In high-fear patients who have recentlyconsumedacannabinoid, I would not recommend using an oral sedative that might have a synergistic effect with it. Watch a conversation with Dr. Donaldson on cannabinoids and dentistry on CDA Oasis: bit.ly/3YAbjUL For patients with high dental anxiety for whom dentists might consider using nitrous oxide, the younger demographic of regular cannabis users brings up an extra consideration. “Chronic obstructive pulmonary disease, or COPD, is a major contraindication for nitrous oxide— oxygen inhalational sedation,” says Dr. Donaldson. “Traditionally, patients with COPD are older, but with more young people smoking cannabinoids on a regular basis since legalization, COPD has become a bigger issue among younger people.” On occasion, a patient may arrive at a dental clinic just after ingesting cannabis. “Some high-fear patients might feel it will make them less anxious,” Dr. Donaldson says. “While I would not recommend treating an active user outside of a dental emergency, you may want to limit the amount of epinephrine that you to expose the patient because of the cardiovascular effects that marijuana can cause.” Cannabinoids can also have sedative effects. “In high-fear patients who have recently consumed a cannabinoid, I would not recommend using an oral sedative that might have a synergistic effect with it,” he says. “It could cause a deeper level of sedation than you intend and that could be an unpredictable situation.” Dr. Donaldson says that it is fairly obvious if a patient has smoked cannabis recently due to smell, but with an increased use of edible cannabinoids and other ways of consuming cannabis with fewer outward indicators of use, it helps to have an open, honest discussion with patients about the topic. “If a patient is not forthcoming, I would suggest saying something like, ‘I want to keep you safe today. I want to give you that smile that we’ve always talked about, and I can’t do that safely if I don’t know all the drugs, chemicals and medicines that might be in your body. This is a nonjudgmental safe space. I’m not sharing this information with anybody else. I just want to be able to make sure that we provide safe dental care for you today,’” says Dr. Donaldson. He suggests that framing the discussion around patient safety might help a person talk more openly about a potentially sensitive subject. 34 | 2024 | Issue 4 Issues and People
RkJQdWJsaXNoZXIy OTE5MTI=