CBD in Dentistry – Can Cannabis Cure Cavities?

Currently, the majority of research in medical marijuana focuses exclusively on analyzing its effectiveness in treating various ailments of the human body. Dental marijuana research has not been extensively investigated, and hallmark features critical to heal dentition with this medicinal drug are vastly unknown. This systematic research review aims to 1) identify various molecular caries (cavities) mechanisms and 2) determine future prospects of cannaboid research in dentistry.

Dental caries (rottenness) has been a somewhat intangible quality to measure, and attempts at eliminating it from dentistry have generally failed due to its intrinsic complexity. Dentistry pervades many aspects of our history and culture. During the mid 16^th century of the Renaissance period, dental patients sought to use herbs such as rosemary charcoal to not only maintain proper oral hygiene, but to alleviate painful tooth decay that many can empathize with to this day. Sage shrubs were also used to become an effective “teeth-whitening strip”, often cooked tediously and compounded to activate the “whitening” ingredients. Dentistry has evolved our entire life for hundreds of centuries, yet modern studies of dentistry have neglected to enhance or advance the same natural remedies used centuries ago to date. To this end, with the emerging knowledge of medicinal marijuana benefits, more specifically cannabidiol active ingredients (CBD), there has been a profound transition to identify the benefits of this drug at a clinical level. Many paste products focusing on hemp and marijuana plant driven ingredients have marketed this plant in hopes of penetrating the 12 billion dollar market share of the toothpaste industry.  Yet the influences of various commercially available toothpaste products are fairly similar, with fluoride as their primary active ingredient in varying quantities. Generally, these pastes contain limited ingredients; resulting in limited data collection to determine the best paste that would effectively combat tooth decay. Furthermore, utilizing a wide range of focus group patients to evaluate caries, or recruiting study participants who are willing to use placebo paste, or ineffective paste in an effort to prevent caries, is often a violation of IRB research protocol. These two factors can limit the breadth and scope of most dental studies, as it is often difficult to control the basic parameters of the oral cavity unique to each participant.

Caries at Molecular Level

There is much dental literature that shows molecularly identified causes of dental caries (cavities). Various pathways that regulate protein metabolism, glucose regulation, and transaminase reactions have been shown clinically to cause caries. These unique pathways allow for colonization of biofilms in the oral mucosa and produce a harmful acidic environment that causes demineralization of dentition, and ultimately infection and caries. Traditionally, dental decay can more or less be detected with radiographs and clinical examination of the dentition. Various descriptions such as E1 (Enamel), E2, D1 (Dentin), D2, D3 lesions are often diagnosed by the dentist and assessed for treatment.

Of note, bacteria such as Streptococcus mutans and Lactobacillus are two of the most common bacterial organisms that are subject to scrutiny due to their prevalence in causing caries. ¹ Furthermore, pH and availability of glycoproteins have the most salient influence on the composition and biochemical activities of biofilms. In other words, the more basic or alkaline the oral cavity, the less probability that bacteria will colonize and cause decay. Research in prevention and treatment of dental caries at the molecular level has become seemingly more important to the medical arena in recent years.^{1, 2}

STAMP tool

A novel method that is currently at a pilot stage is the STAMP tool, which is an acronym for “specifically targeted antimicrobial peptides.”

“The toothy tool comes from scientists including Wenyuan Shi, PhD, of the School of Dentistry at the University of California, Los Angeles (UCLA). They call their tool “STAMP” (specifically targeted antimicrobial peptides). Basically, STAMP is a tiny protein that knocks out a cavity-causing bacterium without harming healthy bacteria,” Dr. Shi explains in a news release from the National Institute of Dental and Craniofacial Research, one of the study’s sponsors.

“The good bacteria are mixed in with the bad ones,” Shi says.

Current treatments “simply clear everything away,” Shi says. “That can be a problem because we have data to show that the pathogens [the bad bacteria] grow back first.” More on this can be found here

Signal Recognition Particle Pathway

Much like other organisms that use various protein pathways to survive, one of the most prevalent mechanisms is the use of a signal recognition particle pathway (SRP) to deliver a protective protein layer to cellular membrane receptors in harsh acidic environmental conditions. ^{1, 7} Research has shown that a lack of infusion of protein to the membrane will yield a weakened cellular membrane that is prone to attack by bacterial defense mechanism in saliva such as beta-defensin-.1 ¹ S. mutans uses this pathway for growth by protein recognition and delivery to membrane.  Recent research however has shown that S.mutans can use an alternative form of this pathway for growth and adherence to tissue. ³ Two other molecular genes called YidC1 and YidC2 has been suggested to act as an alternate route for protein delivery to the membrane in the absence of the SRP pathway. ³

Aspartate Amino Transferase

Delivery of protein by the SRP pathway (or other alternative pathways) has lead researchers to investigate how the organism can metabolize protein within the cell. Investigators have identified much bacterial protein activity on the pellicle layer of teeth, which has been a causative agent in caries. Two of the most ubiquitous protein processes that many bacterial organisms utilize is the alanine amino transferase (ALT), and the aspartate amino transferase (AST) pathways. ⁷ Both amino transferases catalyzes the transfer of an amino group from alanine or aspartate to α-ketoglutarate, which in turn produce either pyruvate and glutamate or oxalacetate and glutamate respectfully.³ This process allows bacterial organisms to use various glycoprotiens (such as proline) within the enamel surface for bacterial adhesion and growth. ³ Studies have shown that the AST and ALT pathways significantly increase with patients suffering from periodontal disease and high-risk caries. This implies a strong correlation with ALT and AST pathways in dental caries, though much analysis is required for recognition. ³

