Cannabinoids in Dentistry PDF

UPFRONT themed issue of the BDJ. In 1981, I suggested oral candidiasis and potentially a greater risk of Similarly, the editors highlighted the that correct posture should ensure straight oral cancer compared to non-cannabis smokers....

UPFRONT themed issue of the BDJ. In 1981, I suggested oral candidiasis and potentially a greater risk of Similarly, the editors highlighted the that correct posture should ensure straight oral cancer compared to non-cannabis smokers. following: teeth for life.1 Oral myologists are trained to More research is needed on the impact of non- 'Any measure of performance has to: do this. Appliances can also change posture, smoking-related oral use of cannabinoids, such 'Be judged against minimum standards, then no retention is required, but I don’t think as in toothpaste or mouthwash. not aspirational standards, that were this is taught in any British university? Larger studies should be conducted acceptable at the time. J. Mew, Kent, UK to ascertain whether there are beneficial 'Be considered within the specific context outcomes for patients with high plaque of the particular patient and environment. Reference levels. Research thus far has shown similar 'Take account of the practitioner’s justification, 1. Mew J R C. The aetiology of malocclusion: can the tropic bacteriocidal efficacy to the gold standard which should be evident from the records'. premise assist our understanding? Br Dent J 1981; 151: chlorhexidine digluconate without the The FGDP(UK) has worked tirelessly in 296–302. detrimental staining potential.3 However, preparing such documents, and as we move https://doi.org/10.1038/s41415-021-3281-8 the authors of the study were found to have forwards through the College of General conflicts of interests as they are financially Dentistry, these will be at the heart of Microbiology invested in cannabinoid production. It would establishing evidence-based guidelines and be interesting to explore the dental potential standards for the whole dental team. Cannabinoids – high expectations? of cannabinoids in future unbiased studies. E. McColl, R. Witton, C. Tredwin, A. Pal, I. Mills, Sir, health stores have been rolling up sales S. Antoniou, London, UK Plymouth, UK following a relatively recent addition of CBD products onto their shelves due to their References References implication in several health benefits. This 1. Feldman M, Smoum R, Mechoulam R, Steinberg D. 1. Roberts-Harry E. Guidelines are not standards. Br Dent Antimicrobial potential of endocannabinoid and J 2021; 230: 688. raises the question: are there any potential endocannabinoid-like compounds against methicillin- 2. Moles D, Tredwin C, McColl E, Robert W, Burns L. dental uses for cannabinoids in the pipeline? resistant Staphylococcus aureus. Sci Rep 2018; 8: 17696. Standards in dentistry. London: Faculty of General Dental In the last few years, CBD has been 2. Joshi S, Ashley M. Cannabis: A joint problem for Practice (UK), 2018. patients and the dental profession. Br Dent J 2016; 220: 3. Hadden A M. Clinical examination and record keeping. incorporated into multiple products ranging 597–601. London: Faculty of General Dental Practice (UK), 2016. from face creams and teabags to pure CBD 3. Stahl V, Vasudevan K. Comparison of efficacy of https://doi.org/10.1038/s41415-021-3283-6 cannabinoids versus commercial oral care products oil taken sublingually for its muscle relaxant in reducing bacterial content from dental plaque: a preliminary observation. Cureus 2020; doi: 10.7759/ and anxiolytic effects. It has also been found cureus.6809. Law and ethics to be antimicrobial against gram-negative and gram-positive bacteria.1 https://doi.org/10.1038/s41415-021-3282-7 Breakingbury v Croad: should we have seen this coming? These findings have potential implications within dentistry, as there is little research The practice of dentistry Sir, the recent case of Breakingbury v Croad1 currently available on the efficacy of cannabinoid triggered shock waves among practice owners.2 molecules in targeting oral commensal bacteria Standards in dentistry Many of us empathised with the retired Mr found in dental plaque. Incorporation of Sir, we read with great interest the letter from Croad when he was found liable for negligent cannabinols into dentifrices may have positive E. Roberts-Harry entitled 'Guidelines are not work carried out at his dental practice by self- outcomes on prevention of periodontal disease. standards'.1 The letter covered succinctly and employed dental associates. However, since the Studies conducted recently had small sample eloquently the many challenges the dental principles which led to the findings of a non- sizes and lacked reproducibility; thus, more team face in the UK and the point made delegable duty of care and vicarious liability by research is needed in this area. about ‘The GDP is stuck between a rock and the County Court have been made clear by the The current legal status of healthcare a hard place’ rang true, when considering the Supreme Court for almost a decade, should we products containing cannabinoids stands many pressures as highlighted. have seen this coming? that any cannabis-derived product with more In writing the second edition of the In Woodland v Essex County Council,3 the than 0.01% THC (psychoactive component of FGDP(UK) Standards in dentistry,2 and the Supreme Court emphasised that there are five cannabis) has to be prescribed by a specialist third edition of Clinical examination and defining features whose presence give rise doctor. Over-the-counter cannabinoid record keeping,3 the editors were acutely to non-delegable duties of care. With words products may be sold without a ‘hemp aware of, and hoped to address, a number pertinent to dental services highlighted herein licence,’ if the THC component is not detected of the issues raised by E. Roberts-Harry. in brackets, these are: that the claimant is a (0.01% as verified by accredited ISO lab). For example, in Standards in dentistry, we patient; there is an antecedent relationship As outlined in a paper published in the highlighted the definitions as follows: between the claimant (the patient) and the BDJ in 2016,2 smoking cannabis with tobacco 'Clinical guidelines are systematically defendant (the practice owner) which places can have detrimental effects in the oral developed statements to assist practitioner the claimant in the actual care of the defendant cavity. Namely, lasting xerostomia post-oral and patient decisions about appropriate and from which it is possible to impute to the cannabis use, cariogenic foods consumed after healthcare for specific clinical circumstances. defendant the assumption of a positive duty to use, higher DMFT scores in cannabis users 'A standard is a definable measure against protect the claimant from harm; the claimant compared to non-cannabis smokers, risk of which existing structures, processes or has no control over how the defendant chooses thermal injuries to soft tissues, higher risk of outcomes can be compared'. to perform those obligations; the defendant has 70 BRITISH DENTAL JOURNAL | VOLUME 231 NO. 2 | July 23 2021 © 2021, British Dental Association.