According to the Oral Cancer Foundation, about 42,000 Americans will be diagnosed with oral or pharyngeal cancer this year due to the use of smokeless tobacco. This product will cause over 8,000 deaths, killing roughly one person per hour, 24 hours per day. Of those 42,000 newly diagnosed individuals, only slightly more than half will be alive in five years.
This is a number, which has not significantly improved in decades. The death rate for oral cancer is found to be much higher than that of cancers, which we hear about routinely. According to the World Health Organization, there is conclusive evidence that certain smokeless tobacco products increase risk of oral cancer, specifically smokeless tobacco in the United States. Studies have shown that one-third of the world’s population uses tobacco and of that one-third, half will die as a direct result to their use of this drug (Petersen).
In today’s society, an individual’s oral health is not only determined by their hygiene habits, but their social habits as well. Smokeless tobacco users have a 50 percent higher rate of oral cancer than non-users. Oral health is an even more immediate concern that all smokeless tobacco users need to be aware of (Heckman). As we all know, tobacco in any type of form is a very addicting drug. According to the Oral Cancer Foundation, for each 1,000 tons of tobacco produced, about one thousand people eventually will die.
Throughout this research paper, I am aiming to explain in greater detail the negative oral health issues associated with the use of smokeless tobacco, early symptoms of diseases related to the use of this product, and alternatives for users to partake in so they can reduce the likelihood of being affected from these various detrimental diseases. Repeated use of smokeless tobacco can cause a long list of oral health issues, such as the risk of oral cancer, as well as increased risk of dental carries, periodontal disease, and gingival recession; these negative significant impacts on an individual’s oral health are a direct result from the use of this product. Smokeless tobacco is also known as chewing tobacco or spitting tobacco.
It is available in two forms, snuff and chew. Both types of smokeless tobacco are held in the mouth inside the cheek or between the cheek and gum. Many people believe that smokeless tobacco is a safer alternative and substitution for smoking cigarettes. But according to U.S. Surgeon General, John Upton, “after a careful examination of the relevant epidemiologic, experimental, and clinical data, the committee concludes that the oral use of smokeless tobacco represents a significant health risk. It is not a safe substitute for smoking cigarettes.”
Many people believe that since they are not actually inhaling smoke into their lungs, that smokeless tobacco is a safer alternative for smoking cigarettes. Either way, there are many harmful chemicals found in both products. “It can cause cancer and a number of non-cancerous oral conditions and can lead to nicotine addiction and dependence.” (Upton) The most harmful chemicals that are found in smokeless tobacco are tobacco-specific nitrosamines, which are formed during the growing, curing, fermenting, and aging of tobacco.
Peter Harrison from the National Cancer Institute states that, “the bioassay data strongly support the epidemiological observation that ST is carcinogenic to humans. 28 carcinogens have been identified in chewing tobacco and snuff. The high concentrations of N-nitrosamines in smokeless tobacco, and especially the high levels of TSNA, are of great concern.” Scientists have found that the nitrosamine levels in tobacco are directly related to the risk of cancer (Harrison). Just like all tobacco products, nicotine is found in smokeless tobacco. While nicotine is absorbed more slowly from smokeless tobacco than from cigarettes, about four times more nicotine is absorbed from smokeless tobacco than from a cigarette, and the nicotine from smokeless tobacco remains longer in the bloodstream.
Nicotine is the main element responsible for tobacco addiction (Ward). “Three percent of adults in the United States around the age of 26 and older were users of smokeless tobacco, while around five percent of people aged 18 to 25 reported using smokeless tobacco.” This statistic shows how smokeless tobacco is very commonly used among younger aged people. If these younger aged users can get the proper knowledge of what is really in the tobacco products that they are using, the rates of these users would surely decrease.
“Rates of use among young people, who are under the age of 18, are higher than those of adults. In 2007, more than 13 percent of male high school students and more than two percent of female high school students reported using smokeless tobacco” (Jones). The connection between oral cancer and smokeless tobacco is very closely related. This is because the oral mucosal disorders that are in a smokeless tobacco user’s mouth are present at the direct site where the tobacco is most often placed for a prolonged period of time in the oral cavity (Cheng).
Oral leukoplakia is a common physical finding in 40 to 50 percent of people who use smokeless tobacco. Oral leukoplakia is a premalignant lesion, with the risk of malignant transformation to oral cancer varying in relation to the product used (Cheng). Smokeless tobacco can damage cells in the lining of the oral cavity and oropharynx. This causes the cells to grow more rapidly to repair the damage that has been done (Wexner Medical Center). Researchers from the American Cancer Society believe that DNA-damaging chemicals found in tobacco are linked to the increased risk of oral cancer. In many cases, the user usually does not recognize the early stages of oral cancer.
Most of the time, there are not many symptoms conspicuously shown. Normally, oral cancer begins as something called leukoplakia, which is a condition that is characterized by small white patches that develop inside areas of the mouth or throat. Erythroplakia, which is characterized by a red patch that develops inside areas of the mouth as well (Rice). Users who survive a first encounter with this disease have up to a twenty times greater risk of developing a second type of cancer.
This risk can last for up to five to ten years after the first occurrence (Oral Cancer Foundation). Leukoplakia has been shown to retrogress in as few as six weeks with smokeless tobacco cessation (Cheng). Gum recession is seen a lot in smokeless tobacco users mouths. This is caused from the constant irritation to the spot in the mouth where the smokeless tobacco is placed for an elongated period of time. This can result in permanent damage to the periodontal tissue and it can also damage the supporting bone structure around the gums. The injured gums pull away from the teeth, which expose root surfaces and leaves teeth very sensitive to heat and cold (Upton).
