TOBACCO & ORAL HEALTH

TOBACCO AND ITS INTERVENTION IN ORAL HEALTH:

Many people are associated to tobacco use when prone to different kinds of cancer, such as lung cancer and Oral cancer.

However, using different tobacco products can cause many different issues, especially within the mouth. 

There are many concerns within the scope of general dentistry, all of which can be avoided by not using tobacco products.

The first step is periodontal disease, otherwise known as gum disease. 

When people smoke or use smokeless tobacco(chewing habit), they are four times as likely to develop gum disease, as opposed to someone who does not use tobacco.

Another impact is increased tooth loss. People who smoke are twice as likely to lose their teeth when compared with someone who does not use any type of tobacco products.

Eventually, people who use tobacco, in any of its forms, will have stained teeth. 

Teeth that are stained are unattractive and can cause people to have self-confidence problems.

Another concern within the scope of general dentistry is bad breath. 

Brushing the teeth or rinsing with mouthwash can temporarily remedy bad breath, otherwise known as halitosis. 

However, the fix is short lived, and once the tobacco enters the mouth or lungs again, all bets are off.

In addition to cancer of the lung, there are other forms associated with tobacco use as well. 

Some of these forms of cancer include throat and oral, both of which are usually linked to tobacco use.

Finally, the tongue can also be a victim of different types of tobacco use. 

Using tobacco products can cause the tongue to turn different colors, such as black or yellow, and give it the appearance of having hair.

It is important to remember that using tobacco products can have a serious impact on your entire body. 

The well-known cancer types and heart disease are only the tip of the iceberg.

In reality, within the scope of general dentistry, tobacco products can do immeasurable damage to the mouth as a whole, and once the issues are there, they may be irreversible. 

The best way to not develop these problems is by not using tobacco products at all.

TOBACCO CESSATION: THE DENTAL HEALTH PROFESSIONAL’S ROLE

In the United States alone, smoking causes approximately 443,000 premature deaths each year, accounts for up to 30% of cancer deaths annually, and is the single most preventable cause of disease and death.10 


Despite the adverse health effects of smoking cigarettes, about 18% of U.S. adults (42.1 million men and women) currently smoke. 


The good news is that the proportion of U.S. adults who were current cigarette smokers declined in the early years of the twenty-first century (20.9% in 2005 to 17.8% in 2013).

RISKS OF SMOKING:

Smoking-Attributable Disease:

Tobacco smoking accounts for an estimated 6 million deaths a year worldwide.

This number is projected to increase to approximately 10 million by the year 2030. 

If current smoking patterns continue, there will be more than 1 billion deaths attributable to tobacco smoking in the 21st century compared with approximately 100 million deaths in the 20th century.

The only other causes of disease with such rapidly increasing impact are those associated with HIV and perhaps obesity in Western countries.

Oral Cancer:

It is estimated that tobacco smoking is responsible for approximately 30% of all cancer deaths in developed countries.

Tobacco use has the potential to cause cancers of the lung, oral cavity, nasal cavity, nasal sinuses, pharynx, larynx, esophagus, pancreas, stomach, liver, lower urinary tract (renal pelvis and bladder), kidney, and uterine cervix; it can also cause myeloid leukemia. 


These cancers can be attributed to smoking cigarettes, pipes, cigars, and other combustible forms of tobacco. Smoking causes an even greater number of deaths from vascular, respiratory, and other diseases than from cancer.

Cardiovascular Disease:

In the United States, 35% of smoking-related deaths are from cardiovascular disease, 

which includes ischemic heart disease (including heart attack), other heart disease, cerebrovascular disease (including stroke), atherosclerosis, aortic aneurysm, and other arterial disease.

People who smoke and already have heart disease reduce their risk of death by as much as half if they quit smoking. 

The risk of death from other chronic diseases is reduced as well.

Respiratory Disease:

Smoking damages bronchial airways and lung alveoli (air sacs), which can lead to chronic obstructive pulmonary disease (COPD). 

Smokers have 10 times the risk of dying from COPD than nonsmokers. 

Women’s rates of dying from COPD have risen proportionally with increased female tobacco use.

Smoking-related respiratory diseases include pneumonia, influenza, chronic bronchitis, emphysema, and chronic airway obstruction.

 Smoking and Pregnancy:

Women who smoke are approximately twice as likely to experience a delay in conception and have approximately 30% higher odds of being infertile. 

Men who smoke are at increased risk of impotence.

Babies born to women who smoke during pregnancy have approximately 30% higher odds of being born prematurely and are more likely to be born with low birth weight (less than 5.5 pounds), both of which conditions increase their risk for illness or death. 

Infants of mothers who smoke are 1.4 to 3.0 times more likely to die of sudden infant death syndrome (SIDS) than those of nonsmoking mothers.

Cessation of smoking during pregnancy and sustained abstinence are optimal for the health and well-being of both the mother and infant. 

There is currently insufficient evidence to determine whether or not nicotine replacement therapy is effective or safe when used in pregnancy for smoking cessation. 

Its use during pregnancy and in nursing mothers is therefore very controversial and must be evaluated on an individual basis as determined by the physician managing the pregnancy.

In theory, the use of nicotine replacement therapy avoids exposure of the fetus to carcinogens and carbon monoxide. 

However, studies have found an increased incidence of congenital malformations and preterm labor in association with the use of nicotine replacement therapies. 

Patients are therefore directed to their physician for guidance.

Oral Effects of Smoking:

The oral effects of tobacco use include an increased risk of periodontal disease, halitosis, poor wound healing, poor implant success, oropharyngeal (oral cavity and pharynx) cancers, mucosal changes, and esthetic issues.

Periodontal Disease:

Smoking is recognized as an important risk factor for periodontal disease. 

A recent literature review described smoking as the strongest of the modifiable risk factors for periodontal disease.

There is a two- to eight-fold increased risk for periodontal attachment and/or bone loss, depending on the definition of disease severity and amount and duration of smoking. 

The given figure shows periodontal disease and staining of the maxillary molars associated with smoking.

Oropharyngeal Cancer:

The American Cancer Society has estimated that in 2015 there were 39,500 new cases of cancer of the oral cavity and pharynx (oropharyngeal cancer) in the United States. 


Males are twice as likely as females to be affected by these cancers. 


The American Cancer Society projected 7,500 deaths from oropharyngeal cancer for this same time period.

It is worth noting that, according to the current literature, another cause of the rise in oropharyngeal cancer is human papillomavirus (HPV).

Mucosal Changes:

Smoker’s palate (nicotinic stomatitis) is a reactive change associated primarily with the heat generated by combustible tobacco, more frequently observed in pipe smokers than cigarette smokers. 

It results in thickening of the mucosa and inflammation of the salivary glands of the palate, causing a grayish-white appearance with reddened spots.

shows a clinical image of nicotinic stomatitis on the palate of a patient who smokes.