Health complications of various forms of tobacco such as Chewing tobacco, Snuff, Creamy snuff, Dipping tobacco, Gutka, Snus, Cigarette, Cigar, Bidi, Kretek and Hookah are discussed in this presentation.

1. HARMFUL HEALTH
EFFECTS OF TOBACCO
CONSUMPTION
Dr.P.Naina Mohamed
Pharmacologist

2. INTRODUCTION
Tobacco use is the largest single
preventable cause of illness and
premature deaths .
 Tobacco use currently causes about 5
million deaths (9% of all deaths)
annually.
 Approximately 1.6 million deaths are
CVD-related.
 If current smoking patterns continue, by
2030 about 10 million deaths would be
caused by tobacco use annually.
 Tobacco use has been the leading cause of
cancer death in men since 1955 and in
women since 1986.


3. FORMS OF TOBACCO
CONSUMPTION
Tobacco is consumed in many forms and through
a number of different methods. They may
include…
 Smokeless Tobacco








Chewing Tobacco
Snuff
Creamy Snuffs
Dipping Tobaccos
Gutka
Snus
Burned Tobacco





Cigarette Smoking
Cigar Smoking
Beedi (Bidi) smoking
Kreteks
Hookah

4. SMOKELESS TOBACCO



Recent research shows the dangers of smokeless tobacco may go
beyond the mouth.
Smokeless tobacco contains more nicotine than cigarettes. Nicotine is
a highly addictive drug.
Harmful health effects of smokeless tobacco include:













Mouth, tongue, and throat cancer
Cancer in the esophagus (the swallowing tube that goes from your mouth
to your stomach)
Stomach cancer
Pancreatic cancer
Possible increase in risk of heart disease, heart attacks, and stroke
Addiction to nicotine
Leukoplakia (white sores in the mouth that can become cancer)
Receding gums (gums slowly shrink from around the teeth)
Bone loss around the roots of the teeth
Abrasion (scratching and wearing down) of teeth
Tooth loss
Stained and discolored teeth
Bad breath

6. LEUKOPLAKIA
Leukoplakia is a white patch in the mouth that
can become cancer.
 They are usually painless.
 Many studies have shown high rates of
leukoplakia at the place in the mouth where
users place their chew or dip.
 One study found that nearly 3 of 4 of daily users
of moist snuff and chewing tobacco had noncancerous or pre-cancerous lesions (sores) in the
mouth.
 The longer a person uses oral tobacco, the more
likely they are to have leukoplakia.


7. GUM DISEASES
Tobacco
Irritate or destroy gum tissue
Receding gums, gum disease, tooth decay (from the
high sugar content in the tobacco), and bone loss
around the teeth
Loosen teeth
Tooth Loss

8. HEART DISEASES
Smokeless tobacco may also play a role in heart
disease and high blood pressure.
 A large American Cancer Society study showed
that men who switched from cigarettes to snuff
or chewing tobacco had higher death rates from
heart disease stroke, cancer of the mouth and
lung, and all causes of death combined than
former smokers.
 Studies in Sweden found that snuff (snus) users
were more likely to die from their heart attacks
than non-users.


9. CANCERS
Snuff and chewing tobacco
Very high levels of tobacco-specific nitrosamines,
benzo[a]pyrene and other polycyclic aromatic hydrocarbons
Cancer-causing agents (carcinogens)
Cancers
About 70 percent of deaths in smokeless tobacco users, are
from oral cancer.
Other cancers caused by tobacco include cancer of the
pancreas, nasal cavity, urinary tract, oesophagus, pharynx,
larynx, intestines and the stomach.

