oral effects of_smokeless_tobacco
DESCRIPTION
TOBACOO EFFECTSTRANSCRIPT
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Oral Effects of Smokeless Tobacco
Lourdes Vazquez, RDH, MS, ECP
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Two Main Types of Smokeless Tobacco
Chewing Tobacco Snuff
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Smokeless Tobacco
Chewing Tobacco Loose leaf
Processed cigar type tobacco loosely packed in small strips
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Smokeless Tobacco
Chewing Tobacco Plug
Small oblng blocks of semi-soft tobacco Place tobacco next to the gingival/buccal
mucosa
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Smokeless Tobacco
Snuff (finely ground tobacco) Moist
Used by dipping Placing it between the gum and the cheek or
under the upper or lower lip
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Smokeless Tobacco
Snuff Dry
Placed in oral cavity or sniffed through the nose
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Smokeless Tobacco Use
The highest rate of smokeless tobacco users is found in: 8-17 year old white male People in the North-Central and South-
Central states Blue collar occupations
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Nicotine Effects on the CNS
Stimulating effects Seen with low dose of nicotine Affecting the brain at the cortex and
Locus ceruleus Reward like effects
Seen with high dose of nicotine levels Affecting the brain in the Limbic system
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Symptoms of NicotineToxicity
Nausea Vomiting Diarrhea Abdominal pain Sweats Flush dizziness
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Effects of Nicotine Toxicity
Perinatal Exposure Hypoxemia of fetus Spontaneous abortion Placental disruption Preterm delivery Decreased milk production
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Nicotine Toxicity
Interferes with birth control pills Infertility Impotence
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Nicotine Dependence
Physiologic Psychologic Behavioral
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Behavioral Dependence
Social use patterns Ritualistic triggers Behavioral habits
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Physiologic Dependence
Withdrawal Tolerance
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Nicotine Withdrawal Symptoms
Anxiety Irritability Poor concentration Restlessness Craving GI problems Headaches drowsy
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Adverse Medical Consequences
Many problems affecting different systems in the body Central Nervous System Heart Disease Hypertension Lipids Diabetes
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Effects of smokeless Tobacco
Physiological effects of Nicotine Cardiovascular System Central Nervous System Endocrine System
Oral cancer Cancer risk of cheek and gum may
reach nearly fiftyfold among long-term snuff users
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Central Nervous System (CNS)
Vascular Disease Cerebrovascular Accidents
TIA’s Stroke
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Central Nervous System
Receptors of nicotine in the CNS Adiction
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Dependence on Smokeless Tobacco
U.S. Surgeon General(1986):”Geven the nicotine content of smokeless tobacco, its ability to produce high and sustained blood levels of nicotine, and the well-established data implicating nicotine as an addictive substance, one may deduce that smokeless tobacco is capable of producing addiction in users”
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Health Consequences of Nicotine Exposure
Nicotine intoxication *Accelerated coronary and
peripheral vascular disease Stroke Hypertension
*Of greatest concern
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Complications
Delayed wound healing *Reproductive or perinatal disorders
(low birth weight, prematurity, spontaneous abortion)
Peptic ulcer disease Esophageal reflux
*Of great concern
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Heart Disease
Smokeless tobacco causes similar effects as those seen in smoking Increase in heart rate (30% higher) Increase in blood pressure Less cardiovascular risk than smoking
possibly due to lack of carbon monoxide and related compounds
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*Cardiovascular Disease
Heart rate acceleration Promote atherosclerotic vascular
disease Aggravate hypertension by causing
vasoconstriction Acute cardiac ischemia (angina,
myocardial infarction, even sudden death)
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Hypertension
Blood pressure levels are affected by: High sodium levels Nicotine Licorice , which causes sodium
retention
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Lipids
According to an article published in the American Journal of Public Health (1989) Smokeless tobacco users had 2.5 times
increase in cholesterol
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Diabetes
Smokeless tobacco as well as Cigarette smokers have increase insulin levels which suggests a link wiht insulin resistance
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MAJOR RISK
HEAD AND NECK DISEASE
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SMOKELESS TOBACCO LESIONS (STL’s)
Appear as changes in color and texture of the oral mucosa
Are the most prevalent oral soft tissue lesions among adolescents in the U.S.
