Cannabis Addiction: Link to Oral and Cerebrovascular Disease

What Are the Origin and Forms of Cannabis?

The plant Cannabis sativa has the mechanism of producing mild sedation and is illicitly used for euphoria or mood enhancement for recreational purposes globally. Though it can also be medically beneficial for analgesic and antiemetic properties in clinical applications, the Food and Drug Administration (FDA) has not approved cannabis safe for the treatment of any medical condition as such. However, cannabidiol, a substance present in cannabis, received approval in June 2018 as a treatment for some rare forms of epilepsy and in neuro medicine.

The psychoactive drug contains cannabidiol (CBD) and tetrahydrocannabinol (THC), two natural compounds extracted from the plants of the genus cannabis. CBD can be extracted either from hemp or from cannabis. Hemp and cannabis have their origin in the Cannabis sativa. CBD is usually sold illegally or legally, depending on the country, either in gels, oils, or even supplements and extracts. THC, the psychoactive component of cannabis, produces euphoria (the sensation coming with a "high"). This feeling can be familiar to those who consume it by smoking cannabis.

The dried leaves are the used part of the cannabis plant that is smoked commonly and historically as marijuana. Unfortunately, it remains the most widely abused form by more than 12 % of American adults. The dried leaves or flowers of the cannabis plant can be either usually used by rolling into a cigarette (joint form) or alternatively placed in water or pipe and smoked. The resin and oil forms are abused either by ingestion or inhalation.

Post-exposure to cannabis smoke, the victims of marijuana abuse are prone to increased THC concentrations between 0.5 % and 9.6 %. Vaping with cannabis or dabbing is another method of misusing cannabis with potent modes of administration, leading to a THC increase of approximately 66 to 75 % in the individual.

Consumption of cannabis or cannabis infiltrated foods may delay the onset of psychoactive effects by one to three hours; however, the THC levels in any of the methods remain a cause of neurovascular impairment and cognitive and psychomotor dysfunctions. Cannabis consumption or smoking is similarly associated with increased carcinogen content, just like tobacco users making them more prone to respiratory disease, oxidative stress, and oral cancers.

What Are the Detrimental Effects of Cannabis on General Health?

The spike in the use of cannabis is proportional to the cases of head and neck cancer types caused in recent decades. In addition, the acute and long-term chronic use of cannabis is associated with detrimental impairment of the central nervous and peripheral systems.

The various conditions associated with acute and chronic cannabis are: Cannabis withdrawal symptoms.

• Exacerbated psychotic disorders.

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• Neurocognitive impairment.

• Cardiovascular, neurological, cerebrovascular diseases.

• Vascular or circulatory systemic diseases.

• Hyperemesis syndrome.

• Premalignant oral lesions.

• Oral cancers.

• Impaired coordination and performance.

• Anxiety.

• Suicidal tendencies and depression.

• Psychotic and mood-induced disorders.

• Pneumomediastinum.

• Pneumothorax.

• Respiratory lung diseases.

• Chronic obstructive pulmonary disease

What Are the Oral Impacts of Cannabis?

The direct impact of cannabis exposure on the oral cavity is even more profound, with the most common disorder like xerostomia (dryness of the mouth). In addition, the oral cavity's microbiota remains severely affected with limited or no salivary production, which risks the patient from developing various other oral health disorders.

Leukoedema is a common disorder observable in cannabis smokers. Other diseases of oral origin associated with marijuana or cannabis smoking include:

• Gingival enlargement.

• Erythroplakia.

• Inflammation of the oral mucosal membranes.

• Hyperkeratosis of oral tissues.

• Leukoplakia.

Is the Risk of Oral Cancer Increased With Cannabis Use?

The inflammation produced in the oral cavity would be termed cannabis stomatitis. In addition, smoking cannabis tends to have an immunosuppressive impact making the individual prone to an increased risk of oral cancer. In the clinical research studies conducted by the ADA, a histormetric experiment conducted on laboratory rats proved a marked increase in alveolar bone loss as an adverse effect of cannabis because it demonstrates how specific healthy oral microbiota are destroyed or contaminated by marijuana, creating a hostile pathologic oral environment promoting periodontal disease and bone loss eventually.

The synergistic effect between tobacco smoke and cannabis can put the individual at high risk for developing head and neck cancers due to oral cancer. This is because cannabis stomatitis that creates oral inflammation of the mucous membranes, tongue, or the gingiva can potentially develop into neoplasia or malignancy if left untreated by the dental surgeon, in substance abusers of tobacco and cannabis for a long-standing period, or chronic users.

As it produces gross intoxication, the users of cannabis may find dental visits or sittings particularly difficult due to the side effects of the psychoactive cannabis, like paranoia, hyperactivity or reactivity, nervousness, dental fear, and anxiety. These mental health issues may complicate the visit to the dentist, especially to sit through surgical or long oral procedures.

The use of local anesthesia also may be complex for the dentist if the patient suffers from undetected systemic diseases, respiratory stress, or mental hyperactivity. In such cases, the physician or the dental surgeon can schedule multiple smaller appointments to treat the patient to rid them of their fear or anxiety.

What Is the Impact of Cannabis in Cerebrovascular Health?

It is also evident from clinical trials and studies that consuming cannabinoids through inhalation or combustion results in cerebral infarction. This occurs due to the natural or synthetic cannabinoids triggering intracranial vasoconstriction, leading to severely reduced cerebral blood flow (CBF), affecting the blood-brain barrier.

Research has established that oxidative stress (OS) is a major cause of vascular endothelial dysfunction in a causative effect due to cannabis smoking. Current scientific research considers that exposure to reactive oxygen species like H2O2, epoxides, nitrogen dioxide, peroxynitrite, other oxidative stress, and OS-induced or mediated pathways lead to cellular inflammation and tissue damage. This neuronal pathogenesis of cerebrovascular and neurological disease may be the leading cause of cerebrovascular stroke and Alzheimer's disease in cannabis users.

Conclusion:

The risk of both oral cancers and mortality due to hemorrhagic or cerebrovascular ischemic diseases is directly correlated by clinical evidence to cannabis (both naturally or synthetically derived). Drug addicts, substance abusers, and even frequent users of cannabis need to be counseled and educated by the dental surgeon and the physician about the detrimental impact of cannabis on oral and neurovascular health. Lifestyle modification by healthy eating, regular dental visits, and most importantly, cessation of cannabis consumption or smoking can only prevent severe conditions that increase the risk of mortality in these individuals.