The hemp component CBD may ease acute dental pain and may provide an equally effective, much safer alternative to opioids, researchers at Rutgers University and the University of Texas at Austin say in a newly published study.
“Our results suggest that a single dose of CBD is as potent as current analgesic regimens and can effectively manage emergency dental pain,” the authors wrote in a study published this month in the Journal of Dental Research. : They said their work appears to be “the first randomized clinical trial testing CBD for the management of emergency dental pain.”
“This new study may catalyze the use of CBD as an alternative opioid analgesic for acute inflammatory pain conditions,” the team said, “which may ultimately help address the opioid epidemic.”
While over-the-counter medications such as acetaminophen, ibuprofen or naproxen are the main options for dental emergency pain relief, the study says some patients cannot take these drugs, while others do not get enough relief from them.
“Dental patients who cannot receive NSAIDs or acetaminophen because of underlying medical conditions or allergies,” it notes, “have no alternatives to avoid opioid prescriptions for pain relief.”
The situation means dentists have historically been among the biggest prescribers of opioids, said lead study author Vanessa Chrepa, a professor and director of clinical and translational research in the endodontics department at Rutgers School of Dentistry.
“The increase in opioid-related addiction and death has everyone looking for better alternatives, things that can alleviate serious pain without harming so many patients,” Chrepa said in a Rutgers news release. While other research so far has focused more on THC, he added: “We looked at cannabidiol, or CBD, because previous research in other specialties suggested that it could relieve dental pain without any psychoactive effects, which is really what everyone wants to find.”
“This randomized trial provides the first clinical evidence that oral CBD can be an effective and safe analgesic for dental pain.”
The researchers used the Food and Drug Administration (FDA)-approved drug Epidiolex, an oral solution consisting of pure CBD that is used to treat some forms of epilepsy. Study participants, adults with moderate to severe toothache, were given a single dose of a cannabinoid or a placebo and then monitored for three hours. CBD recipients were divided into two groups, one receiving a higher dose of CBD (10 milligrams per kilogram of body weight) and the other receiving a lower dose (10 mg/kg).
By measuring the subjects’ pain on a numerical scale over time, both CBD groups experienced a significant reduction in pain compared to both their baseline and placebo groups. Both groups experienced maximum pain reduction at about 180 minutes after administration, although the researchers found that the higher dose of CBD led to a faster reduction in pain relief at 15 minutes versus 30 minutes with the lower dose.
As for the degree of relief, the study showed a maximum average pain relief of 73 percent at 180 minutes.
The study found that CBD treatment also increased the bite force of subjects, especially among patients who received a higher dose of CBD. It is noted that reducing the force of the bite can “jeopardize the patient’s nutrition and quality of life”.
Using a metric known as the number needed to treat (NNT), which measures the number of patients needing treatment before a single patient achieves at least 50 percent pain relief, the higher CBD dose had an NNT of 2.4 and the lower dose had an NNT of 2.4. It was 3.1
In comparison, the study notes, past research has shown that the standard opioid combination in dentistry, 10 mg oxycodone and 650 mg acetaminophen, had an NNT value of 2.3.
The authors note that the NNT for CBD treatment “falls within the range of both standard opioid treatment in dentistry and treatment with ibuprofen alone.”
Despite the strong results showing dental pain relief, there were also some side effects, with the researchers noting that “sedation, diarrhea, and abdominal pain were significantly associated with the CBD groups.”
Chrepa said the study results were “strong enough to make a compelling case for using pure CBD like Epidiolex for dental pain.”
“A larger Phase 3 trial will be the next step in obtaining FDA approval for Epidiolex or other pure CBD solutions for use in dental pain management,” he said. “I’m looking forward to this becoming a regular practice. It will help patients with acute toothache and possibly other acute inflammatory pain tremendously.”
Epidiolex, which is FDA approved for the treatment of certain types of epilepsy, is not currently approved for dentistry. Non-pharmaceutical CBD, however, is a legal derivative of hemp that was legalized nationally through the 2018 federal farm bill.
“There is much more to explore through further research,” Chrepa said in the Rutgers release. “Can CBD be used to manage postoperative pain in patients who have undergone tooth extraction or root canal? Can we get better pain relief by combining it with other medications like Tylenol?”
A separate study last month found that allowing people to buy CBD legally significantly reduced opioid prescription rates, resulting in 6.6 to 8.1 percent fewer opioid prescriptions.
Although hemp-derived cannabinoids, including CBD, typically do not receive the same degree of attention or political scrutiny as high-THC marijuana, the market for the product has grown rapidly in recent years following federal legalization.
Although still largely unregulated, the U.S. hemp industry was larger than all state marijuana markets combined in 2022, according to a new report, and roughly equaled national beer sales. The report found that about $28.4 billion worth of hemp-derived cannabinoid products were sold last year.
The FDA has said it doesn’t have the authority to regulate hemp-derived cannabinoids on its own, and lawmakers in Congress have proposed new rules in response.
Meanwhile, a pro-business, center-left group of House Democratic lawmakers is trying to use the next Farm Bill to reduce the regulatory burden on hemp growers by creating a distinction between “industrial” hemp, which is grown for fiber, and “cannabis for anyone.” goal,” which would include crops engineered to extract cannabinoids like CBD.
Recent House subcommittee hearings have focused specifically on the lack of FDA rules, and a separate pair of bicameral health committees have sought expert input on the issue as they consider possible legislative fixes.
State marijuana regulators with the Cannabis Regulators Association (CANNRA) also recently sent a letter to the heads of the House Agriculture Committee asking them to use the Farm Bill to adjust the federal definition of the crop and amend the rules on hemp-derived cannabinoids.
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