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HARD TISSUES
Effects on teeth: Discoloration of the teeth and receding gingiva
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ATTACHED GINGIVA
Recession of gingival margin
Loss of attachment Tooth abrasion Hyper keratinized
soft tissues
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Periodontal Disease 3-5% of diseased gingival and
periodontal tissue becomes oral cancer
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Potent Carcinogens
Nitrosamines Polycyclic aromatic hydrocarbons Radiation-emitting polonium
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Abnormal Changes at Cancerization site
Clinically: Leukoplakia Erythroplasia Dysplasia Carcinoma in situ
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Hyper Keratosis
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Oral Leukoplakia
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Leukoplakia
Under the tongue
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Oral leukoplakia/Cancer under the upper lip
A portion of leukoplakias can under go transformation to dysplasia and further to cancer.
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TONGUE
Cancer under the tongue
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FLOOR OF THE MOUTH
Cancer behind the teeth
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Papillary Squamous Cell Carcinoma of lower gingiva
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Precancerous Lesion
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Cancerous Lesion/Vestibule
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Vericous Carcinoma
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Cancer of the cheek with erosion of tissue
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Cancer/Smokeless Tobacco
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Role of Oral Health Professionals in Cessation Counseling: Survey Findings
73-item survey mailed to 1,064 dentists in Central Ohio
529 responded 9% were effective at getting
patients to quit 71% willing to provide educational
pamphlets 6% would consider to prescribe
nicotine gum
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Dentists
Results indicate the need for further education in tobacco and cessation counseling for dentists.
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ROLES OF THE DENTAL PROFESSION
ORAL CANCER SCREENINGNon-invasive procedure
No discomfortNo pain
Inexpensive
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Clinically…What to look for?
Head and Neck examination Intraoral examination
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INTRAORAL EXAMINATION
Where to look? Site of Smokeless Tobacco Placement Vestibular area Attached Gingiva Oral mucosa Tongue Floor of the mouth Hard tissues
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Oral Examination
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Intra-oral examination
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Base and borders of the tongue
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Pharynx, Soft Palate, Pilars….
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Buccal Mucosa
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Ventral
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Vermillion Borders
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Discovery and Diagnosis
Any sore, discoloration, induration, prominent tissue, horseness which does not resolve within a two week’s period on its own, with or without treatment, should be considered for further examination or referral.
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DISCOVERY & DIAGNOSIS
Result from Visual and manual examination Systematic visual exam of all the soft
tissues of the mouth
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DIGITAL PALPATION OF THE NECK
INCLUDING THE THYROID AND SURROUNDING LYMPH NODES SURROUNDING THE ORAL CAVITY.
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OTHER DIAGNOSTIC AIDS
LIGHTS DYES OTHER TECHNIQUES APPEARING IN
THE MARKET.
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BIOPSY
ONLY MEANS OF DIAGNOSIS OF ORAL CANCER MAY BE THROUGH BIOPSY.
How long has the suspicious lesion been present? Herpes simplex ulceration Aphthous lesions
14 days
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BIOPSY BRUSH
Easy, painless, accurate diagnosis of soft tissue abnormalities.
Not designed to provide the information, specifically cellular architecture that a punch or incisional biopsy would provide.
Will allow us to know whether a malignancy exists or not through minimal and inexpensive procedure.
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Brush Biopsy
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Tissue sample
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Early Cancerous Lesions
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Conventional biopsy
A positive result from the brush biopsy needs to be followed by a conventional biopsy.
Often the only way to diagnose oral lesions and diseases
Most are performed at a hospital
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POINTS TO CONSIDER PRIOR TO MUCOSAL BIOPSY
Why is biopsy being taken? What information is required from the
pathologist? Is the biopsy to exclude malignancy? Is the biopsy incisional or excisional? Will the specimen be required to be
orientated? Is a fresh specimen required?
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Information to accompany mucosal biopsies
Patient demographic data Description of the clinical appearance of
the lesion and suspected diagnosis The site of the biopsy The relationship of the lesion to
restorations, particularly amalgam A detailed drug history Medical history including blood dyscrasias Smoking and alcohol consumption
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Referral
Dental specialist: periodontist Oral medicine specialist
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Confirmation of the Disease
By the pathologist is obtained Referral of patient to a proper
medical intervention, Oncologist
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Continued help after diagnosis
Preparing the patient for treatment through proper management of oral tissues before, during and after treatment.
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ALTERNATIVES TO QUITING
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PROGRAMS AND SUPPORT GROUPS