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Tobacco |
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Smoking and chewing There are approximately 13 million adult smokers in the UK - 28 per-cent of the population. It is
estimated that about 4 million smokers a year attempt to quit the habit but of these only about 5% succeed. The damaging and harmful
effects of tobacco on oral health and the mouth tissues are now well recognised:- Smoking tobacco Tobacco smoke is made up of "side-stream smoke"
from the burning tip of the cigarette and "main-stream smoke" from the filter or mouth end. Tobacco smoke contains thousands of different
chemicals that are released as particles and gases. Many toxins (poisons) are present in tobacco smoke. The particle part includes
nicotine and "tar" (itself composed of many chemicals). The gas part includes carbon monoxide, ammonia, formaldehyde, hydrogen cyanide
and other complex chemicals. Some of these are known to be irritants and some 60 chemicals have been shown to cause cancer (carcinogens).
There is no evidence that switching to lower tar cigarettes will reduce the harm done to oral tissues. Chewing tobacco and snuff In
the European Union there is a ban on the sale of both chewing tobacco and snuff except in Sweden. Chewing tobacco is however, used
in England, predominantly by Asian communities. Most often it is mixed with other substances such as areca nut. People who chew tobacco
mix it to produce a ball (quid), which is often kept in the mouth for some considerable time. It is frequently tucked in one place
- for example the cheeks of the mouth where it greatly increases the user's risk of developing leukoplakia - a pre-cancerous lesion.
It is well established that there is a much higher number of cases of oral cancer among the Asian community who chew tobacco or areca
nut. Smoking causes discolouration of the teeth. It is likely to cause halitosis (bad breath) and may affect smell and taste. Wound
healing is impaired in tobacco smokers. There is fair evidence that tobacco use contributes to the pro-gression of periodontal (gum)
disease. Treatment for periodontal disease often fails among smokers and it is difficult to halt the progression of the disease, which
results in the destruction of the fibres holding the teeth in place. For similar reasons dental implants fail twice as often in people
who smoke compared with non-smokers. 75% of oral cancers are associated with tobacco smoking (i.e. cigarette, pipe or cigar smoking)
especially when combined with heavy alcohol intake. The risk of developing oral and pharyngeal (throat) cancers is similar for cigarette
and cigar smokers, with an overall risk seven to ten times higher than for people who have never smoked. When the frequency of daily
tobacco use is taken into consideration there is a strong relationship between smoking rates and the risk of mouth cancer. In other
words, the more a person smokes the more at risk they are. After giving up tobacco for a decade or so the risk of oral cancer of a
past smoker drops significantly to levels almost comparable to people who have never smoked. Dependence on tobacco shows the many
features of a chronic disease. People who regularly smoke are addicted to the habit because tobacco use results in true drug dependence.
Only a small minority are able to stop smoking in one attempt and the majority will need some assistance to quit altogether. Many
effective treatments are now available and dentists and their team members are becoming more actively involved in helping patients
to stop smoking. As with other chronic diseases, the most effective treatment of smoking requires several approaches in addition to
the willpower of the smoker and the advice of a clinician. Many products available in high street chemists are proven to be effective
and improve the success rates for people quitting smoking. Nicotine replacement therapy (NRT) is the first line of treatment. Several
products are available; patches, gum, lozenges, inhalers and nasal sprays. All of these are now available on prescription from a general
medical practitioner or through pharmacists. Other non-nicotine alternatives also exist to help with smoking cessation. Both forms
of treatment offer very significant success in the quest to stop smoking. In assisting a smoker who is willing to quit, a dentist
will have the five ‘A’s’ in mind. He or she will:- 1. Ask about tobacco use. 2. Assess
the willingness to quit. 3. Advise those unwilling to quit that the topic will be revisited at their next
dental appointment. 4. Assist in the quit attempt - set a quit date, emphasise the importance of total abstinence,
provide supplementary material, and recommend support from a doctor or tobacco councellor (smoker’s clinic). 5. Arrange a follow up dental appointment and reference to a doctor if the quit attempt has failed. |