Glucose Transport

Glucose transport to various parts of cellular tissue is a common pathway for many organisms to function properly. ^{6, 7} Many bacteria use a specific glucose transport system to regulate their metabolism and allow for the survival of cohort species. Research has investigated that oral bacteria (S. mutan, S sanguis) generally use a Phosphoenolpyruvate (PEP-dependent) mechanism for glucose transport. ^{4, 5} Through various target receptors and secondary messengers, the main mechanism of action allows for phosphorylation of a glucose molecule at carbon 6, which has been shown to cause resistance to fluoride. ^{5, 6} Research has also shown that this pathway has inhibitory effects on glycolysis by blocking enolase activity, thus allowing the bacteria to prevent excessive uptake of glucose while in the anabolic process of growth. ^{4, 5}         

These pathways are just a select few that have given dental clinicians artillery of information to combat dental decay.  The focus on the mechanism of action (protein metabolism, glucose regulation, and transaminase reactions) of oral bacteria can be one of the most promising areas of knowledge to prevent dental caries. There may be a growing need for many clinicians is to look further into medical marijuana effects in dental caries, more specifically enabling biofilm degradation as well as preventive treatment of caries with antibacterial properties of CBD. The technology and science behind this type of dental research has been documented for decades, but lacks the necessary focus required to determine CBD effects in dentistry. I believe as the general public becomes more aware of the beneficial ingredients of medical marijuana in quality treatment and care, it will soon find its way to become a multi-billion dollar industry in dentistry.

Cannabidiol (CBD) and Dentistry
With the emerging indications of the effectiveness of CBD in medical therapy, dentists should begin to seriously consider the vast implications of medical marijuana as part of their dental therapy regiment. And while ignoring the stigma and taboo that marijuana often faces in society, progressive clinicians and dentists should recognize CBD as a powerful treatment modality. A simple google search on CBD and its benefits is readily available and such benefits are generally recognized by clinicians. Below is a chart adopted from marijuana.com that gives insight to the powerful affects of CBG, CBGA and CBCA. Note that antibacterial and anti-inflammatory ingredients are one of the most salient qualities needed in dentistry.

Cannabis Products

Cannabis products created by companies such as Axim Biotech are paving the way to fight dental decay with CBD. Cannabigerol, the active ingredient in Axim’s dental products, has shown to have anti-inflammatory properties, which are ideal in periodontal disease and gum sensitivity. This is a tantamount milestone in the world of dentistry. Much of the anti-inflammatory agents used currently are chlorohexidene irrigation rinses, which often tastes bitter and can leave a slight tooth discoloration with continual use.  Axim is also engaged in creating a type of Canagum, which can basically allow for cannabinoids to be secreted into saliva, thus preventing biofilm attachment.

Another company, Cannaderm has a hemp infused toothpaste that is readily able to re-mineralize enamel and decrease tooth sensitivity.

The future of dentistry

Pilot clinical trials with CBD at a molecular level should be evaluated with the most common types of bacteria that cause tooth decay. (S. mutans, and Lactobacillis) Even a simple research experiment, where injections of CBD strains are assessed to determine colony forming units on a blood agar dish with S. mutans and Lactobacillis would be a promising attempt to develop an advance in this area. Dental research with CBD is far from over, but a handful of companies have demonstrated its potential value. In future work, clincians should seek to perform large-scale comparisons between CBD toothpaste vs regular toothpaste, and corresponding dental composite fillings treated with CBD infused composite glass ionomer products. The possibilities are truly endless.

This collective approach will allow us to combat tooth decay both comprehensively and vigorously. Future studies will emulate ideas conveyed in this paper and may realistically require more than 100 clinical trials in order to achieve profound evidence based clinical power, nevertheless, it is something that should be sought and meticulously scrutinized by dental clinical research.

Desmond fargo

References

1. J Ruby, J Barbeau. The buccale puzzle: the symbiotic nature of endogenous infections of the oral cavity. Can J Infect Dis 2002; 13 (1): 34-41
2. A. Burne, R. E. Marquis. Alkali production by oral bacteria and protection against dental caries. FEMS Microbiol. Lett. 2000, 193 (1): 1–6
3. Jeanine, Streptoccus mutans survives without important biochemical pathway. Journal of American Dental Association 2006; 137, (2), 154
4. C Hannig, B Spitzmüller, M Hannig. Transaminases in the acquired pellicle. Archives of oral biology. 2009; 54(5): 445-8
5. F. Schachtele, J.A. Mayo. Phosphoenolpyruvate–dependent glucose transport in oral streptococci. Journal of Dental Research. 1973;. 52, 1209-1215
6. Hannig C, Hannig M, Attin T. Enzymes in the acquired enamel pellicle. Europe Journal of Oral Science. 2005;113:2–13.
7. Rajesndran, Shafer’s Textbook of Oral Pathology. Elsevier Health Sciences. 2009 (6th Edition)