Bill Klaproth (host): This is OMS Voices, an AAOMS podcast. I’m Bill Klaproth and with me is Dr. Kathlyn Powell, who is here to discuss the impact of tobacco, alcohol and marijuana on pre and postsurgical outcomes. Dr. Powell, thanks for being here.

Dr. Kathlyn Powell: Hi, Bill. Thank you so much for having me. I’m excited to be here and look forward to our discussion. 

Bill Klaproth (host): Absolutely and interested to hear what you have to say about this. So, let me ask you this, Dr. Powell, when a patient prepares for surgery, why is it important they follow presurgery recommendations? 

Dr. Kathlyn Powell: Yeah, absolutely. So, there are lots of recommendations out there that we would advise patients follow. Patients may be familiar with recommendations related to not eating or drinking after a certain time before undergoing general anesthesia. The reason for this is that when you receive anesthesia, you’re unconscious, so your body reflexes are not functioning as they naturally would. 

The same goes to avoiding certain substances like marijuana, alcohol and smoking. 

Bill Klaproth (host): So, it sounds like you don’t want to mess with the anesthesia in this situation. So, how does the use of substances like marijuana, alcohol and tobacco, how does that affect a patient’s risk during oral surgery? 

Dr. Kathlyn Powell: Yeah, so substance use, especially smoking and alcohol, can significantly increase the risk of surgical complications. Smoking affects blood flow, it delays wound healing and it increases the risk of infection. Alcohol can also interfere with anesthesia and postoperative medications. Marijuana can alter the effects of anesthesia, making it less predictable and even potentially more risky. 

Bill Klaproth (host): Well, that’s interesting you mentioned smoking. I wouldn’t have thought that.

So, what specific risks are associated with smoking before undergoing oral surgery? 

Dr. Kathlyn Powell: Yeah, so it leads to several complications. For example, it impairs blood flow, which is crucial for wound healing. It also increases the risk of dry socket after tooth extractions. It can even lead to poor wound healing and higher risk of infection. It can also negatively impact the success rates of dental implants. 

Bill Klaproth (host): All right, well, these are really important tips for someone to know. And then let’s dive a little bit deeper on alcohol. Can you explain why abstaining from alcohol is important before oral surgery? 

Dr. Kathlyn Powell: Yeah, alcohol thins your blood, which will increase your risk of bleeding during and after surgery. It also interacts with anesthetics and medications that are used during surgery, which can lead to anesthesia complications. Abstaining from alcohol ensures a safer anesthesia experience and also a much smoother postoperative recovery. 

Bill Klaproth (host): And that’s really what everyone is looking for. So, it’s good to know do not smoke marijuana or regular tobacco cigarettes before oral surgery, but someone might say, well, okay, when do I need to stop? So, is there a recommended period for patients to avoid smoking or using marijuana before their oral surgery? 

Dr. Kathlyn Powell: Yeah, so patients should cease smoking and using marijuana at least 72 hours before their surgery. This 72-hour period will allow for a decrease in carboxyhemoglobin levels. It also will help decrease airway reactivity as well as improve cardiovascular stability. So, even refraining from the use of marijuana 48 hours will have some benefit and very little risk to the patient. 

This period will help reduce the risk associated with these substances. It will also improve wound healing and be less likely to alter the effects of anesthesia. The longer the period of abstinence of marijuana or tobacco products will improve surgical outcome. 

Bill Klaproth (host): So, you said 72 hours, that’s three days. So, for someone that is really addicted to smoking and you said 48 for marijuana, what advice would you give to patients who struggle to abstain from these substances before surgery? 

Dr. Kathlyn Powell: Yeah, that can be a significant challenge for our patients. And so those patients that are finding that this is very, very difficult, I recommend that they seek support such as smoking cessation programs or even counseling. We certainly advise that our patients are transparent about their substance use, as this information is crucial for planning for safe surgical procedures and anesthesias. 

There are also medications and nicotine replacement therapies that are available that can help in the short term. 

Bill Klaproth (host): So, you said something there that caught my ear, if you will. You said we advise patients to be transparent about their substance use. What would you say to a patient who may be embarrassed about sharing their drug or alcohol use with their doctor? 

