In our experiments we presented the olfactory and visual stimuliCannabis sativa contains more than 140 terpene-like compounds, called cannabinoids, that share the cannabinoid chemical scaffold. The 2 main members of this chemical family are Δ9 -tetrahydrocannabinol and cannabidiol . Animal and human studies have demonstrated that THC is responsible for the majority of the intoxicating effects of cannabis; it acts by binding to G protein-coupled cannabinoid receptors in the brain and other tissues of the body. By contrast, CBD exhibits a distinct set of pharmacological properties, including anti-epileptic and anti-inflammatory effects that are mostly independent of CB receptor activation.Data obtained from the National Health and Nutrition Examination Survey indicate that frequent use of recreational cannabis is positively associated with severe periodontitis, which was observed both in a bivariate analysis and in a multi-variable analysis adjusted for demographics , alcohol and tobacco use, diabetes mellitus, and past periodontal treatment. Research has also found that cannabis may produce adverse effects on oral tissues including gingival enlargement, nicotinic stomatitis, and uvulitis. Remarkably, a number of beneficial effects have also been reported. Considerable evidence supports that pharmacological strengthening of the endogenous cannabinoid system may exert beneficial effects on periodontal inflammation and nerve pain. CBD was shown to exert anti-inflammatory and anti-oxidative effects resulting in a faster resolution of oral mucositis in a murine model. Additionally, enhancing endocannabinoid signaling in cells that initiate local immune responses in the periodontium, the periodontal ligament cells, greenhouse grow tables significantly dampened their proinflammatory responses to lipopolysaccharide produced by Porphyromonas gingivalis.
It has been also shown that selective agonists for type 2 CB receptors exert anti-inflammatory effects in human periodontal ligament fibroblasts. Finally, pharmacological activation of the endocannabinoid system in periodontal ligament cells exhibited hostprotective effects by both dampening inflammation and preserving cellular integrity, while palmitoylethanolamide, a bio-active lipid structurally related to endocannabinoids, exacerbated inflammation. All in all, these results suggest that targeting the endocannabinoid system, in particular by boosting local CB2 receptor signaling, may lead to novel therapeutics that improve current treatments for periodontal disease and other oral inflammatory pathologies.The coronavirus disease 2019 pandemic due to the worldwide spread of severe acute respiratory syndrome coronavirus 2 infection has significantly affected the use of cannabis in 2 particular human populations, among others. First, it was shown that those who engaged in self-isolation used 20% more cannabis during the pandemic than those who did not, which was associated with self-reported isolation and loneliness. In addition, people with mental health conditions reported increased use of medicinal cannabis by 91% during the COVID-19 pandemic, compared to those with no mental health conditions. Therefore, during the pandemic, health care providers should pay particular attention to oral diseases. Importantly, communication and cooperation between physicians and dental practitioners should be encouraged in managing and treating patients. In addition, the seemingly opposite contribution of the 2 main ingredients of cannabis, THC and CBD, to periodontitis should be kept in mind when addressing the effects of cannabinoids. Certainly, further research is required to evaluate the beneficial and harmful effects of various phytocannabinoids and pharmacological modulators of the endocannabinoid system.In 2000, the Surgeon General identified oral disease as a “silent epidemic” . Despite the availability of effective prevention and treatment methods, oral health has improved little over the past two decades. Among some sub-populations , oral health disparities remain . In the United States, nearly a quarter of adults aged 20-64 have untreated dental caries and more than half have lost a permanent tooth .
Oral pain and tooth loss have a significant negative impact on quality of life and employment by affecting the ability to eat, speak, and smile . Older adults have worse oral health than younger adults due to age-related physiological changes and a higher prevalence of chronic conditions . Despite their heightened need for dental care, older adults have less access to such care . The homeless population is aging, with a growing proportion of adults experiencing homelessness at ages 50 and over . Older homeless adults have a high prevalence of chronic disease and poor dental health . In California, most adult dental services were discontinued as a Medicaid benefit in 2009 , eliminating coverage for more than 8 million people . Enactment of the Affordable Care Act in 2014 expanded Med-Cal medical insurance coverage to 3.8 million people in California, and restored basic adult dental coverage . Unlike pediatric dental care, which is considered an essential health benefit under the ACA, adult dental care coverage is not mandatory. In California, after the enactment of the ACA, adults with Medi-Cal became eligible for dental services, including basic preventive and restorative treatments, complete dentures, and complete denture reline/repair services through the Denti-Cal program . Access to dental care is important because poor oral health is associated with poor nutrition, oral pain, and impairments in oral functioning . People experiencing homelessness have inadequate resources for regular dental hygiene and a higher prevalence of risk for tooth loss, including smoking and substance use . Tooth loss, or edentulism, is a key indicator of oral health; it is affected by both access to dental care and risk factors for poor oral health . Edentulism is a risk factor for coronary artery plaque formation, diabetes, and certain cancers . Prior research in a sample of homeless adults found homeless adults had a higher prevalence of poor oral health than the general population, with high prevalence of tooth loss, or untreated dental decay . In a national study of homeless adults, approximately half of homeless adults had an unmet need for dental care as assessed by tooth or gum problems in the past year . Little is known about oral health in the growing population of homeless adults aged 50 and older. We examined the prevalence of tooth loss, oral pain, denture fit, and impairments in eating or sleeping due to oral pain as well as factors associated with poor oral health, in a population-based cohort of older homeless adults in Oakland, CA. The HOPE HOME Study, is a longitudinal study of life course events, geriatric conditions, and their associations with health-related outcomes among older homeless adults.
