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BMJ 2008; 336 doi: (Published 14 February 2008) Cite this as: BMJ 2008;336:354

Cannabis associated with destructive gum disease

Smoking cigarettes causes gum disease. If left untreated, gum disease can lead to an unsightly mouth, bad breath, and the loss of teeth. Smoking cannabis was also associated with gum disease in a large prospective cohort from New Zealand. Participants answered questions about cannabis use on four occasions between the ages of 18 and 32. They had dental examinations at ages 26 and 32. Periodontal disease was clearly linked to cannabis use. The heaviest users were up to three times more likely to have diseased gums than those who didn’t smoke cannabis. The effect was independent of smoking, dental plaque, and use of dental services. One fifth of the participants said they smoked cannabis more than 40 times a year. Nearly half were more moderate users. Just under a third (32.3%, 293/903) didn’t use cannabis at all. The authors estimate that 36% of new periodontal disease in young adults is a result of cannabis.

If cannabis does cause early gum disease it could be because the drug shares many of its 400 constituent compounds with tobacco, say the researchers. These compounds may cause disease by poisoning immune defences and provoking inflammation within periodontal tissues. Dentists should tell young adults about the link and advise heavy cannabis users that the habit could loosen their teeth.

Rebound effect possible after stopping clopidogrel

Cardiology guidelines recommend double antiplatelet therapy with clopidogrel and aspirin for patients recovering from acute coronary syndrome. Aspirin is usually continued indefinitely, but what happens to coronary risk when people stop taking clopidogrel?

One cohort study found evidence of a rebound prothrombotic effect. In patients who had just stopped treatment, heart attacks and deaths peaked during the first 90 days then tailed off during the next 90 days. The difference between the two periods was significant for patients treated medically (incidence rate ratio 1.98, …

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