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.