The nicotine that is present in smokeless tobacco causes the veins and arteries to tighten. When this happens, it decreases the sanguineous flow and then directly leads to gum recession. Gum recession causes teeth to move, and the movement of the teeth causes the teeth to eventually fall out. Nicotine found in any tobacco product stains the gums and teeth. The removal of nicotine stains is a very long and painful process.
Although gingival and periodontal inflammation and bone damage can clearly be in association with smokeless tobacco use, there surprisingly have not been studies that have been able to eliminate perplexing factors such as the use of other forms of tobacco, periodontal disease that was previously present in the mouth, or other systemic diseases such as diabetes that may affect oral hygiene (Cheng). Recent studies have shown that there is an increased risk for dental caries relating to the use of smokeless tobacco. Dental caries are the formation of cavities in the teeth due to the presence of bacteria (Jensen). According to Aparna Mir from her article in “Dental Health”, there are about six stages when it comes to the severity of dental caries.
The first stage of dental caries is when the surface of a tooth begins to formulate yellowish spots. This is due to the loss of calcium. If detected this early, the tooth can in fact be saved from further decay and damage by a fluoride application and minerals, which are present in the salvia. Stage two of dental caries is when tooth enamel begins to break below the surface layer without causing any damage over the actual surface of the tooth. If the decaying continues, it will lead to breakage on the tooth surface and this damage is permanent. In the third stage, the soft tissue part of the tooth near the root canals gets affected. When this happens, the roots become loose and then results in tooth loss.
A tooth cavity cleaned and filled by a professional prevents any further severe infection. The soft tissue surrounding the tooth becomes very tender due to the presence of bacteria. This results in pus formation causing surrounding blood vessels and nerves to die. A root canal is done to treat this type of condition. If the infection worsens, it will eventually reach the very tip of the tooth. The bones surrounding the tooth also get infected, which causes extremely severe pain. At the final stage of infection, the tooth gets completely infected and either falls out or has to be removed to stop any further infection (Mir). Over time, the tooth decaying can lead to the death of a tooth. There were some other studies conducted, and researchers have come to the conclusion that there is a insignificant relationship between smokeless tobacco and the cause of dental caries (Jensen).
It has been speculated that the lack of dental caries may be minor due to the fast salivary flow that the tobacco stimulates. Meaning that the amount of salvia that is naturally produced in the glands washes away the bacteria that cause the formation of dental caries (Greer). The risk of caries can result to the recession of the gingiva. With the softer dentin of the tooth exposed, there is a greater chance for demineralization and builds up of decay in the receded areas. Researchers from the American Dental Association conducted a study among 1,100 professional baseball players during their spring training in 1988, which looked at the risk of oral mucosal lesions connected with the use of smokeless tobacco. J. Greene and TE Daniels reported that leukoplakia was found to be strongly connected with the use of this product among the population of the baseball players.
They said that out of 423 smokeless tobacco users, 196 had leukoplakia compared to seven of the 493 nonusers. The amount of smokeless tobacco used, the type (snuff versus chewing tobacco), and brand of snuff used were directly related with risk for leukoplakic lesions among these smokeless tobacco users. 98 leukoplakic areas in 92 users were biopsied and examined microscopically by professionals in this field. All of the lesions, which were carefully examined were nonthreatening, but one specimen had mild epithelial dysplasia. The long-term connotation of leukoplakia in smokeless tobacco users and their relation to oral cancer still is not very clear (Greene, Daniels).
The more the negative health risks associated with the use of smokeless tobacco have increased, the more people are out to search for an alternative for this toxic product. Whether it is smoked or chewed, there is always a certain “ritual” to preparing and consuming tobacco that psychologically enhances its effects for many users and makes it more difficult to quit (Applebee). Luckily, these smart manufacturers of chewing tobacco alternatives have picked up on this. Tony Applebee explains how many manufacturers design their products with the appearance, texture, and mouth feel of chewing tobacco in mind. In his article, he talks about how there are two categories of alternatives to smokeless tobacco: replacement foods that mimic the feel of smokeless tobacco, and herbal chew alternatives specially designed to replace tobacco. He shows that there are some simple alternatives that replicate the feel of smokeless tobacco.
Certain foods, which include seeds or hard fruits and vegetables such as apples and carrots, which require you to chew them thoroughly and can go a long way toward satisfying oral cravings associated with smokeless tobacco are listed throughout the article to help give smokeless tobacco users an idea of what to use as an alternative (Applebee). In a way the unfavorable effects of smokeless tobacco can be thought of as a tiered cake. The existence of lesions is present at the bottom, the base, and then ending with the formation of oral cancer as the top of the cake. By taking out even one tier of the cake can result in an incomplete final product. Because the effects of using smokeless tobacco build on one another, the same is true for the oral cancer prevention. For example, by having the ability to detect the early stages and symptoms of oral cancer will help the user prevent for any further damage that could not just potentially harm their oral health, but their overall health as well.
Repeated use of smokeless tobacco can cause a long list of oral health issues, such as the risk of oral cancer, as well as increased risk of dental carries, periodontal disease, and gingival recession; these negative significant impacts on an individual’s oral health are a direct result from the use of this product. It is vital that more is done to ensure that public awareness of tobacco-related oral diseases continues to improve and more people are regularly screened.
Advising patients to quit tobacco use is a dental professional’s responsibility. This will dramatically improve the quality of life of those people who are at greatest risk of these diseases. The combination of providing opportunistic advice, particularly to stop using smokeless tobacco, together with regular screening will reduce the overall morbidity and morality from oral cancer and other mouth disorders.
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- Greene, J., and TE Daniels. “Oral Mucosal Lesions Found in Smokeless Tobacco Users.” The Journal of American Dental Association. By D. Grady. 1st edition Vol. 121. 117-23. Print. 25 March 2013.
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