Cannabidiol (CBD) is a cannabinoid which is a compound that binds to specific receptors in cells that affect the activity of neurotransmitters.
CBD is extracted from the cannabis (marijuana) plant and diluted with a carrier oil to produce CBD oil.
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Overview of Periodontitis
Periodontitis is a condition that denotes infection and inflammation of the bones and ligaments that support the dental structure.
Also known as gum disease, it is the second most widespread disease affecting the teeth after dental decay.
It occurs when unmonitored inflammation of the gums (gingivitis) and spreads to the ligaments and the bones. Plaque formation also aggravates this condition as the teeth lose their support and fall out. 
How CBD Oil Benefits in the Periodontitis?
The major benefits of using CBD to treat periodontitis is due to its nature as a cannabinoid. It mediates its anti-inflammatory effect by binding to receptors of the endocannabinoid system (ECS). As periodontal disorders are spread by the presence of persistent inflammation, subduing such a response is beneficial. CBD also acts as an analgesic and reduces pain.
Phytocannabinoids have been found to exhibit antibacterial as well as antiseptic activities. A major advantage over commercial antibiotics is that CBD products are not affected by resistant strains of bacteria and can easily inhibit their growth and impede the spread of infection.
As it prevents teeth decay and tissue destruction, CBD also protects the integrity of the jaw bone.
1. CBD Oil Reduces Inflammation
Inflammation occurs as a part of an immune response to signals that indicate the presence of infection.
This leads to increased accumulation of fluids and leukocytes at the site of infection.
A normal inflammatory response is a positive process; however, complications arise when the response persists even in the absence of infection. 
Specific strains of bacteria have been implicated in the pathogenesis of periodontal diseases that affect the tissues supporting the teeth.
These pathogens form ecological complexes or biofilms and the products of these complexes initiate inflammatory responses.
In case of a compromised periodontium, the microbes tend to suppress the host response and the inflammatory condition persists leading to tissue damage. 
Several studies have been conducted to reduce the extent of inflammation and improve dental health.
While antibiotics have been used to suppress the build-up of periodontal pathogens, excessive use may lead to resistance without restoring the normal state of the tissue. 
The use of cannabis to treat inflammatory diseases has become quite popular as it helps in restoring the normal state by the endocannabinoid (ECS) system.
A 2012 review at The University of Mississippi Medical Center revealed that the phytocannabinoid, CBD, can help in reducing the state of chronic inflammation in periodontal diseases. 
The researchers explained that the ability of CBD to modulate the immune response is due to the expression of cannabinoid receptors (CB1 and CB2) on immune cells like natural killer cells, B cells, and macrophages.
CBD binds to these receptors and mediates the activity of immune cells that cause inflammation. 
What does it mean? As CBD and cannabinoids help in the lowering the intensity of inflammation, it can help in treating periodontal diseases.
2. CBD Oil Acts as An Antibiotic
As mentioned earlier, many investigative studies behind the aetiology of periodontitis have linked the disease with bacterial growth.
Around the 1980s, interest in dental health had peaked and it was determined that the areas affected by periodontitis chiefly contained Gram-negative bacteria while the healthy microflora included Gram-positive organisms. 
After a decade of clinical research, it was found that abnormal inflammatory responses and specific subtypes of bacteria were found in the periodontium of the affected individuals.
The most common species that were isolated from the gums and adjoining tissues were Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, and Treponema denticola. 
Gram-negative bacteria are the principal pathogens because their cell walls are rich in lipopolysaccharides (LPS) which bind together to form the biofilms.
Bacteria thrive after the formation of biofilms because the ‘keystone’ pathogen, P. gingivalis, suppresses the host response and changes the microflora to support pathogenesis. 
P.gingivalis usually overcomes the immune system by blocking the host receptors in particular inaccessible corners of the mouth.
As it enhances biofilm formation in such areas, plaque deposition occurs which supports the growth of even benign microbes. This aggravates the inflammatory response and tissue damage is the usual outcome. 