From July 2013 to June 2014, we enrolled a population-based sample of 350 homeless adults aged 50 years and older from all 5 overnight homeless shelters in Oakland that served single adults over age 25, all 5 low-cost meal programs that served homeless individuals at least 3 meals per week, a recycling center, and homeless encampments. Study visits took place at St Mary’s Center, a non-profit that serves indigent older adults. Participants did not have to receive services at St Mary’s to be eligible. To be eligible, participants had to be English-speaking, aged 50 years and older, defined as homeless as outlined in the Homeless Emergency Assistance and Rapid Transition to Housing Act , and able to provide informed consent. After determining eligibility, study staff administered an in-depth structured enrollment interview and collected extensive contact information from participants. We gave participants a $25 gift card to a major retailer for their participation in the screening and enrollment interview. The University of California, San Francisco Institutional Review Board reviewed and approved all study protocols. This analysis uses data from the baseline interview. Participants self-reported age, sex, race/ethnicity, and highest level of education. We categorized race/ethnicity as African American, White, or Other. We categorized highest level of education as less than high school versus high school graduate/General Educational Development or greater. Participants reported their total lifetime years of homelessness after the age of 18. To assess the prevalence of depressive symptoms, we administered the Center for Epidemiologic Studies Depression Scale. Using a shortened time frame of the previous 6 months to correspond to study time intervals, we administered the World Health Organization’s Alcohol Use Disorders Identification Test . To assess illicit drug use, we administered the WHO’s Alcohol, Smoking, and Substance Involvement Screening Test to assess for amphetamines, cocaine, opioids and cannabis growing system, using a lengthened time frame of the previous 6 months. We dichotomized substance use risk for each substance as low vs. moderate-to-high severity . We used the California Tobacco Survey to assess tobacco use. We classified smokers who had smoked at least 100 cigarettes in their lifetime as “ever smokers.”We adapted oral health questions from the Oral Health Impact Profile – 14 . We asked participants about tooth loss . For our primary dependent variable, we dichotomized responses as missing less than half versus missing half or more. We asked participants who reported having any teeth if they were able to eat with their teeth. For participants who reported missing all of their teeth, we asked if they had dentures, and if so, whether they fit . We asked participants how often they had oral pain in the last six months . If participants noted oral pain, we asked if the pain kept them from eating or sleeping . To assess access to dental care, we asked participants about how long it had been since they last visited a dentist: <6 months, 6 months to 1 year, >1 year to <5 years, or ≥5 years. To assess unmet dental need, we asked participants if, during the past 6 months, there was a time when they needed dental care but could not obtain it. We described sample characteristics and reported oral health variables using medians for continuous variables and proportions for categorical variables.
We examined oral health status by evaluating bivariate associations between independent variables and our primary dependent variable using Wilcoxon rank sum tests for continuous variables and chi-squared tests for categorical variables. Using multivariate logistic regression, we examined factors associated with participants having lost half or more of their teeth. We included all covariates in the model and through stepwise removal eliminated variables failing to achieve a significance of less than 0.2. We conducted these analyses using Stata version 14 . In a population-based sample of older homeless adults with a median age of 58, we found evidence of poor oral health and poor access to dental care. Over half of participants reported oral pain, which is over three times greater than the prevalence of oral pain in the general population over age 65 and more than twice that of the general poverty population over age 65 . Despite oral health needs, older homeless adults had poor access to dental care. Only a quarter reported visiting a dentist in the prior year, compared with 62% of adults in the general population . We found that over half of older homeless adults had been unable to get dental care in the prior year, compared with fewer than ten percent of adults aged 65 and older in the general population . Whereas approximately 10% of edentulous adults in the general population lack dentures, we found that almost half of edentulous participants either lacked dentures or had ones that couldn’t be used due to poor fit . Over a quarter of our participants reported that mouth pain prevented them from eating. Edentulism and oral pain may limit homeless individuals’ ability to eat, worsening food insecurity . Dental care is ranked as one of the leading unmet needs among the general homeless population . Many of our participants lacked health insurance; in addition, prior to Medicaid expansion , Med-Cal in California did not include access to dental care. However, even with Medicaid-supported dental coverage, access to dental care remains limited. Only about 20% of the nation’s 179,000 practicing dentists accept Medicaid payment for dental services and more than 49 million people live in areas categorized as dental health shortage areas . In California, only 1 in 4 dentists provide services to Medi-Cal beneficiaries. On average, throughout California, there are only 7.3 dentists that accept Medi-Cal per 10,000 beneficiaries. As many dentists who accept Medi-Cal limit the number of Medi-Cal patients they are willing to provide services to, the shortage is worse than it appears. . Having lost half or more of teeth was strongly associated with increased age, consistent with previous studies in both the general and homeless populations . This could reflect the increased adoption of preventive measures such as improved fluoridation and dental sealants with later birth cohorts .