Cannabis and Oral Health Implications for 3 Priority Populations: A Special Communication
1Dental Public Health Discipline, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
2Division of Oral Epidemiology and Dental Public Health, University of California San Francisco, San Francisco, CA, USA
3Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
4Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
5Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
Abstract
As the legal status and social perceptions of cannabis shift globally, the potential impact of cannabis use on health and well-being merits heightened attention among practitioners and researchers, including possible effects on oral health. Evidence suggests that cannabis use may be associated with adverse oral health outcomes, including periodontal disease and xerostomia, with less conclusive links to dental caries and oral cancer. It is also becoming increasingly clear that certain population segments are at greater risk of cannabis use and may consequently face a greater burden of oral disease, underscoring the need for focused research and targeted interventions. In response to these concerns, a group of researchers convened a symposium titled “Cannabis and Oral Health: A Focus on Priority Populations” at the 2025 AADOCR/CADR Annual Meeting and Exhibition (American Association for Dental, Oral, and Craniofacial Research and Canadian Association for Dental Research). This session aimed to highlight the unique oral health challenges faced by priority populations in the context of a changing landscape of cannabis use. The presenters examined cannabis’ impact among populations with whom they closely work, including Indigenous Canadians, adolescents and young adults, and 2SLGBTQI+ youth (Two-Spirit, lesbian, gay, bisexual, transgender, queer or questioning, intersex, and people that identify with other sexual orientations, gender identities, and expressions). Understanding the specific effects of cannabis on these groups is crucial, as social determinants of health are deeply intertwined with oral health outcomes. Historical and societal inequities, compounded by emerging health risks, demand a participatory research approach and targeted public health strategies. Evidence presented at the symposium highlights the need of addressing cannabis-related oral health impacts through inclusive, population-specific research and policy. A nuanced understanding of this evolving issue can inform the development of clinical guidelines and public health initiatives aimed at mitigating harm among populations that have been vulnerable within our societies. The symposium and this communication serve as a call to action for the dental and research communities to prioritize these perspectives in future work.
Knowledge Transfer Statement:
Amid shifting social and legal contexts, cannabis takes on heightened importance as a potential risk factor for oral diseases. Among specific priority populations, cannabis is one of several confluent health determinants that merits greater recognition and tailored research attention to inform appropriate clinical and public health practice.
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Keywords: marijuana use, public health dentistry, Indigenous peoples, adolescent health, sexual and gender minorities
Article notes
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Collection date 2026 Jul.
Introduction
The rise in the legalization, commercialization, and resulting escalated consumption of cannabis across various regions globally holds significant implications for a range of health outcomes, including oral health. Expanding the knowledge of cannabis’ impact on health has garnered particular attention due to evolving policies, expanding modes of consumption, increasing potency in products, and shifting societal attitudes regarding its acceptability and perceived risks and benefits.
Contemporary evidence has linked the consumption of cannabis with poor periodontal outcomes and xerostomia and, less conclusively, with caries and potential increased risks of oral and neck cancers (Bellocchio et al. 2021). As comprehensive and longitudinal research expands to make sense of the relationships between oral health and cannabis, there is a growing need to understand the biological, social, and behavioral effects that cannabis use can have on the oral health of priority populations. As conceptualized here, priority populations are demographic groups that, on average, have been made vulnerable by systems of oppression, are systematically underrepresented in policy and research, and have been underresourced in terms of their health and well-being. A focus on priority populations is warranted as it has been documented that population-specific determinants of health are closely interwoven with intersectionality-related oral health outcomes. For instance, when oral health is viewed through an intersectionality lens, the role of identity and social structures may reveal how certain populations are predisposed to particular outcomes at a personal level (e.g., experiences with health care providers) and a system level (e.g., access to care). Therefore, understanding the intertwined relationships of self-identity and oral health are important when considering population approaches to oral disease impact, prevention, and treatment, especially when emerging health and social-related phenomena such as cannabis access and use are shifting.
The 2025 AADOCR/CADR Annual Meeting and Exhibition (American Association for Dental, Oral, and Craniofacial Research and Canadian Association for Dental Research) brought together a group of researchers who study the role of cannabis on oral health for the symposium titled “Cannabis and Oral Health: A Focus on Priority Populations.” The researchers work alongside Indigenous adults in Canada, adolescents and young adults, and 2SLGBTQI+ youth (Two-Spirit, lesbian, gay, bisexual, transgender, queer or questioning, intersex, and people that identify with other sexual orientations, gender identities, and expressions). The aim of the symposium was to highlight the implications of cannabis use in relation to oral health policy, practice, and research. Summaries and highlights of the effects of cannabis on these diverse priority populations are provided within this special communication, accompanied by a brief discussion of proposed steps ahead in terms of dental public health research and policy action.
