Lack of formal education on cannabis in dentistry

Iveta Ramonaite, Dental Tribune International

Tue. 16. April 2024

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BUFFALO, N.Y., US: As the field of medicine continues to evolve, the American Dental Association (ADA) has recognised the importance of integrating knowledge about medical cannabis, including therapeutic issues and legal complexities, into dental education. In line with the ADA’s thinking, a recent study has explored dental students’ understanding of cannabis and cannabinoids, revealing significant educational gaps in the curriculum. The findings highlight the urgent need for enhanced instruction on cannabis at dental schools to ensure that future dental professionals are fully prepared to meet the emerging challenges and opportunities that medical cannabis presents in their practices.

Cannabis is the most commonly used illicit drug in the US, and data from the Centers for Disease Control and Prevention shows that approximately 48.2 million people are using the substance. As of this month, 38 states have legalised medical cannabis use and 24 states have legalised its recreational use. However, countries such as New Zealand, which had a cannabis referendum back in 2020, continue to prohibit its use.

Addressing dental patient intoxication

A dental appointment can be challenging when a patient is under the influence of cannabis, since dentists lack a reference guide to assess the effects of specific doses and the drug’s potency. A recent ADA study found that 52% of the respondents had encountered patients who arrived for their appointments intoxicated by marijuana or another drug, and nearly half needed to increase anaesthesia because cannabis was affecting the central nervous system. Additionally, discussions about cannabis use remain difficult for many dentists, particularly in states where its use is still illegal.

Dr Jessica S. Kruger. (Image: Jessica S. Kruger)

“With legalisation, the population that chooses to use cannabis is increasing. Dentists are responsible for knowing and asking about patients’ drug history—both prescribed and recreational—as these conditions or substances can have interactions with dental materials. For example, high blood pressure might affect the use of local anaesthetic,” lead author Dr Jessica S. Kruger, director of teaching innovation and excellence in the School of Public Health and Health Professions and clinical associate professor in the Department of Community Health and Health Behavior at the University at Buffalo, told Dental Tribune International (DTI). “In addition, the effects of cannabis on dentition are not well known,” she continued.

“Dentistry is not just fixing teeth—we need to get to the root of the cause. Dentists must be aware of patients’ drug history to educate and inform their patients properly,” co-author Dr Alyssa Tzetzo, a clinical assistant professor in the Department of Restorative Dentistry at the university, told DTI.

Cannabis sativa L. and its derivatives are widely used in medicine. In dentistry, the plant is often incorporated into various dental products, such as toothpastes, mouthwashes, sprays, powders and chewing gum. While it is noted for its numerous beneficial properties, among which are anti-carcinogenic effects, its primary roles in dentistry include providing pain relief, reducing inflammation and serving as an antiseptic or antimicrobial agent to tackle oral infections. However, studies have shown that frequent cannabis users have poorer oral health, including higher decayed, missing and filled teeth scores, higher plaque scores, unhealthy gingivae, xerostomia and oral lesions.

Limited knowledge of cannabis among dental students

For the purpose of the study, the researchers recruited predoctoral dental students from the University at Buffalo School of Dental Medicine and asked them to fill out a validated, anonymous 22-item online survey on cannabis. The survey encompassed a total of 56 knowledge points, covering general knowledge of cannabis and cannabinoids, of efficacy of cannabis in treating health and medical conditions, of risks associated with cannabis use and of harm reduction strategies.

“Dentistry is not just fixing teeth—we need to get to the root of the cause.”—Dr Alyssa Tzetzo, University at Buffalo

The study found that the average knowledge score among the participants was 38.6% correct responses and the standard deviation was 9.2%. Notably, there were no significant differences in cannabis knowledge based on sex, years in dental school or any formal education on cannabis.

The findings showed that 72.3% of the participants were aware of the endogenous cannabinoid system and 76.6% of the participants recognised that tetrahydrocannabinol (THC) causes the high associated with cannabis use. Conversely, more than half of the dental students were unfamiliar with the effective doses of THC (58.2% of the students) and of cannabidiol (CBD; 66.7% of the students), which is considered a non-opioid analgesic alternative.

The data also revealed that students who engaged in independent research on cannabis tended to have higher knowledge scores. Dr Kruger believes that seeking out cannabis-related information outside a formal educational setting shows an interest in the topic. However, it could also lead to misinformation. She commented: “Not all the information on the internet is correct. Information students obtain from others could also be incorrect. This is worrisome if accurate information is not provided in programmes.”

“People who did their own research were more knowledgeable despite the questionable quality of information on the internet, and this shows that formal education is lacking. There is a need for the dental school curriculum to be revised to incorporate the topic in both didactic and clinical settings,” she added.

Implications for curriculum development

The researchers found the results concerning because dental professionals’ limited understanding of cannabis could have an impact on both the outcome of dental treatment and communication with patients. “Cannabis use impairs informed consent. Legal implications alone could result from a lack of knowledge or communication regarding cannabis,” Dr Kruger commented.

Considering the significant effects of cannabis use on patient interactions and dental health, the researchers believe that dental schools should integrate content on cannabis into existing courses about substances or develop a separate module on cannabis. Topics that should be covered in the curriculum include THC, CBD, usage methods, effects on dental health and dosage guidelines.

“Legal implications alone could result from a lack of knowledge or communication regarding cannabis.”—Dr Jessica S. Kruger, University at Buffalo

Dr Kruger told DTI that the following specific topics on cannabis should be included in the dental curriculum: medical emergencies and complications of cannabis use; ethics, including a consent form; cariology and the effect of cannabis on dentition; periodontics, including the effect of cannabis on dentition, bone and gingivae; the evaluation of the medically complex patient who uses cannabis as prescribed for anxiety; and public health and cannabis, including oral healthcare awareness.

Additionally, Dr Tzetzo sees a great need for adding information on cannabis use to dental screening and patient intake forms and discussing the topic with every patient when taking a medical history.

The study, titled “Assessing dental student knowledge on cannabis and demonstrating the need for cannabis education”, was published online on 29 March 2024 in the Journal of Dental Education, ahead of inclusion in an issue.