Associations Between Cannabis Use, Methylphenidate Exposure, and Radiographically Detected Pulp Stones: An Exploratory Case-Control Study.

AIMS: This exploratory study investigated the associations between cannabis use, methylphenidate (MPH) exposure, demographic factors, and radiographically detected pulp stones.

MATERIALS AND

METHODS

A retrospective case-control study was conducted to analyze the records of 200 adults (100 with pulp stones and 100 controls) treated at a university dental clinic (2020-2023). The variables included age, sex, cannabis use, MPH use, tobacco smoking, and clenching/grinding behaviors. Analyses included Fisher's exact test, Mann-Whitney U test, and multivariable logistic regression with Benjamini-Hochberg (BH) correction.

RESULTS

Cannabis use showed the strongest independent association with radiographic pulp stones (OR = 6.54, 95% CI: 1.95-21.95; BH-corrected p = 0.012). Age was also independently associated (OR = 1.08/year; BH-corrected p = 0.035). MPH use was associated with pulp stones on unadjusted analysis (OR = 2.3, p = 0.042), but not after adjustment (OR = 1.72; BH-corrected p = 0.232). MPH users demonstrated significantly higher rates of documented clenching/grinding behaviors than nonusers (41.7% vs. 23.8%; p = 0.038). Tobacco smoking was not associated with the presence of pulp stones.

CONCLUSIONS

Cannabis use was the strongest independent factor associated with radiographically detected pulp stones. MPH users showed higher rates of clenching/grinding behaviors, supporting a possible mechanistic relationship between psychostimulant exposure and parafunctional activity. The findings should be considered exploratory and hypothesis-generating.

CLINICAL SIGNIFICANCE: Pulp stones may be radiographic indicators of underlying parafunctional activity and behavioral risk factors, supporting more comprehensive dental history-taking and monitoring strategies.