Priority Populations
Indigenous Adults in Canada
Passed by the Canadian Parliament in 2018, the Cannabis Act legalized nonmedical cannabis for adult use in Canada, the first G7 nation to do so. The act has had, and no doubt will have, significant ramifications for public health in the coming years. Legalization will most likely necessitate prevention and harm reduction initiatives targeting at-risk populations. Indigenous communities are experiencing the effects of legalization, positively and negatively. Prior to legalization, Indigenous and racialized Canadians were more likely to be convicted of marijuana possession, production, and sale, but after legalization, many Indigenous communities are asserting their inherent right of self-governance to develop and regulate their own cannabis industries on their lands. The Indigenous cannabis industry has arisen in the face of barriers embedded within the Cannabis Act and provincial cannabis regulations, which have prevented some Indigenous entrepreneurs from entering the cannabis trade (Halseth and Cappe 2023). At the same time, Indigenous communities have adopted cannabis substitution programs to provide cannabis products to individuals in place of opioids to combat the opioid crisis. Against the backdrop of legalization, the First Nations Regional Health Survey (RHS) of 2015 to 2016 found that 30.3% of adults residing on reserves had used cannabis for nonmedical purposes within the past 12 months (First Nations Information Governance Centre 2018), as compared with 22% of adult respondents in the 2017 Canadian Cannabis Survey (CCS). After legalization, the CCS of 2020 and 2021 reported increased use of cannabis, and a similar trend is expected among First Nations in future RHS surveys. An increased use may also add to the burden of illness among Indigenous populations who experience poorer oral health than the general Canadian population.
A secondary analysis of the data from RHS phase 3 (2015 to 2016) examined the association between cannabis use in the past 12 months and self-rated oral health among First Nations adults 18 years or older. Past-year use of cannabis was positively and significantly associated with self-rated fair or poor overall oral health. However, when the analysis adjusted for sociodemographic characteristics, dental care access, self-reported oral health conditions and perceived treatment needs, smoking, alcohol and drug use, diabetes, and sugary foods, only the adjusted odds ratio for medical cannabis use vs no cannabis use was statistically significant (1.37; 95% CI, 1.08 to 1.74). This research was undertaken prior to the legalization of cannabis; thus, there are knowledge gaps that will need to be addressed through collaborative or community-led studies. The efforts put into designing culturally relevant public health initiatives in Indigenous communities must first weigh issues of Indigenous sovereignty and traditional use of cannabis so that oral health inequities are not exacerbated by legalization.
Adolescents and Young Adults
Cannabis product use among younger populations is far from a recent phenomenon. Yet, the confluence of liberalizing policies, more accepting social attitudes, and expanding product variety yields an unprecedented landscape for examining adolescent and young adult cannabis use. In the United States, the largely unchanged prevalence of adolescent cannabis use over the past 25 years and the inconsistent evidence connecting state-level cannabis legalization to subsequent surges in youth use do not suggest a swelling epidemic. However, contextualized against steady declines in tobacco smoking and alcohol use, cannabis stands out as a persistent and increasingly primary form of youth substance use (Chaffee 2022). Motivations for using cannabis among young people may be evolving as well. As the licit cannabis marketplace loudly promotes health claims, youth and even some parents may view cannabis products therapeutically. For some, cannabis is perceived to mollify stress, anxiety, and other mental health concerns exacerbated under the COVID-19 pandemic. For others, flavored products, included cannabis-infused drinks and treats, boost cannabis appeal and lessen perceived harms.
The oral health implications of cannabis use among youth are far less studied than those applicable to older adults, for whom use of smoked cannabis is consistently associated with periodontal disease. High-quality clinical and population-based studies are needed to address oral health outcomes relevant to youth (e.g., caries, xerostomia, gingivitis) and encompass modern cannabis products, especially high-potency and noncombustible products.
Irrespective of oral health, youth unquestionably represent a public health priority population, not solely from a vulnerability perspective but for the importance of this developmental period in setting healthy life course trajectories. Protecting adolescents and young adults from potential cannabis harms within a permissive social environment is a considerable challenge. Dental professionals could help to advance this goal via providing factual, nonjudgmental guidance to young patients and their parents. Thus, research needs in health communication parallel those for understanding cannabis health effects.
