on oral soft tissues. Community Dent Oral Epidemiol, 1993 vol. 21(2) pp. 78-81

5Darling, MR; Learmonth, GM; Arendorf, TM. Oral cytology in cannabis smokers. SADJ, 2002 vol. 57(4) pp. 132-135.

6Darling, MR; Arendorf, TM. Review of the effects of cannabis smoking on oral health. Int Dent J, 1992 vol. 42(1) pp. 19-22.

7Gregg, JM; Campbell, RL; Levin, KJ; Ghia, J; Elliott, RA. Cardiovascular effects of cannabinol during oral surgery. Anesth. Analg., vol. 55(2) pp. 203-213. “Pharmaceutical Drugs Based on Cannabis.” 8 May 2013. Web. 22 Aug. 2013.

9Maloney W. The Significance Of Illicit Drug Use To Dental Practice. WebmedCentral DENTISTRY, DRUG ABUSE 2010;1(7):WMC00455

10W. Murray Thomson, PhD; Richie Poulton, PhD; Jonathan M. Broadbent, BDS; Terrie E. Moffitt, PhD; Avshalom Caspi, PhD; James D. Beck, PhD; David Welch, PhD; Robert J. Hancox, MD. Cannabis Smoking and Periodontal Disease Among Young Adults. JAMA. 2008;299(5):525-531.

11Robson, Philip. Therapeutic aspects of cannabis and cannabinoids. The British Journal of Psychiatry, 2001 vol. 178(2) pp. 107-115.

12Scully, C. Cannabis; adverse effects from an oromucosal spray. British Dental Journal, 2007 vol. 203(6) pp. E12-E12.

13Veitz-Keenan, Analia; Spivakovsky, Silvia. Cannabis use and oral diseases. Evidence-Based Dentistry, 2011 vol. 12(2) pp. 38-38.

What do Drugs have to do with Dental Visits? Crack and Cocaine

Growing up as a kid in the ’80′s during a crack epidemic I was bombarded with anti-drug messages that meant little to me at the time, but have stuck with me over the years.  There is no doubt in my mind that crack is wack, or that I do NOT want my brain to fry like an egg from doing drugs.  These public service announcements were memorable, but unfortunately media is fickle and what they focus on in one decade fades in the next.  My kids won’t see these same commercials while watching cartoons but I still want them to know the dangers of drugs so they can make good choices as they get older as well.
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