Dr. Kathlyn Powell: As an oral and maxillofacial surgeon, I understand that discussing personal habits like drug and alcohol use can certainly be challenging and maybe even potentially embarrassing for many patients. However, it is crucial to remember that as healthcare providers, our primary concern is the patient’s safety and the patient’s well-being. 

Sharing accurate information about your drug or alcohol use is not about us passing judgment. It is surely just to allow us to ensure that we can provide the safest and most effective care possible.

Substances like and drugs and alcohol can significantly impact surgical outcomes, anesthesia, pain management and healing processes. For example, certain drugs, prescribed or recreational, can interact with anesthesia or pain medication, which can lead to anesthetic or postoperative complications. As mentioned before, alcohol can affect blood clotting as well as wound healing. 

And by having this information, we can tailor your treatment plan to specifically reduce these risks and enhance your recovery. 

Bill Klaproth (host): And Dr. Powell, what guidance can you provide regarding the use of substances after surgery? Is using marijuana or THC acceptable for postsurgery healing? 

Dr. Kathlyn Powell: In simple terms, not many studies have looked into how cannabis affects lung function, especially in people undergoing surgery. Some research has been done on animals, as well as people not having surgery, and this research shows that THC, a component in cannabis, can negatively affect breathing, how much air is breathed in and out as well as how much CO2 is kept in the body, can lead to lung problems like pneumonia or bronchitis. 

However, there are a few studies that did look at people having surgery who used cannabis and it didn’t find any bad effects on their lungs. These studies aren’t very strong because they look back in time and involve a small number of people. We’re not sure if different types of cannabis, amounts or ways of using it might affect lung function differently in surgical patients. 

We really need more research to understand how cannabis affects the lungs of people having surgery. As more people use cannabis, surgeons need to know how it might affect the patients around the time of surgery, especially concerning healing as well as the effects on the heart, lungs and blood. Some research has looked into how cannabis affects pain after surgery, but, we really don’t know how much it affects wound healing, how much it affects the heart, lungs and blood. The studies we have often use different types of cannabis, different ways of taking it as well as various times of use. And it makes it very hard to understand the real effects of these studies and to compare these. More research is needed to figure out how these different ways of using cannabis, the amount and the timing may affect people having surgery and if there are any other side effects out there. 

Bill Klaproth (host): Well, this is really important. As you said, by smoking, drinking, etc., this can lead to complications, so you do want to be up front with your oral and maxillofacial surgeon. What if someone is concerned about confidentiality and privacy, Dr. Powell? What then? 

Dr. Kathlyn Powell: Certainly, I understand that that would be concerning, but please be assured that all of the discussions you have with your oral and maxillofacial surgeon should be confidential and they’re solely for the purpose of your care. Our goal is to create a safe and comfortable environment for you to receive the best possible care and treatment. 

Remember that if you withhold this information, it can have serious implications for your health and the success for your treatment. We’re here to help you, not judge, and your honesty is a critical part of your healthcare journey. We certainly want to take that honesty and provide that best tailored outcome for you. 

Bill Klaproth (host): I love how you said that. We’re here to help you, not judge you. So, keep that in mind. Well, this has been fascinating, Dr. Powell, talking about the importance of avoiding marijuana, smoking and drinking before surgery. As we wrap up, is there anything else you want to add? 

Dr. Kathlyn Powell: Absolutely. So, I think again, it’s always important to follow those presurgical recommendations that have been provided to you by your oral and maxillofacial surgeon or anesthesia provider. For example, remembering those guidelines of not eating and drinking within a certain time before undergoing general anesthesia is extremely important. 

And then certainly remembering that use of substances like marijuana, alcohol and tobacco can have an effect not only in the short term on your anesthetic, but also in the long term in your wound healing and other potential surgical complications. 

Bill Klaproth (host): Absolutely. Again, as you said, you’re there to help, not judge. Dr. Powell, this has really been fascinating and informative. Thank you so much. 

Dr. Kathlyn Powell: Thank you for having me today. 

Bill Klaproth (host): Absolutely. Once again, that is Dr. Kathlyn Powell. And for more information and the full podcast library, please visit MyOMS.org. And if you found this podcast helpful, please share it on your social channels. 

And don’t forget to subscribe. Thanks for listening.