Study Finds CBD as a Promising Pain Treatment for Dental Issues, Offering an Opioid Alternative

Recently disseminated research undertaken by academic scholars affiliated with Rutgers University and the University of Texas has elucidated the prospective utility of cannabidiol (CBD), a constituent compound derived from cannabis, in mitigating instances of acute dental pain. This groundbreaking investigation posits CBD as a plausible alternative of comparative efficacy, albeit notably safer, to conventional opioid-based analgesic interventions for the management of such painful conditions.

The findings of this research, featured in this month’s edition of the Journal of Dental Research, demonstrate that a single dose of CBD can be as potent as existing analgesic treatments in effectively managing emergency dental pain. Notably, this study stands as one of the pioneering endeavors in the field of randomized clinical trials to assess the efficacy of CBD in addressing emergency dental pain.

The implications of this novel research are profound, as it has the potential to catalyze the adoption of CBD as an alternative analgesic to opioids, particularly for acute inflammatory pain conditions. In light of the ongoing opioid epidemic, this development bears significance, as it may offer a promising avenue for mitigating the overreliance on opioids for pain management.

Traditionally, over-the-counter medications like acetaminophen, ibuprofen, or naproxen have been the primary options for emergency dental pain relief. However, this study underscores that some individuals may not be suitable candidates for these medications due to underlying medical conditions or allergies. Furthermore, certain patients may find these medications insufficient in providing the necessary relief from dental pain.

As a consequence, this research highlights a significant gap in pain management options, particularly for dental patients who are unable to receive non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, leaving them with no recourse but to resort to opioid prescriptions for pain alleviation. The potential integration of CBD into dental pain management strategies may thus offer a safer and more accessible alternative for individuals facing such circumstances, ultimately contributing to addressing the opioid crisis.

Oral CBD for Dental Pain: A Promising Alternative to Opioids

The circumstances at hand have historically positioned dentists as one of the primary groups of healthcare providers responsible for prescribing opioid medications. This assertion comes from the lead author of the study, Vanessa Chrepa, who serves as a professor at the Rutgers dental school and holds the position of Director of Clinical and Translational Research within the Department of Endodontics.

As elucidated by Chrepa, the escalating prevalence of opioid-related addiction and fatalities has prompted a collective search for superior alternatives—strategies capable of alleviating severe pain without subjecting a substantial number of patients to potential harm. In an official press release from Rutgers, Chrepa articulated, “While prior investigations have primarily centered on THC, we chose to investigate cannabidiol or CBD due to previous research findings in diverse medical fields suggesting its potential for mitigating dental pain without inducing any psychoactive effects. Such a quality is unequivocally desirable in the pursuit of an ideal pain relief solution.”

“This randomized trial provides the first clinical evidence that oral CBD can be an effective and safe analgesic for dental pain.”

In this research endeavor, investigators employed an FDA-approved pharmaceutical known as Epidiolex, an oral solution comprising pure cannabidiol (CBD), primarily indicated for the treatment of specific forms of epilepsy. The study cohort consisted of adult participants afflicted by moderate to severe toothache conditions. These individuals were administered a singular dose of either CBD or a placebo, and their responses were meticulously observed over three hours. The subjects who received CBD were further categorized into two distinct groups: one receiving a higher CBD dosage (10 milligrams per kilogram of body weight) and the other administered a lower CBD dosage (10 mg/kg).

By assessing the self-reported pain levels of the study participants on a numerical scale throughout the observation period, both groups administered with CBD exhibited noteworthy reductions in pain when compared to their respective baseline measurements and the placebo group. Notably, the most substantial reduction in pain was observed approximately 180 minutes after CBD administration, indicating a progressive amelioration of pain levels over time. Importantly, researchers observed that the group subjected to the higher CBD dosage experienced a swifter onset of significant pain relief, with a notable decrease in pain reported at 15 minutes post-administration, as opposed to the 30-minute timeframe observed in the lower dosage group. These findings suggest a dose-dependent relationship in the effectiveness of CBD in mitigating dental pain, with higher doses providing more rapid and pronounced relief.

In terms of the extent of pain relief achieved, the study revealed that the maximum median pain relief reached 73 percent at the 180-minute mark, indicating a considerable reduction in pain levels following CBD administration.

Furthermore, the investigation unveiled that CBD treatment had a positive impact on the subjects’ bite force, particularly among those individuals who received the higher CBD dosage. This is of clinical significance, as diminished bite force can have adverse consequences, potentially compromising a patient’s nutritional intake and overall quality of life.

