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MORTSEL, Belgium: After two decades of practising dentistry, Dr Veronica Stahl became frustrated about the lack of consumer products that combat dental plaque effectively. After being introduced to hemp-derived cannabinoids through a course on medical cannabis, Stahl undertook her own research which proved that cannabinoids fight plaque as effectively as chlorhexidine in mouthwash. She has now launched the STOP range of oral care products for dentists and consumers, and says that the naturally occurring compounds have huge untapped potential in dentistry.
Cannabidiol (CBD) and cannabigerol (CBG) are non-psychoactive phytochemicals that are produced naturally by the cannabis plant. They belong to the more than 120 cannabinoid compounds that have been identified in the cannabis plant genus, and their medicinal applications are only now being discovered. The health problems that are already being treated with CBD include anxiety, chronic pain, and childhood epilepsy syndromes that often do not respond to anti-seizure medications. Stahl was the first medical researcher to test the antibacterial and anti-inflammatory qualities of the compounds in the oral cavity.
The story, sadly, began with a personal tragedy. Originally from Israel, Stahl travelled to Tel Aviv to speak with researchers about new developments in oncology—her father was suffering from an aggressive form of cancer. While in the city, she attended a course on medical cannabis, and this was her first exposure to the plant. She told Dental Tribune International (DTI): “I did not know anything about it before that—not even that the plant has psychoactive and non-psychoactive parts. I learned that it has great efficacy on a number of mechanisms that regulate the body, and I asked myself, if this can be effective in reorganising nerve cells and many other kinds of cells in the body, then why not in my field, in the oral cavity?”
The effectiveness of chlorhexidine without side effects
Stahl received a licence and a grant from the Belgian Flemish government to undertake research into the effects of cannabinoids on the mouth. In a 2019 study, she tested her own STOP CBD- and CBG-infused mouthwash products in vitro against the total culturable bacteria from dental plaque samples collected from 72 adults. The efficacy of these products in inhibiting the bacteria was compared with that of 0.2% chlorhexidine digluconate and that of two popular consumer mouthwash products—one containing essential oils and alcohol and the other containing fluoride and no alcohol.
On average, the products infused with cannabinoids were found to display a similar or better bacterial efficacy when compared with 0.2% chlorhexidine. The cannabinoid-infused mouthwashes and 0.2% chlorhexidine were found to be effective against all of the samples that were tested. Stahl explained to DTI that cannabinoids have been shown to regulate biofilm formation by interfering in autoinducer-2 quorum sensing signalling cascade. This, she said, in combination with their antimicrobial agency, makes them good candidates for application in dental care.
“What is unique about CBD, and what our research has shown, is that it does not kill the microorganisms but rather interacts in the communication between them, which is a totally different mechanism from that of other disinfectants,” she said.
Speaking about the new STOP range of oral care products, Stahl said that it combines hemp-derived cannabinoids with other natural materials and extracts and that it is backed by science. “These products have been tested for efficacy in the laboratory over a period of three years,” she explained. “They are made by a dentist who cares for her patients. I see my patients every day, and I am concerned when I find they are using a toothpaste that is not efficient.”
Stahl pointed out that chlorhexidine can cause tooth discoloration and that cannabinoid-infused mouthwash products may therefore be an appealing alternative. “The nice thing about our products is that they do not have side effects. We have seen in the research that their inhibition of bacteria is equivalent to that of chlorhexidine, or often even greater. But our product, which is an over-the-counter product, differs from chlorhexidine in that it does not cause staining on the teeth. You can use it year-round without the side effect of discoloration but while still having a very high efficacy similar to that of chlorhexidine.”
Cannabinoid-derived oral care products for dental professionals
The company CannIBite, situated in Belgium, has also launched a mouthwash formulation that has been adapted to prevent the spread of SARS-CoV-2 in dental and other healthcare settings. It combines the STOP hemp-derived CBD formulation with hydrogen peroxide 1% and is available from the Oral Health Care Store and, in Belgium, through the distributor ADT.
“Using CBD, we will be able to combat many infections that are a danger in root canal treatment, and we will finally be able to eliminate the microorganisms which we have been trying to eliminate for such a long time”
Stahl has filed a number of patents and she says that cannabinoids have a great future in oral health. “When I started my research on cannabinoids in dentistry there was nothing on the market—no research, no articles, nothing. But we have changed that, and it is plain to see that there is huge potential for CBD—not only on the cosmetic level, which is what we are currently talking about—but indeed in almost every discipline of the dental field.”
She explained: “Let’s consider, for example, the potential in endodontics. Using CBD, we will be able to combat many infections that are a danger in root canal treatment, and we will finally be able to eliminate the microorganisms which we have been trying to eliminate for such a long time, and in a much more efficient way. Cannabichromene also has a very high potential for use in the induction of bone regeneration, which will be very useful in the areas of implantology and orthopaedics. There is a great deal of potential for future product development.”
The next step for CannIBite, Stahl says, is to increase awareness of cannabinoid-derived products in the oral health sector and to increase confidence in the use of CBD and CBG products. “We need to get away from the negative stigma that is often associated with this plant, particularly because we are using only the non-psychoactive part. We want to encourage confidence in using it because it is a natural extract, and it is much better than chemicals. Many governments no longer classify CBD as an illegal substance, and what we are using in our formulation is CBD that originates from hemp—just to be on the safe side—so that there is no trace of tetrahydrocannabinol.”
At the same time, CannIBite aims to raise capital so that it can establish and further the distribution of its products and continue its research. “We want to be able to go further,” Stahl said, “aiming for other important pharmaceutical products and bringing these to the dental field so that we can combat and treat those oral health problems for which we still, today, do not have solutions.”