Tetracyclines, doxycycline, ciprofloxacin, and a combination of amoxicillin-clavulanate potassium are usually the drugs of choice to treat aggressive periodontitis.
However, some strains of the keystone pathogen, P. gingivalis, exhibit antibiotic resistance and hence alternative medicines are being sought to overcome this problem. 
A 2008 study by the Università del Piemonte Orientale investigated the role of several cannabinoids isolated from Cannabis sativa in inhibiting the growth of bacteria.
The results showed that CBD and several others acted as antibiotics without being affected by resistant strains.
Thus, the use of CBD and its products has great potential in treating bacterial infections which trigger periodontitis. 
What does it mean? CBD acts as a broad-spectrum antibiotic and is not affected by resistant subtypes of pathogens. Therefore, it can be essentially used to treat periodontal infections and inflammation.
3. It Protects the Jawbone
Loss of jaw bone is one of the most common consequences of chronic and aggressive periodontitis.
In the case of periodontal inflammation, the indiscriminate growth of pathogenic bacteria and biofilm expansion decays the underlying jawbone and severely damages the periodontal ligaments that connect the teeth to the bone. 
The major cause of concern for bone loss is the loss of multiple teeth that are left without replacements.
The structure and the integrity of the jawbone are usually sustained through the pressure that comes from the action of chewing.
However, when this stimulus is removed due to the loss of teeth, the bone degenerates and gets reabsorbed into the body (bone resorption). Generally, after the first tooth extraction, almost 25% of the bone is lost. 
The bone loss usually happens in the bone surrounding and supporting the teeth, which is referred to as the alveolar bone.
This bone creates the ridges and hollows within which the teeth remain firmly embedded to maintain the dental structure.
With the atrophy of the alveolar bone and teeth loss, these ridges shrink both vertically and horizontally. 
While replacing lost teeth with partial or full dentures provides a temporary solution to chewing, it does not present a long-term solution as because dentures exert an extremely low pressure on the jaw bone as compared to natural teeth.
The pressure applied might be as low as 10% and therefore, is not adequate to maintain and protect the integrity of the jaw bone. 
A 2009 study at the Hebrew University of Jerusalem observed the cannabinoids isolated from the Cannabis plant in treating bone loss.
It was revealed that THC and CBD play major roles in reversing the loss of the jaw bone by activating the CB2 receptors of the endocannabinoid (ECS) system.
One of the chief functions of this receptor is to prevent bone resorption by maintaining the integrity of the bones. 
What does it mean? CBD and THC prevent bone resorption and protect the integrity of the jaw bone by activating the receptors of the ECS and lowering inflammation in the periodontium.
4. It Is A Powerful Analgesic
The entire spectrum of periodontal diseases including gingivitis and periodontitis begins with a bacterial infection that leads to persistent inflammation leading to tissue damage and bone resorption.
Bacteria settled in the plaques invade the periodontium trigger chronic inflammation, destroy the gum, and loosen the teeth. This condition gives rise to pain. 
As the disease progresses, the gum tends to recede due to tissue loss and small pockets are formed between the teeth and the gum.
Such pockets harbour several harmful bacteria and also cause the gums to bruise easily during brushing, flossing, and even chewing.
As a result, minor to severe pain is experienced accompanied by bleeding. 
Several analgesics are usually prescribed to provide symptomatic relief. Anti-inflammatory drugs like ibuprofen might also be taken to relieve pain by reducing inflammation.
In the case of sensitivities, paracetamols can also be consumed to reduce the intensity of the pain.
However, therapeutic strategies are being devised to promote analgesia as well as treat the disease. 
Phytocannabinoids such as CBD and THC have come into prominence due to their capacities to reduce the inflammatory tissue damage.
In fact, CBD has also been known to promote pain relief. 
A 2017 study by the University Hospital Gottingen observed the role of cannabinoids in pain management.
The results revealed that vaporizers containing THC and CBD oils help in providing immediate relief from excessive pain particularly because they mediate the nociceptors (pain-sensitive nerve endings) to control the sensation and achieve analgesia. 
