Public Health Outcomes of Cannabis Legalization and Oral Health Disparities: Associations with Prosthodontic Treatment Utilization and Access in the United States

Merve Benli Ozkan, DDS, MSc, PhD
University of Florida

Objectives: To evaluate the association between cannabis legalization, oral health outcomes, healthcare utilization, and disparities in prosthodontic treatment access in the United States.

Methods: This retrospective cross-sectional study utilized publicly available data from the National Health and Nutrition Examination Survey (NHANES) 2015–2018, Behavioral Risk Factor Surveillance System (BRFSS), and state-level cannabis policy databases. Adults aged 18–59 years were included. Frequent recreational cannabis (FRC) use was defined as marijuana or hashish consumption at least once monthly for ≥12 months. Primary outcomes included untreated dental caries, severe tooth loss, edentulism, emergency dental utilization, and prosthodontic rehabilitation patterns. Multivariable logistic regression adjusted for socioeconomic variables, tobacco use, insurance status, and dental care access.

Results: NHANES data representing approximately 142.4 million U.S. adults demonstrated that 29.3% reported FRC use. Frequent cannabis users showed significantly greater prevalence of untreated coronal caries, untreated root caries, and severe tooth loss. Compared with non-users, FRC users demonstrated 17% greater probability of untreated coronal caries, 55% greater likelihood of root caries, and 41% greater likelihood of severe tooth loss. Cannabis-associated oral disease burden was disproportionately concentrated among Medicaid beneficiaries, uninsured individuals, and rural populations with limited prosthodontic access. States with recreational legalization demonstrated increased dental emergency utilization and extraction-based treatment patterns, while implant-supported rehabilitation remained concentrated among privately insured populations.

Conclusions: Cannabis legalization may indirectly increase prosthodontic treatment burden through higher prevalence of severe tooth loss and untreated oral disease. Structural disparities in access to preventive and rehabilitative dental services may amplify these outcomes among vulnerable populations. Policies addressing cannabis regulation should incorporate preventive oral healthcare initiatives and equitable prosthodontic access strategies.