Relationship Between Frequent Recreational Cannabis (Marijuana and Hashish) Use and Periodontitis in Adults in the United States: National Health and Nutrition Examination Survey 2011 to 2012

• Autores: Jaffer A. Shariff, Kavita P. Ahluwalia, Panos N. Papapanou
• Localización: Journal of periodontology, ISSN 0022-3492, Vol. 88, Nº. 3, 2017, págs. 273-280
• Idioma: inglés
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• Resumen

  • Background: Recreational use of cannabis, following its legalization in some countries, poses emergent oral and periodontal health concerns. The objective of this study is to examine the relationship between frequent recreational cannabis (FRC) (marijuana and hashish) use and periodontitis prevalence among adults in the United States.

    Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2011 to 2012 were analyzed. Primary outcome (periodontitis) was defined using the Centers for Disease Control and Prevention/American Academy of Periodontology classification as well as continuous measurements of probing depth (PD) and clinical attachment loss (AL). Exposure of interest was self-reported cannabis use, defined as “FRC use” versus “non-FRC use.” Bivariate and multivariable regression models were performed using the entire analytical sample (model 1) as well as those who had never used tobacco (never-users) (model 2).

    Results: Of 1,938 participants with available cannabis use data and essential covariates, 26.8% were FRC users. Mean number of sites per participant with PD ≥4, ≥6, and ≥8 mm and AL ≥3, ≥5, and ≥8 mm was significantly higher among FRC users than among non-FRC users (mean difference in number of PD sites: 6.9, 5.6, and 5.6; P <0.05; mean difference in number of AL sites: 12.7, 7.6, and 5.6; P <0.05). Average AL was higher among FRC users than among non-FRC users (1.8 versus 1.6 mm; P = 0.004). Bivariate analysis revealed positive (harmful) association between FRC use and severe periodontitis in the entire sample (odds ratio [OR]: 1.7, 95% confidence interval [CI]: 1.3 to 2.4; P = 0.002) as well as in never-smokers (OR: 2.0, 95% CI: 1.2 to 3.5; P = 0.01). This association was retained in multivariable models adjusted for demographics (age, sex, race/ethnicity, and income level), alcohol and tobacco use, diabetes mellitus, and past periodontal treatment (model 1: adjusted OR [aOR]: 1.4, 95% CI: 1.1 to 1.9; P = 0.07; model 2: aOR: 1.9, 95% CI: 1.1 to 3.2; P = 0.03).

    Conclusion: FRC use is associated with deeper PDs, more clinical AL, and higher odds of having severe periodontitis.

    Cannabis preparations are derived from the hemp plant, Cannabis sativa, which contains ≈460 known compounds called cannabinoids, 60 of which are unique to the plant and contain a primary active chemical (δ-9-tetrahydrocannabinol [THC]) shown to have psychoactive properties.1 Marijuana, hashish, and hash oil are three types of recreational cannabis. Marijuana (0.5% to 5% THC) is the most common and least concentrated form, followed by hashish (2% to 20% THC), and hash oil (15% to 50% THC), which is the most concentrated and potent form.2 The most common methods of cannabis consumption for recreational purposes are smoking (usually marijuana) and mixing in food (usually hashish).3 Marijuana is the most commonly used recreational drug in the United States,4 and its use for both medical and recreational purposes has become increasingly common in recent years. As of 2015, 24 states have legalized medical marijuana use, and four states, including the District of Columbia, have legalized its recreational use.5 As prior studies have shown adverse effects of cannabis use in the oral cavity (such as xerostomia, oral cancer, risk for dental caries, infection with candida albicans, gingivitis, and periodontitis),6 widespread use of cannabis may pose significant oral and periodontal health concerns.

    Periodontitis is a major cause of tooth loss among adults in developed countries7 and thus represents an important oral health problem.8 The disease is known to have a strong genetic component but is also affected by environmental and behavioral factors.9 The literature on the association between cannabis use and periodontitis is sparse. One experimental animal study in rats10 and three epidemiologic studies in adolescents and young adult participants11-13 suggested a detrimental role of cannabis use in the pathobiology of periodontitis in a manner similar to that of tobacco smoking.

    There is paucity of epidemiologic data in adults on the impact of regular use of recreational cannabis on periodontal tissues. Critical appraisal of this association is important to inform the practicing clinician and to promote appropriate public health initiatives, including education, counseling, and treatment guidelines for cannabis users.

    In this study, a nationally representative sample is used to determine the relationship between recreational cannabis use and periodontal status in adults aged ≥30 years living in the United States.