What does it mean? CBD oil provides instant relief when it comes to periodontitis-related pain by mediating the pain receptors. Barring symptomatic relief, it also helps in the long run by impeding disease progression.
5. It Is an Antiseptic
Periodontitis is essentially a condition of bacterial infection that triggers an inflammatory immune response.
As mentioned earlier, the disease is brought about by the pathogenesis of P. gingivalis and A. actinomycetemcomitans.
As the gum recedes further away from the teeth, the pockets become septic and harbour a mixed microbial community. 
The infection, if unchecked, usually spreads to adjoining tissues and particularly to the ligaments that support the teeth.
Bacteria also form colonies in the inaccessible subgingival spaces which spreads the infection further triggering a severe immune response.
It is this septic condition that initiates the disease that leads to the decay and loss of the teeth. 
Antibiotics are mostly administered to inhibit microbial growth and activity but the presence of antibiotic-resistant strains pose a problem.
Furthermore, the pockets between the gum and the teeth often act as grounds for invasion by anaerobic bacteria. As a result, medical therapies should involve compounds that are antiseptic and prevent infection altogether. 
In fact, a 2008 study by the University of London established that cannabinoids such as CBD have antibacterial potential.
This was taken a step further by the 2010 study conducted at the Universidade do Extremo Sul Catarinense which revealed that administration of cannabinoids like CBD can actually treat sepsis by reversing oxidative stress and preventing the spread of infection. 
What does it mean? CBD can be used as an antiseptic to prevent the growth of pathogenic bacteria in the tissues surrounding the teeth and thereby, help in checking the spread of infection.
It is always recommended to consult a medical practitioner before using medication containing THC.
The dosage depends on the mode of delivery as the CBD products can be orally ingested or inhaled by a vaporizer.
There is no prescribed dose for using CBD oil to treat periodontitis as the application is mostly topical. 3-4 drops of this oil can be added to the toothpaste before brushing.
Another way to use the oil is to mix 4-5 drops in a cup of warm water and use the mixture to wash the mouth without ingesting it.
In case of excessive plaque formation, patients can apply 1-2 drops directly on the gums. 
Vaporizers containing the oil (very low amount of THC) can be used to relieve pain and 1-2 puffs (inhalations) can produce a measurable effect. Care should be taken that only 5-10mg is ingested.
Cannabidiol is known to have very few side-effects.
In the case of ingestible products, oral doses of up to 500mg can be had for as long as 6 months without experiencing any harmful complications.
According to a 2011 review, very high daily doses of almost 1500mg can be consumed for up to a period of 3 months. 
It is crucial to consider that the majority of the CBD products have negligible to moderate amounts of the psychotropic cannabinoid, tetrahydrocannabinol (THC), which is mainly responsible for the side-effects.
Despite the amount of THC being inadequate to produce a substantial hallucinatory effect, some individuals may be sensitive and therefore, it is necessary, to begin with, small doses. 
CBD also interacts with a class of liver enzymes called cytochrome P450. They are involved in metabolizing drugs and hence, CBD usage might reduce the efficacies of such medications.
These products might also cause tachycardia i.e. increased heart rates for a short duration. Cannabis products containing high amounts of THC should also not be accompanied by alcohol and should be avoided before driving. 
Pregnant and lactating women should consider the side-effects and consult a gynecologist before consuming CBD products.
Children and adolescents should only be administered small doses as cannabis products might affect their CNS differently. 
To summarize, it can be said that CBD holds great potential for treating periodontitis. As a cannabinoid, it can reduce the intensity and spread of inflammation via the ECS.
Since periodontitis is triggered by chronic and aggressive inflammatory responses, lowering the inflammation reduces tissue damage and prevents the decay of teeth and gum.
The antibacterial and antiseptic activities of CBD help in inhibiting the growth of pathogens like P.gingivalis and also prevent the spread of infection to inaccessible corners of the mouth.
By preventing the decay of teeth, CDB also protects the jaw bone and prevents bone resorption. Finally, being a great analgesic, CBD provides instantaneous relief to pain caused by inflammation and teeth decay.