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Cannabis and the Canadian Dentist: Are you ready for the legalization of Cannabis?

Cannabis will become legal on July 1st, 2018; and we at CDA Oasis are exploring the many facets of this professional issue. In particular, we are exploring the various impacts of this substance, namely clinical and legal. 

I welcomed once again Dr. Mark Donaldson, pharmacologist and senior executive director at Vizient Pharmacy Advisory Solutions. He is also clinical professor in the Skaggs School of Pharmacy at the University of Montana. Dr. Donaldson shared his expertise on the topic of cannabis in the dental office. 

We recognize this is an important conversation that needs to take place in the dental practice as well as within the overall dental profession and we welcome your feedback, questions and suggestions. Please get in touch with us at oasisdsicussions@cda-adc.ca

Until next time!

Chiraz Guessaier, CDA Oasis Manager

Highlights

Cannabis has been available and used from the time of early civilizations to treat various conditions. Evidence-based research suggests that there are certain indications for the medical use of cannabinoids. As an example, clinical evidence supports the use of medical grade cannabis in angle glaucoma to decrease the intraocular pressure in patients. However, from a dental perspective, there is no evidence-based information for the use of cannabis in the management of TMJ, neuropathic or post-operative orofacial pain. 

As oral health care professionals, dentists must be aware of the oral manifestations of disease that may arise from the use of medical-grade marijuana. The inhaled form of cannabis poses a risk to the patient’s respiratory tissues and may lead to various conditions, including hyposalivation and xerostomia. 

Dentists will also need to be mindful of the psychoactive reactions that patients using cannabis might experience. As well, there are potential drug interactions with benzodiazepines or antihistamines that may occur with the use of this substance. Because cannabinoids are organic matter and contain active ingredients, it is challenging to know the perfect ratio of cannabinoids as the potency may vary from dose to dose and batch to batch and as a result, make it difficult to ascertain the drug interactions which may occur.

On the legal implications for dentists, it is important to determine whether the patient is an active user. Active users should not have elective dental treatment. At times, this may be easy to spot; however, where the patient ingests this substance, it may be more difficult to predict. In these cases, dentists will benefit from having an open, non-judgmental conversation with patients to determine whether the patient is using cannabis or not to assess potential risks to the patient’s safety.

In terms of prescribing medical grade cannabis, it is likely that the prescription privileges will be restricted to a specific group of dentists and will require additional education and significant regulations around this substance.

Full Conversation (19.03″)

 

6 comments

  1. Interesting conversation. Thanks for the information.

  2. Thank-you for publishing this interview.
    I disagree with the opinions expressed by Dr. Donaldson.
    I think that Cannabis can and should be prescribed by dentists in selected situations.
    As a dentist with a practice largely limited to the diagnosis and treatment of orofacial pain and TMJ dysfunction, primarily from trauma, Cannabis has successfully been used for patients with long term chronic pain. I know they are on it and to say we cannot do routine dental treatment on them because they are on CBD or CBD/THC is untenable. It is certainly safer than narcotic pain medications, or other antipsychotic drugs that are routinely used and I could go on and on about other medications used by the general population.
    Additionally, what about the use of THC/CBD for anxiety management? Indications? Dosing? % of CBD or THC combinations?
    The Netherlands made Cannabis legal more than 10 years ago. What is the Netherlands Dental Associations experience with Cannabis for pain management or anxiety management in the dental office?
    We need the CDA and Provincial Dental Associations to create appropriate protocols for training, prescribing, monitoring and using Cannabis in the dental/medical environment.

    • Dr. Mark Donaldson

      Thank you for your insightful comments Dr. Stanleigh. As a specialist in a very particular area, you may be correct that as another tool in your toolkit medical cannabinoids may play a role. My comment was for the majority of the dental population (general dentists), who already have a significant armamentarium of pharmaceutically elegant and evidence-based products at their disposal to help manage orofacial pain. I am glad that we have specialists such as yourself to refer these more challenging patients to, since your higher level of expertise may be able to decifer those patients in whom medical cannabinoids may play a role.

      Again, for the practicing, general dentist, since we have no current dose standardization nor evidence-based guidelines to follow, medical cannabinoids should not be considered part of the usual dentally prescribed armamentarium. As you mentioned, we are hoping to learn from our colleagues experiences overseas and in time, there may even be a role for these products, once standardized, to help with anxiety and other medical indications.

      Thank you very much for your insightful comments.

      • Mark,
        I completely agree that we need standardization and appropriate protocols in place to help us decide when and how to use these options as well as who we should and should not be prescribing them to.
        I am also surprised that so many are talking about cannabinoids for pain management and I have not been able to find any information about it’s potential (safe?) use as an anti-anxiety tool as well.
        I would love to incorporate this into my practice however, with so many uncertainties, and so many good questions for which no one seems to have any answers (yet), I am hopeful that we can help stimulate those who have the position and authority to provide answers to these questions are able to do so sooner rather than later.
        I await the results with baited breath.
        As my friend and colleague, Professor Jose Lanca, University of Toronto, pointed out to me, Cannabis legalization will open up avenues of challenges in society that alcohol and nicotine have already established. We need to go forward very carefully and mindful of that reality.

  3. Hello Dr. Donaldson,
    As a dental hygienist in Washington State where Cannabis is legal for medical and recreational use, I would like to know of the evidence-based resources available for use in documenting the adverse effects and potential drug interactions that may occur with the use of Cannabis.
    Thank you,
    Merri Jones

  4. Hi Merri, thank you for taking the time to watch the interview and write. In the United States if you would like to submit information on adverse effects and drug interactions, the website for MedWatch (The FDA Safety Information and Adverse Event Reporting Program), can be found here:

    https://www.fda.gov/safety/medwatch/

    Best regards,

    Mark

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