In NHANES data from 3,690 adults, marijuana or hashish use was associated with 4.3 times higher odds of severe periodontitis after adjusting for confounders.
Dentists, periodontists, public health researchers, cannabis users
4.3x higher odds of severe periodontitis with marijuana use
What the researchers found
Among 3,690 NHANES participants (2011-2014), 54% reported ever using marijuana or hashish. Marijuana/hashish use was significantly associated with severe periodontitis, affecting 39% of users (adjusted OR: 4.276, 95% CI: 3.682-4.967, P=0.001). Cocaine use was also linked to periodontitis but primarily mild disease. Alcohol consumption showed a smaller positive association (OR: 1.255). No significant associations were found for heroin or methamphetamine use.
Why it matters
Periodontitis affects millions of adults and is linked to systemic health conditions including cardiovascular disease and diabetes. If cannabis use substantially increases periodontal disease risk, this has implications for dental screening and patient counseling as cannabis use becomes more widespread.
The numbers in context
n=3,690; 54% reported marijuana/hashish use; 39% of users had severe periodontitis; adjusted OR 4.276 (95% CI: 3.682-4.967); cocaine associated with mild periodontitis; alcohol OR 1.255; no association for heroin or methamphetamine
How the study worked
Cross-sectional analysis of NHANES 2011-2012 and 2013-2014 cycles. 3,690 participants with demographic information, clinical periodontal examinations, and drug use questionnaires. Logistic regression models adjusted for age, sex, race/ethnicity, education, income, marital status, occupation, alcohol, BMI, dental insurance, and dental visit frequency.
What this study cannot tell us
Cross-sectional NHANES design cannot establish causation. Self-reported drug use may be inaccurate. Cannabis smoke exposure patterns (frequency, duration, method) were not fully characterized. Residual confounding from unmeasured factors like oral hygiene practices is possible.
How to read the evidence
Large nationally representative dataset with clinical periodontal examinations and multivariable adjustment provides moderate evidence, though cross-sectional design cannot establish causation.
When this study was published
2025 publication analyzing NHANES 2011-2014 data
The bigger picture
The oral health effects of cannabis use have received far less attention than respiratory or cardiovascular effects. This finding of a strong association with severe periodontitis adds dental health to the growing list of health domains where cannabis use may have meaningful consequences.
Questions still open
- Is the periodontal effect driven by cannabis smoke specifically, or would edible or vaporized cannabis show similar associations? Does the mechanism involve local tissue effects from smoke or systemic immune modulation?
Common questions
How strong was the association between marijuana and gum disease?
Could other factors explain the association?
Read the original research
Association Between Substance Use and Periodontitis: A Cross-Sectional Analysis of NHANES Data on Marijuana, Hashish, and Cocaine.
Clinical, cosmetic and investigational dentistry, 17, 293-304
Citation
Aljoghaiman, Eman. (2025). Association Between Substance Use and Periodontitis: A Cross-Sectional Analysis of NHANES Data on Marijuana, Hashish, and Cocaine.. Clinical, cosmetic and investigational dentistry, 17, 293-304. https://doi.org/10.2147/CCIDE.S536382