In a large-scale study commissioned by Duke University, researchers observed the dental health of regular cannabis users, and the results weren’t very reassuring.

The study looked at 1,000 New Zealanders who had been using cannabis for more than 20 years. Thankfully, there were no adverse health effects when it came to lung function, blood pressure, cholesterol, and weight – however, the health and gums seemed to suffer. Researchers made sure to account for any confounding factors such as poor hygiene and the use of tobacco, alcohol, or illicit drugs.

The results remained the same. “Study participants who had used marijuana to some degree over the last 20 years showed an increase in periodontal disease from age 26 to 38,” researchers reported. This isn’t the first study to find that cannabis might not be the best thing for our chompers. Research from 2005 and 2008 has reached the same conclusion.

As a result, the American Dental Association’s (ADA) official position is that cannabis smoking “is associated with periodontal complications, xerostomia (chronic dry mouth), and leukoplakia (white patches inside mouth) as well as increased risk of mouth and neck cancers."

As you may know all too well, smoking cannabis often results decreased saliva production, AKA cotton mouth. Although the issue is certainly well documented among users, the science behind it is a bit less understood.

The reason this happens is because THC mimics ananadamide – a natural endocannabinoid that regulates many different functions in the body, including saliva production. When we use products that are too high in THC, they bind to the CB1 and CB2 receptors in the submandibular region and signal them to create less saliva.

Saliva is one of the most important components in the homeostasis of the human mouth. It’s responsible for breaking down food, clearing away bacteria and other buildup, and preventing cavities, tooth rot, and various gum diseases. Because saliva is full of antimicrobial components, as well as electrolytes and enzymes, a mouth without enough it is a perfect breeding ground for bacteria.

But it’s not just the THC that’s causing mayhem. Smoking anything is bad for the mouth and gums, and I’ve been told by dentists that the heat from holding a lit pipe or joint in front of your teeth is also bad.

Combine all that with the munchies and the urge to often eat foods high in sugar, it’s no surprise cannabis users are on the dentist’s watch list. “People’s behaviors when smoking cannabis—drinking more sugary drinks, eating junk food and not taking good care of their teeth, are probably more harmful than the THC itself,> said Dr. Jared Helfant DDS, a practicing dentist in Florida and president of Sparx, a California-based cannabis purveyor.

So what’s the takeaway here? Well, if plan to continue smoking cannabis, make sure you stay hydrated, floss regularly, brush 3 times daily, and use some type of mouthwash afterwards to prevent the buildup of extra bacteria around your teeth and gums.

If you make sure to take good care of your teeth, there is no reason to stop using cannabis as the risks of periodontal disease don’t outweigh the many benefits of using cannabis.