Cannabidiol (CBD) for Dental Pain
Objective: To identify safer non-opioid analgesics for dental pain. Cannabidiol (CBD) is a non-psychoactive and non-addictive cannabinoid. CBD analgesic effectiveness for dental pain is largely unknown. This research proposed to identify CBD effectiveness, safety, and mechanism of action for treating dental pain using a translational in vivo model and a clinical trial. For the clinical trial, sixty-one patients with moderate-to-severe toothache were randomized into CBD 10mg/kg or 20mg/kg and Placebo. After a single oral dose, pain, bite force, and safety data were collected. Both CBD groups resulted in significant visual analog scale (VAS) pain reduction compared to their baseline and the Placebo, with a 73% maximum pain reduction. Bite force was significantly increased in CBD 20mg/kg compared to the Placebo Group. There were no psychoactive effects. The animal study utilized a behavioral mouse model of apical periodontitis-induced mechanical allodynia (MA) to assess CBD effectiveness, site of action, and transient receptor potential TRPV1 involvement. Mice received pulp exposure (AP) or sham surgery (Sham). Behavioral experiments were performed after 21 days with Von Frey filaments. AP mice that ingested CBD experienced a significant MA reduction compared to controls. Unlike intraoral injection, intrathecal and intracisternal CBD injection produced MA reduction in the AP (CBD) group, indicating a central site of action. Central TRPV1 inhibition blocked the CBD analgesic effect, suggesting TRPV1 involvement in CBD's MA reduction in the apical periodontitis model. Overall, CBD can be an effective analgesic for dental pain with a central site of action modulated through the TRPV1 channel.