CBD effectively treats toothache and could provide a useful alternative to opioids, studies show

The CBD component of cannabis can relieve acute dental pain and may provide an equally effective, far safer alternative to opioids, researchers from Rutgers University and the University of Texas say in recently published research.

“Our results show that a single dose of CBD is as potent as current analgesic regimens and can effectively manage emergency dental pain,” the authors wrote in the 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 analgesic to opioids for acute inflammatory pain conditions,” the team said, “which could ultimately help address the opioid epidemic.”

While over-the-counter medications such as acetaminophen, ibuprofen, or naproxen are choices for emergency dental pain relief, the study says some patients can’t take these medications, while others don’t get enough relief from them.

“Dental patients who cannot receive NSAIDs or acetaminophen because of underlying medical conditions or allergies,” it notes, “have no alternative to avoiding opioid prescriptions to achieve pain relief.

The situation means dentists have historically been among the biggest prescribers of opioids, said the study’s lead author, Vanessa Chrepa, a professor at Rutgers School of Dentistry and director of clinical and translational research in the department of endodontics.

“The rise in addiction and opioid-related deaths has everyone looking for better alternatives, things that can relieve serious pain without hurting so many patients,” Chrepa said in a Rutgers news release. While other research so far has focused more on THC, she added: “We studied cannabidiol or CBD because previous research from other specialties suggested that it could relieve tooth 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 used to treat certain forms of epilepsy. Adult subjects with moderate to severe toothache were given a single dose of cannabinoids or a placebo and then monitored for three hours. Those receiving CBD were divided into two groups, with one receiving a higher dose of CBD (10 milligrams per kilogram of body weight) and the other receiving a lower dose (10 mg/kg).

Measuring subjects’ pain on a numerical scale over time, both CBD groups experienced a significant reduction in pain compared to their baseline and placebo groups. Both groups experienced maximum pain reduction around 180 minutes after administration, although the researchers found that the higher dose of CBD led to a faster decrease in significant pain relief at 15 minutes as opposed to 30 minutes with the lower dose.

In terms of degree of relief, the study found that maximum mean pain relief was 73 percent at the 180-minute mark.

The study found that CBD treatment also increased subjects’ bite force, particularly among patients who received the higher dose of CBD. Reduced bite force, it notes, can “compromise 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 who need treatment before a patient experiences a minimum of 50 percent pain relief, the higher dose of CBD had an NNT of 2.4 and the lower dose’s NNT was 3.1

By comparison, the study notes, previous research has shown that the standard opioid mix in dentistry of 10 mg oxycodone and 650 mg acetaminophen has an NNT value of 2.3.

The authors note that the NNT for CBD treatment “falls in the range” of both standard opiate dental treatment and ibuprofen-only treatment.

Despite the strong results indicating dental pain relief, some side effects were also noted, with the researchers noting that “sedation, diarrhea, and abdominal pain were significantly associated with the CBD groups.”

Chrepa said the results of the study were “strong enough to be compelling evidence for using pure CBD like Epidiolex for toothaches.”

“A larger phase 3 trial will be the next step in obtaining FDA approval for Epidiolex or other pure CBD solutions to be used to manage dental pain,” she said. “I look forward to translating this into common practice.” It will greatly help patients with acute toothache and possibly other acute inflammatory pain.”

Epidiolex, which has received FDA approval for the treatment of certain types of epilepsy, is not currently approved for dental use. Non-pharmaceutical CBD is, after all, a legal hemp derivative, which was legalized nationally through the 2018 federal Farm Bill.

“There are still things to study with follow-up research,” Chrepa said in a Rutgers statement. “Can CBD be used to treat post-operative pain in patients who have had tooth extractions or root canals?” Can we get even better pain relief by combining it with other agents like Tylenol?

A separate study last month found that allowing people to buy CBD legally significantly reduced opioid prescription rates, leading to 6.6 to 8.1 percent fewer opioids.

Although hemp-derived cannabinoids, including CBD, have typically not received the same degree of attention or political scrutiny as high-THC marijuana, the market for these products has grown rapidly in recent years since federal legalization.

Although still largely unregulated, the U.S. hemp industry in 2022 was larger than all state marijuana markets combined, according to a new report, and roughly equal to craft beer sales nationally. The report found that about $28.4 billion worth of hemp cannabinoid products were sold last year.

The FDA has said it does not have the authority to regulate hemp-derived cannabinoids on its own, and in response, lawmakers in Congress have floated proposals to establish new rules.

Meanwhile, a group of center-left, pro-business House Democrats is pushing to use the next farm bill to reduce regulatory burdens on hemp growers by creating a distinction between industrial hemp grown for products like fiber and hemp for any purpose that would cover cultivated crops for the extraction of cannabinoids such as CBD.

A recent House subcommittee hearing focused specifically on the impact of the FDA’s lack of rules, and a separate pair of bicameral health committees have requested expert input on the issue as they consider potential legislative fixes.

State marijuana regulators with the Cannabis Regulators Association (CANNRA) also recently sent a letter to the leaders of the congressional agriculture committee, asking them to use the farm bill to adjust the federal definition of the crop and modify the rules on hemp-derived cannabinoids.

The federal health agency is releasing a revised drug survey with new data on marijuana product preferences and CBD

Photo courtesy of Kimzi Nanney.