10. CHEWING TOBACCO










Chewing tobacco is used by putting a wad of tobacco inside the cheek.
Chewing tobacco and snuff contain 28 cancer-causing agents.
Chewing tobacco is more addictive because it contains higher levels of addictive
nicotine than cigarettes and can be harder to quit than cigarettes.
The most common sign of possible cancer in smokeless tobacco users is
leukoplakia, a white scaly patch or lesion inside the mouth or lips, common
among many chewing tobacco users.
Red sores are also a warning sign of cancer.
Studies have found that 60 to 78 percent of chewing tobacco users have oral
lesions.
Those who mix snuff and chewing tobacco, are more likely to develop
precancerous lesions than those who use only one type of chewing tobacco.
Long-term snuff users have a 50 percent greater risk of developing oral cancer
than non-users, and chewing tobacco users are more likely to become cigarette
smokers.
Chewing tobacco has been known to cause cancer, particularly of the mouth
and throat.
Smokeless tobacco is a major cause of oral cancer, pancreatic cancer, and
esophageal cancer.

11. SNUFF
Snuff is a smokeless tobacco made from ground
or pulverised tobacco leaves which is either
sniffed through the nose or placed between the
cheek and gum.
 The nicotine in snuff is absorbed through the
mucus membrane.
 Scientists have known for more than a century
that using snuff increases the risk of nasal and
oral cancers.


12. CREAMY SNUFFS








Creamy snuff is marketed mainly to women in India, and
is known by the brand names IPCO (made by Asha
Industries).
Creamy snuff is a paste consisting of tobacco, clove oil,
glycerin, spearmint, menthol, and camphor.
It is sold in a toothpaste tube.
According to the U.S NIH-sponsored Smokeless Tobacco
Fact Sheet, it is marketed as a dentifrice.
The same factsheet also mentions that it is "often used to
clean teeth.
The manufacturer recommends letting the paste linger in
your mouth before rinsing.
The product is addictive.
A similar product, known as gul or gadakhu, is made with
tobacco powder and molasses, and used mainly by women
in Central and South Asia as a dentifrice.

13. DIPPING TOBACCOS









Dipping tobacco, traditionally referred to as moist snuff, is a type
of finely ground or shredded, moistened smokeless tobacco product.
It is used by placing a lump or "dip" of tobacco between the lip and
the gum.
Nicotine is the main ingredient of concern in smokeless tobacco.
It is estimated that a normal, 30-minute dip of smokeless tobacco
delivers the same amount of nicotine as 3-4 cigarettes.
Nicotine affects the brain and central nervous system and changes
neurotransmitters levels regulating mood, learning, alertness, and
ability to concentrate.
Nicotine causes the release of endorphins, which provide a
tranquilizing effect.
Nicotine is considered more addictive .
According to the American Cancer Society, chewing tobacco users are
50 times more likely than non-users to get cancers of the cheek, gums,
and inner surface of the lips.
Dipping tobacco can cause fatal oral cancers and tooth loss.

14. GUTKA






Gutka or Gutkha is manufactured in India and exported
to a few other countries.
It is a preparation of crushed areca nut (also called betel
nut), tobacco, catechu, paraffin, slaked lime and sweet or
savory flavorings.
It is consumed by placing a pinch of the mixture in the
mouth between the gum and cheek and gently sucking and
chewing.
A gutkha user can easily be identified by prominently
stained teeth ranging from dirty yellowish-orange to
reddish-black. The stains are difficult to remove by normal
brushing and usually need the attention of a dentist .
Excessive gutkha use can eventually lead to loss of
appetite, promote unusual sleep patterns, and loss of
concentration along with other tobacco-related problems.
It is considered responsible for oral cancer and other severe
negative health effects.

15. SNUS









Snus is originated in Sweden and Norway.
Snus is packaged in small bags, similar to tea bags.
Snus is typically placed under the upper lip.
Each bag lasts around 30 to 45 minutes.
Snus, is made of tobacco, salt, and sodium carbonate.
The ground tobacco is mixed with water, salt, and an
alkylizing agent (sodium carbonate) and aroma and is
prepared through heating.
Snus is linked to mouth sores, dental cavities, heart
attack, stroke, and diabetes risk.
Snus use causes 40% increased risk of death from
cardiovascular disease and strokes.
Snus users are twice likely to develop pancreatic
cancer when compared to non-tobacco users.

