CBD Oil For Dental Pain? Maybe

CBD Oil For Dental Pain? Maybe


I am always skeptical of claims about the therapeutic uses of CBD (cannabidiol) oil and also of the results of clinical trials that contain a small number of participants. So when I came across a 2023 article in the (peer-reviewed) Journal of Dental Research about a clinical trial with 61 participants that examined whether CBD could be used to treat toothache, I was tempted to ignore it But the judgment by the The Rutgers School of Dental Medicine should not be overlooked; was a double-blind placebo-controlled randomized clinical trial (RCT) with two different doses of the drug: the so-called “gold standard”.

The Rutgers groups divided 61 patients suffering from moderate to severe toothache into three blind randomized groups:

  1. placebo
  2. Treated with low-dose CBD (10 mg/kg body weight (bw))
  3. Treated with CBD in high doses (20 mpk) (1)

The primary outcome was numerical reduction in pain score, while there were several secondary outcomes, including the amount of time to relief and how hard participants could bite. The CBD used was Epidiolex (2)the brand name for a pharmaceutical CBD solution, which was approved by the FDA for certain types of epilepsy in 2018.

Summary of results

pain

Figure 1 (below) shows the magnitude of pain reduction as measured by the visual analog scale. Although there appears to be a considerable difference in pain in the CBD-treated participants, note that statistical significance is only seen at 120 and 180 minutes in the high-dose group and 180 minutes in the low-dose group. Although the authors claim that the onset of relief is 15 minutes for the high-dose group and 30 minutes for the low-dose group, neither the graph nor the statistics seem to support this claim. It should be noted that pain in the placebo group also decreased, so the magnitude of the effect in the treated groups must be adjusted downward for the placebo group.

Conclusion: If any real pain reduction occurs, these data neither prove nor disprove it.

Figure 1. Mean visual pain score on an analogue scale at different times. Red and blue arrows indicate the onset of pain score relief from baseline (BL) for the cannabidiol (CBD) groups. Asterisks denote statistical significance. There are only three such data points, all very late in the measured time interval. Source: Chrepa, et. al., “Cannabidiol as an alternative analgesic for acute dental pain.” Journal of Dental Research, online first 11/1/23. https://doi.org/10.1177/0022034523120081

Bite force

Although biting into something with an atomic tooth may not seem as pleasant as, say, a day spa treatment, it is nevertheless one of the measures used to determine the possible reduction of dental pain with a drug. These data are shown in Figure 2.

Figure 2. Bite force as a function of two doses of CBD.

At 90 and 180 minutes there is statistical significance between the high dose and placebo groups. However, there is no significant difference between the low-dose and placebo groups at any time point, so there is no way to demonstrate dose-dependence, a strong indicator of a drug response.

Conclusion: This graph is more convincing than the one in Figure 1. The effect of high doses of CBD appears to be real. The low-dose group may or may not be experiencing relief, but note that this group (10 mpk) is receiving half the FDA-recommended dose for patients with the two types of epilepsy for which it is approved .

bottom line

All in all, CBD may have a helpful effect, but the evidence from this study is far from robust. Nor is it clear that the drug fails completely. A higher dose of CBD may be effective, although an increase in side effects is probably inevitable. (3). A larger study, which is probably worth doing, will be necessary to tighten the statistics and possibly define a protocol with a sufficient difference between placebo and drug-treated patients and determine what dose, if any, can relieve pain with acceptable adverse effects.

NOTES:

(1) For epilepsy, the FDA recommended dose is 20 mpk.

(2) Epidiolex is the brand name for a CBD solution made by Greenwich Biosciences Inc., Carlsbad, CA

(3) The drug has numerous side effects, especially gastrointestinal. These effects (not shown) were: 20mpk > 10mpk > placebo. It is unclear whether patients with pain could tolerate a significantly higher dose. (20 mpk is equivalent to 1.4 grams per day in a 70 kg person.)

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