Examining CBD’s Effectiveness in Dental Pain Relief and Its Potential Role in Reducing Opioid Prescriptions

To gauge the effectiveness of CBD treatment in terms of providing at least 50 percent pain relief, the study employed a metric known as the number needed to treat (NNT). The results demonstrated that the higher CBD dose exhibited an NNT of 2.4, while the lower dose had an NNT of 3.1. By comparison, the study underscored that previous research had indicated that a conventional opioid mixture commonly employed in dentistry, comprising 10 mg of oxycodone and 650 mg of acetaminophen, possessed an NNT value of 2.3. The authors of the research highlighted that the Number Needed to Treat (NNT) values for CBD therapy align with the spectrum encompassing both the conventional dental-standard opioid treatment and the utilization of ibuprofen as a solitary analgesic.

It is important to note that, despite the promising results concerning the relief of dental pain, the study also recorded certain side effects. Specifically, the researchers observed that sedation, diarrhea, and abdominal pain were significantly associated with the groups receiving CBD.

Vanessa Chrepa, the lead author of the study, emphasized that the results of this research carry sufficient weight to advocate for the utilization of pure CBD, such as Epidiolex, in the context of dental pain management. She further expressed her anticipation of advancing this approach into routine practice, highlighting its potential to greatly benefit patients with acute toothache and, possibly, individuals experiencing other forms of acute inflammatory pain.

It is noteworthy that while Epidiolex has garnered FDA approval for the treatment of specific types of epilepsy, it is not currently approved for dental applications. Nonetheless, non-pharmaceutical CBD derived from hemp is legally available, having received national legalization through the 2018 Farm Bill at the federal level. This study offers valuable insights into the potential expansion of CBD usage in dental care, paving the way for further research and, potentially, FDA approval in the future.

Vanessa Chrepa, the lead author of this research, has emphasized that there remain numerous avenues for further investigation through follow-up studies. As articulated in the Rutgers release, she posed questions such as, “Can CBD be employed to effectively manage postoperative pain in patients who have undergone procedures such as tooth extraction or root canal treatments? Might we achieve even more effective pain relief by combining CBD with other agents, such as Tylenol?” These inquiries underscore the potential broader applications of CBD in the realm of dental and medical pain management, presenting opportunities for future research endeavors.

A separate study conducted last month yielded intriguing findings, demonstrating that legal access to CBD significantly reduced the rates of opioid prescriptions. Specifically, this phenomenon led to a reduction of 6.6 percent to 8.1 percent in the issuance of opioid prescriptions. Such results underscore the potential of CBD not only as a pain relief agent but also as a harm-reduction strategy in the context of opioid prescription practices.

While cannabinoids derived from hemp, including CBD, have not traditionally garnered the same degree of attention or regulatory scrutiny as high-THC marijuana, the market for these products has been experiencing rapid growth in recent years, following federal legalization. Despite being largely unregulated, the U.S. hemp industry in 2022 reached a size that exceeded the collective markets of all state-level marijuana industries. This notable expansion roughly equaled the sales figures for craft beer on a national scale. A report revealed that approximately $28.4 billion worth of hemp-derived cannabinoid products were sold in the previous year.

Regulatory Developments and Proposals Surrounding Hemp and CBD in the United States

The Food and Drug Administration (FDA) has indicated that it lacks the sole authority to regulate hemp-derived cannabinoids, prompting Congressional lawmakers to introduce proposals aimed at establishing new regulatory frameworks.

Simultaneously, a group of House Democratic lawmakers, characterized by a pro-business, center-left orientation, is advocating for a reduction in regulatory burdens on hemp growers through the forthcoming Farm Bill. They propose the creation of a clear distinction between “industrial” hemp, cultivated for purposes such as fiber production, and “hemp for any purpose,” which would encompass crops cultivated for the extraction of cannabinoids like CBD. This proposal aims to streamline regulatory measures and facilitate the growth of the hemp industry.

Recent developments have also seen a House subcommittee convening a hearing that specifically delved into the consequences of the absence of FDA regulations concerning hemp-derived cannabinoids. Additionally, bicameral health committees have solicited expert insights on this matter as they contemplate potential legislative solutions.

Notably, state regulators in the Cannabis Regulators Association (CANNRA) have taken active steps by sending a letter to congressional leaders responsible for agriculture committees. In this letter, they call for the utilization of the Farm Bill as a platform to revise the federal definition of hemp and amend regulations about hemp-derived cannabinoids. These efforts underscore the evolving landscape of hemp and CBD regulation and the active engagement of both federal and state entities in shaping its future trajectory.