16. BURNED (SMOKING) TOBACCO
All forms of burned tobacco generate toxic and
carcinogenic smoke.
 There are about 1.3 billion tobacco smokers
worldwide and this number is still increasing.
 About 1 in 5 adults smoke.
 More men (nearly 24%) than women (about 18%)
smoke.
 Smoking rates are higher among people with a
lower education level.
 Tobacco smoke contains chemicals that are
harmful to both smokers and nonsmokers.
 Breathing even a little tobacco smoke can be
harmful.
 Tobacco smoke contains about 4800 compounds.


17. HEALTH RISKS OF TOBACCO
SMOKING


Atherosclerotic diseases of the heart and blood vessels:
 Cardiovascular disease (including myocardial infarction
and sudden death)
 Cerebrovascular disease (Stroke)
 Peripheral vascular disease (Claudication, etc)
Noncancerous lung diseases:




Chronic obstructive pulmonary disease
Asthma
Cancers at many sites, including the lung, larynx, oral
cavity, esophagus, bladder, kidney, pancreas, and uterine
cervix.
Toxicity to the human reproductive system
 Reduced Fertility

19. CIGARETTE SMOKING

Cigarettes are uniform in size and contain less than 1 gram of
tobacco each.

Cigarette (Tobacco) smoke contains irritating, suffocating,
dissolving, inflammable, toxic, poisonous, carcinogenic gases and
substances and even radioactive compounds (nickel, polonium,
plutonium, etc.).

Some of these include benzopyrene, dibenzopyrene, benzene,
isoprene, toluene (hydorcarbons); naphthylamines; nickel,
polonium, plutonium, arsenic, cadmium (metallic constituents);
carbon dioxide, methane, ammonia, nitric oxide, nitrogen dioxide,
hydrogen sulphide (gases); methyl alcohol, éthanol, glycerol or
glycerine, glycol (alcohols and esters); acetaldehyde, acrolein,
acetone (aldehydes and ketones); cyanhydric or prussic acid,
carboxyl derivatives (acids); chrysene, pyrrolidine, nicoteine,
nicotinine, nicoteline, nornicotine, nitrosamines (alkaloids or
bases); cresol (phenols), etc.

20. CIGAR SMOKING
Cigar is a roll of tobacco wrapped in leaf tobacco
or in any substance containing tobacco.
 Most cigars are made of a single type of air-cured
or dried tobacco.
 Like other forms of tobacco use, cigar smoking
also poses a significant health risk depending on
dosage.
 Health risks are similar to cigarette smoking in
nicotine addiction, periodontal health, tooth loss,
and many types of cancer, including cancers of
the mouth, throat, and esophagus.
 Cigar smoking also can cause cancers of the lung
and larynx.
 Cigar smoking also increases the risk of lung and
heart diseases such as chronic obstructive
pulmonary disease and myocardial infarction
respectively.


21. BEEDI (BIDI) SMOKING







Bidis are small, thin hand-rolled cigarettes imported
primarily from India and other Southeast Asian countries.
Bidis are a combustible tobacco product.
Despite their small size, their toxin levels are higher than
cigarettes because of the need to puff harder to keep bidis
lit.
Smoke from a bidi contains three to five times the amount
of nicotine as a regular cigarette and places users at risk
for nicotine addiction.
Bidi smokers also have three times the risk for developing
coronary heart disease and having a heart attack and four
times the risk for chronic bronchitis, according to the
Indian research.
Bidi smoking increases the risk for oral cancer, lung
cancer, stomach cancer, and esophageal cancer.
Bidi smoking is associated with emphysema and a nearly
fourfold increased risk for chronic bronchitis.