Cannabis, Oral Health, and 2SLGBTQI+ Youth
The 2SLGBTQI+ community comprises a rich and diverse group of individuals who share lived experiences. Despite resilience and collaborative empowerment, outcomes related to health and well-being within the 2SLGBTQI+ community continue to indicate the presence of disparities that are driven by sociostructural, economic, and access-related factors. Evidence indicates that these disparities persist in oral health, particularly within the intersection of the community’s subgroups. This is relevant in terms of cannabis use, as data suggest that sexual and gender-diverse individuals may have higher cannabis consumption rates than their non-2SLGBTQI+ counterparts. In the Canadian context of legal adult use cannabis sales, the CCS has consistently reported a >10% difference in higher cannabis consumption rates among individuals who self-identify as bisexual, lesbian, gay, or other as compared with the general population in the years 2019 to 2024. This all translates into the possibility that 2SLGBTQI+ people could be facing the compounding effects of oral health and well-being disparities, with increased cannabis consumption.
To better comprehend the relationship of the closely intertwined factors at play, a participatory project—stemming from a community service-learning program being conducted in southwestern Ontario, Canada—is examining individual and psychosocial factors among 2SLGBTQI+ youth, their perceived oral health needs, and how these are intersected with self-described cannabis perceptions and consumption (Jessani et al. 2025). Preliminary data from these insights highlight that some 2SLGBTQI+ youth are reporting negative experiences in dental settings, the use of cannabis to cope with issues faced by the community, and awareness of perceived oral health changes derived from cannabis use. These findings underscore the importance of expanding knowledge on self-reported needs to improve access to care, enhance dental provider awareness, and facilitate oral health research for and with the adolescent/young adult and adult 2SLGBTQI+ communities.
Reflections and Future Directions
The relationship between cannabis and oral health, briefly showcased through population-specific lenses in this communication, serves as a critical prompt for the oral health community to engage more comprehensively with this topic across diverse populations. The findings shared are relevant to clinicians, educators, researchers, and decision makers, as they provide a better understanding of the impact of cannabis on Indigenous populations, adolescents and young adults, and sexual and gender minorities. At a time when sociopolitical movements in parts of the world are shifting toward the erasure and minimization of diversity and equity among groups that have been made most vulnerable within our societies, it is important that the oral health profession stand up and vocalize these populations’ needs to materialize positive change in their health and well-being.
Within the understanding of cannabis’ effect on oral health, it must be acknowledged that multiple unanswered matters warrant further research. Longitudinal multisite studies with diverse populations that include comprehensive and reliable end points are needed to determine cannabis’ underlying role in oral health. This must be informed by the substance’s use in its various cannabinoid concentrations, methods of consumption, and frequency. Additionally, epidemiologic trends of consumption must be closely followed, as these are diverse and vary from group to group, as exemplified by the presented trends among adolescents and 2SGLBTQI+ youth in this communication. Moreover, participatory policy design and research that reflect the needs and perspectives of priority populations should be pursued, as such approaches can produce more relevant data and initiatives, foster collaborative knowledge, and promote empowerment and self-determination.
It is important to note that, although this publication focused primarily on 3 specific groups, there are many other priority populations to include within this subject matter, such as unhoused individuals and persons with mental health diagnoses to name a few. Furthermore, educators, researchers, clinicians, and policy makers must be vigilant of emerging cannabis-related knowledge and its potential for better understanding the substance’s effect on oral health. If the association between cannabis use and oral health proves causal, cannabis has the potential to emerge as a significant public health problem that will require targeted attention. Dental public health is likely to face significant challenges in preventing and mitigating the negative oral health impacts of cannabis use, particularly among priority populations. These challenges are influenced by factors such as public and commercial support for liberalized cannabis policies, potential hesitancy among dental professionals to intervene (a topic that demands further research and attention), and a societal climate characterized by dwindling trust in public health and its institutions. Each of these issues may significantly influence policy development and public sentiment in the coming years and should be closely monitored.
Final Remarks
In closing, as the evidence revealing the relationship of cannabis use and oral health continues to mount, it is important that population-specific studies be conducted in a participatory manner to develop targeted public health approaches that work to benefit priority populations. Educators, clinicians, researchers, and decision makers are invited to expand in the generation and integration of knowledge from within each of their areas, as cannabis poses itself as an increasingly relevant substance to understand in terms of health and well-being for years to come.
Acknowledgments
The researchers acknowledge and thank the Behavioral, Epidemiologic and Health Services Research Group, as well as the Clinical and Translational Science Network of the International Association for Dental, Oral, and Craniofacial Research for sponsoring the conducted symposium.
Footnotes
Footnote Group
References
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References
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