Smoking is associated with a high incidenceofperiodontal complications, xerostomia, leukoplakia and an increased risk of developing head and mouth cancers. Regular cannabis smokers also sometimes present with gingival enlargement, hyperplasia and oral candidiasis. A complete comprehensive oral examination is essential for all patients and may be of extra importance for regular cannabis users. Dr. Donaldson suggests intake forms can include specific questions related to cannabis use that includes information about how it is consumed and how often. “Some cannabis users may need to see the dentist more often than every six months to maintain their oral health,” he says. A conversation about healthy snacking is often helpful because cannabinoids are appetite stimulants. “Non-medical or non-pharmacological approaches to xerostomia are also often beneficial because hyposalivation is a common side effect of cannabinoid use,” says Dr. Donaldson. Clinically, both nicotine and marijuana smokers tend to be less sensitive to local anesthetic because such anesthetics are metabolized by enzymes that are induced by these drugs in the body. Specifically, the enzyme cytochrome P450 1A2 (CYP1A2) is responsible for metabolizing most, but not all, local anesthetics, and people who smoke tend to produce more CYP1A2. “Smokers usually need a higher dose of local anesthetics to be comfortable,” says Dr. Donaldson. “Rather than giving higher doses of local anesthetics, however, you could avoid this interaction between smokers and local anesthetics by simply switching to articaine.” The two most common subclasses of local anesthetics are amino amides, such as bupivacaine, ropivacaine and lidocaine, and amino esters, such as procaine, chloroprocaine and tetracaine. Both subclasses are primarily metabolized by CYP1A2. “The articaine molecule is unique, in that it has both an ester and an amide linkage, and it is not metabolized by CYP1A2,” he says. “Instead, it is metabolized by carboxyesterases in the periphery, which means it will avoid this enzyme induction and be more effective in smokers.” 33 Issue 4 | 2024 | Issues and People
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