22. KRETEKS SMOKING







kreteks are the most widely smoked form of cigarettes in Indonesia,
where about 90% of smokers usually smoke kreteks.
Kreteks are cigarettes made with a blend of tobacco, cloves and other
flavors.
The eugenol in clove smoke causes a numbing of the throat which can
diminish the gag reflex in users.
Kretek smoking is associated with an increased risk for acute lung
injury (i.e., lung damage that can include a range of characteristics,
such as decreased oxygen, fluid in the lungs, leakage from capillaries,
and inflammation), especially among susceptible individuals with
asthma or respiratory infections.
Regular kretek smokers have 13 to 20 times the risk for abnormal
lung function (e.g., airflow obstruction or reduced oxygen absorption)
compared with nonsmokers.
Kretek smoking is associated with an increased risk of acute lung
injury, especially among individuals with asthma or other breathing
problems.
The venous plasma nicotine and carbon monoxide levels from 10
smokers were tested after smoking kreteks and were found to be
similar to non-clove brands of cigarettes.

23. HOOKAH SMOKING








Hookahs are single- or multi-stemmed instruments for vaporizing and
smoking flavored tobacco called shisha in which the vapor or smoke is
passed through a water basin (often glass-based) before inhalation.
Each hookah session typically lasts more than 40 minutes, and consists of
50 to 200 inhalations that each range from 0.15 to 0.50 liters of smoke.
In an hour-long smoking session of hookah, users consume about 100 to
200 times the smoke of a single cigarette and in a 45-minute smoking
session a typical smoker would inhale 1.7 times the nicotine of a single
cigarette.
The water moisture induced by the hookah makes the smoke less
irritating and may give a false sense of security and reduce concerns about
true health effects.
Use of hookah can be as detrimental to a person's health as smoking
cigarettes, and a study by the World Health Organization also confirmed
these findings.
A study in the Journal of Periodontology found that water pipe smokers
were five times more likely than non-smokers to show signs of gum
disease.
A study on hookah smoking and cancer in Pakistan, concluded that heavy
hookah smoking (2–4 daily preparations; 3–8 sessions a day ; >2 hrs to ≤ 6
hours) substantially raises Carcinoembryonic antigen (CEA) levels.
Hookah smokers were nearly 6-times at risk for development of lung
cancer as compared to healthy non-smokers in Kashmir (India).

24. REFERENCES




CURRENT Diagnosis & Treatment in Family
Medicine, 3e
Jeannette E. South-Paul, Samuel C. Matheny, Evelyn
L. Lewis
Harrison's Online
Featuring the complete contents of Harrison's
Principles of
Internal Medicine, 18e
Dan L. Longo, Anthony S. Fauci, Dennis L. Kasper,
Stephen L. Hauser, J. Larry Jameson, Joseph
Loscalzo, Eds.
Behavioral Medicine: A Guide for Clinical
Practice, 3e
Mitchell D. Feldman, John F. Christensen
CURRENT Practice Guidelines in Primary
Care, 2013
Joseph S. Esherick, Daniel S. Clark, Evan D. Slater

25. REFERENCES




Goodman & Gilman's The Pharmacological
Basis of Therapeutics, 12e
Laurence L. Brunton, Bruce A. Chabner, Björn C.
Knollmann
Hurst's The Heart, 13e
Valentin Fuster, Richard A. Walsh, Robert A.
Harrington
Hazzard's Geriatric Medicine and Gerontology,
6e
Jeffrey B. Halter, Joseph G. Ouslander, Mary E.
Tinetti, Stephanie Studenski, Kevin P. High, Sanjay
Asthana
CURRENT Diagnosis & Treatment: Psychiatry,
2e
Michael H. Ebert, Peter T. Loosen, Barry Nurcombe,
James F. Leckman

26. REFERENCES
http://www.nlm.nih.gov/medlineplus/smokelesstobacco.htm
 http://www.cancer.org/cancer/cancercauses/tobaccocancer/sm
 http://www.cancer.gov/cancertopics/tobacco/smokeless-tobac
 http://www.cdc.gov/tobacco/data_statistics/fact_sheets/smok
 http://www.webmd.com/smoking-cessation/features/snus-to
