TOBACOO EFFECTS

1. Oral Effects of Smokeless
Tobacco
Lourdes Vazquez, RDH, MS, ECP

2. Two Main Types of Smokeless
Tobacco
 Chewing Tobacco
 Snuff

3. Smokeless Tobacco
 Chewing Tobacco
 Loose leaf
 Processed cigar type tobacco loosely
packed in small strips

4. Smokeless Tobacco
 Chewing Tobacco
 Plug
 Small oblng blocks of semi-soft tobacco
 Place tobacco next to the gingival/buccal
mucosa

5. 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

6. Smokeless Tobacco
 Snuff
 Dry
 Placed in oral cavity or sniffed through the
nose

7. 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

8. 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

9. Symptoms of NicotineToxicity
 Nausea
 Vomiting
 Diarrhea
 Abdominal pain
 Sweats
 Flush
 dizziness

10. Effects of Nicotine Toxicity
 Perinatal Exposure
 Hypoxemia of fetus
 Spontaneous abortion
 Placental disruption
 Preterm delivery
 Decreased milk production

11. Nicotine Toxicity
 Interferes with birth control pills
 Infertility
 Impotence

12. Nicotine Dependence
 Physiologic
 Psychologic
 Behavioral

13. Behavioral Dependence
 Social use patterns
 Ritualistic triggers
 Behavioral habits

14. Physiologic Dependence
 Withdrawal
 Tolerance

15. Nicotine Withdrawal Symptoms
 Anxiety
 Irritability
 Poor concentration
 Restlessness
 Craving
 GI problems
 Headaches
 drowsy

16. Adverse Medical Consequences
 Many problems affecting different
systems in the body
 CentralNervous System
 Heart Disease
 Hypertension
 Lipids
 Diabetes

17. Effects of smokeless Tobacco
 Physiological effects of Nicotine
 CardiovascularSystem
 Central Nervous System
 Endocrine System
 Oral cancer
 Cancer risk of cheek and gum may
reach nearly fiftyfold among long-term
snuff users

18. Central Nervous System (CNS)
 Vascular Disease
 Cerebrovascular Accidents
 TIA’s
 Stroke

19. Central Nervous System
 Receptors of nicotine in the CNS
 Adiction

20. 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”

21. Health Consequences of Nicotine
Exposure
 Nicotine intoxication
 *Accelerated coronary and
peripheral vascular disease
 Stroke
 Hypertension
 *Of greatest concern

22. Complications
 Delayed wound healing
 *Reproductive or perinatal disorders
(low birth weight, prematurity,
spontaneous abortion)
 Peptic ulcer disease
 Esophageal reflux
 *Of great concern

23. 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

24. *Cardiovascular Disease
 Heart rate acceleration
 Promote atherosclerotic vascular
disease
 Aggravate hypertension by causing
vasoconstriction
 Acute cardiac ischemia (angina,
myocardial infarction, even sudden
death)

25. Hypertension
 Blood pressure levels are affected
by:
 High sodium levels
 Nicotine
 Licorice , which causes sodium
retention

26. Lipids
 According to an article published in
the American Journal of Public
Health (1989)
 Smokeless tobacco users had 2.5 times
increase in cholesterol

27. Diabetes
 Smokeless tobacco as well as
Cigarette smokers have increase
insulin levels which suggests a link
wiht insulin resistance

28. MAJOR RISK
HEAD AND NECK DISEASE

29. 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.

30. HARD TISSUES
 Effects on teeth:
Discoloration of
the teeth and
receding gingiva

31. ATTACHED GINGIVA
 Recession of
gingival margin
 Loss of attachment
 Tooth abrasion
 Hyper keratinized
soft tissues

32. Periodontal Disease
 3-5% of diseased gingival and
periodontal tissue becomes oral
cancer

33. Potent Carcinogens
 Nitrosamines
 Polycyclic aromatic hydrocarbons
 Radiation-emitting polonium

34. Abnormal Changes at Cancerization
site
 Clinically:
 Leukoplakia
 Erythroplasia
 Dysplasia
 Carcinoma in situ

35. Hyper Keratosis

36. Oral Leukoplakia

37. Leukoplakia
 Under the tongue

38. Oral leukoplakia/Cancer under the
upper lip
 A portion of
leukoplakias can
under go
transformation to
dysplasia and
further to cancer.

39. TONGUE
 Cancer under the
tongue

40. FLOOR OF THE MOUTH
 Cancer behind the teeth

41. Papillary Squamous Cell Carcinoma of
lower gingiva

42. Precancerous Lesion

43. Cancerous Lesion/Vestibule

44. Vericous Carcinoma

45. Cancer of the cheek with erosion of
tissue

46. Cancer/Smokeless Tobacco

47. 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

48. Dentists
 Results indicate the need for further
education in tobacco and cessation
counseling for dentists.

49. ROLES OF THE DENTAL
PROFESSION
ORAL CANCER SCREENING
Non-invasive procedure
No discomfort
No pain
Inexpensive

50. Clinically…What to look for?
 Head and Neck examination
 Intraoral examination

51. INTRAORAL EXAMINATION
 Where to look? Site of Smokeless
Tobacco Placement
 Vestibular area
 Attached Gingiva
 Oral mucosa
 Tongue
 Floor of the mouth
 Hard tissues

52. Oral Examination

53. Intra-oral examination

54. Base and borders of the tongue

55. Pharynx, Soft Palate, Pilars….

56. Buccal Mucosa

57. Ventral

58. Vermillion Borders

59. 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.

60. DISCOVERY & DIAGNOSIS
 Result from Visual and manual
examination
 Systematic visual exam of all the soft
tissues of the mouth

61. DIGITAL PALPATION OF THE NECK
 INCLUDING THE THYROID AND
SURROUNDING LYMPH NODES
SURROUNDING THE ORAL CAVITY.

62. OTHER DIAGNOSTIC AIDS
 LIGHTS
 DYES
 OTHER TECHNIQUES APPEARING IN
THE MARKET.

63. BIOPSY
 ONLY MEANS OF DIAGNOSIS OF
ORAL CANCER MAY BE THROUGH
BIOPSY.
 How long has the suspicious lesion
been present?
 Herpessimplex ulceration
 Aphthous lesions
 14 days

64. 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.

65. Brush Biopsy

66. Tissue sample

67. Early Cancerous Lesions

68. 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

69. 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?

70. 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

71. Referral
 Dental specialist: periodontist
 Oral medicine specialist

72. Confirmation of the Disease
 By the pathologist is obtained
 Referral of patient to a proper
medical intervention, Oncologist

73. Continued help after diagnosis
 Preparing the patient for treatment
through proper management of oral
tissues before, during and after
treatment.

74. ALTERNATIVES TO QUITING

75. PROGRAMS AND SUPPORT
GROUPS