Download pdf - Oral Effects of Smokeless Tobacco

7/28/2019 Oral Effects of Smokeless Tobacco

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Oral Effects of SmokelessTobacco

Lourdes Vazquez, RDH, MS, ECP


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Two Main Types of SmokelessTobacco

Chewing TobaccoSnuff
http://www.maxillofacialcenter.com/images/SnuffDental.jpg


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Smokeless Tobacco

Chewing TobaccoLoose leaf

Processed cigar type tobacco looselypacked in small strips


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Smokeless Tobacco

Chewing TobaccoPlug

Small oblng blocks of semi-soft tobaccoPlace tobacco next to the gingival/buccalmucosa


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Smokeless Tobacco

Snuff (finely ground tobacco)Moist

Used by dippingPlacing it between the gum and the cheek orunder the upper or lower lip


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Smokeless Tobacco

Snuff Dry

Placed in oral cavity or sniffed through thenose


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Smokeless Tobacco Use

The highest rate of smokelesstobacco users is found in:

8-17 year old white malePeople in the North-Central and South-Central statesBlue collar occupations


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Nicotine Effects on the CNS

Stimulating effectsSeen with low dose of nicotine

Affecting the brain at the cortex andLocus ceruleus

Reward like effectsSeen with high dose of nicotine levels

Affecting the brain in the Limbic system


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Symptoms of NicotineToxicity

NauseaVomiting

DiarrheaAbdominal painSweats

Flushdizziness


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Effects of Nicotine Toxicity

Perinatal ExposureHypoxemia of fetus

Spontaneous abortionPlacental disruptionPreterm deliveryDecreased milk production


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Nicotine Toxicity

Interferes with birth control pillsInfertility

Impotence


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Nicotine Dependence

PhysiologicPsychologic

Behavioral


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Behavioral Dependence

Social use patternsRitualistic triggers

Behavioral habits


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Physiologic Dependence

WithdrawalTolerance


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Nicotine Withdrawal Symptoms

AnxietyIrritability

Poor concentrationRestlessnessCravingGI problemsHeadachesdrowsy


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Adverse Medical Consequences

Many problems affecting differentsystems in the body

Central Nervous SystemHeart DiseaseHypertensionLipids

Diabetes


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Effects of smokeless Tobacco

Physiological effects of NicotineCardiovascular SystemCentral Nervous SystemEndocrine System

Oral cancer

Cancer risk of cheek and gum mayreach nearly fiftyfold among long-termsnuff users


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Central Nervous System (CNS)

Vascular DiseaseCerebrovascular Accidents

TIAs Stroke


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Central Nervous System

Receptors of nicotine in the CNSAdiction


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Dependence on Smokeless Tobacco

U.S. SurgeonGeneral(1986):Geven the nicotinecontent of smokeless tobacco, itsability to produce high andsustained blood levels of nicotine,and the well-established dataimplicating nicotine as an addictivesubstance, one may deduce thatsmokeless tobacco is capable of producing addiction in users


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Health Consequences of NicotineExposure

Nicotine intoxication*Accelerated coronary andperipheral vascular diseaseStrokeHypertension

*Of greatest concern


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Complications

Delayed wound healing*Reproductive or perinatal disorders

(low birth weight, prematurity,spontaneous abortion)Peptic ulcer diseaseEsophageal reflux

*Of great concern


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Heart Disease

Smokeless tobacco causes similareffects as those seen in smoking

Increase in heart rate (30% higher)Increase in blood pressureLess cardiovascular risk than smokingpossibly due to lack of carbon

monoxide and related compounds


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*Cardiovascular Disease

Heart rate accelerationPromote atherosclerotic vascular

diseaseAggravate hypertension by causingvasoconstrictionAcute cardiac ischemia (angina,myocardial infarction, even suddendeath)


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Hypertension

Blood pressure levels are affectedby:

High sodium levelsNicotineLicorice , which causes sodiumretention


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Lipids

According to an article published inthe American Journal of PublicHealth (1989)

Smokeless tobacco users had 2.5 timesincrease in cholesterol


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Diabetes

Smokeless tobacco as well asCigarette smokers have increaseinsulin levels which suggests a linkwiht insulin resistance


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MAJOR RISK

HEAD AND NECK DISEASE


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SMOKELESS TOBACCO LESIONS(STLs)

Appear as changes in color andtexture of the oral mucosa

Are the most prevalent oral softtissue lesions among adolescents inthe 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 marginLoss of attachmentTooth abrasionHyper keratinizedsoft tissues


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Periodontal Disease3-5% of diseased gingival andperiodontal tissue becomes oralcancer


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Potent Carcinogens

NitrosaminesPolycyclic aromatic hydrocarbons

Radiation-emitting polonium


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Abnormal Changes at Cancerizationsite

Clinically:LeukoplakiaErythroplasiaDysplasiaCarcinoma in situ


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Hyper Keratosis


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Oral Leukoplakia
http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/derm/images/Large/2674der2.jpg&template=izoom2


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Leukoplakia

Under the tongue
http://www.maxillofacialcenter.com/images/LeukTongue.jpg


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Oral leukoplakia/Cancer under theupper lip

A portion of leukoplakias canunder go

transformation todysplasia andfurther to cancer.


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TONGUE

Cancer under thetongue


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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
http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/derm/images/Large/2673der1.jpg&template=izoom2


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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 inCessation Counseling: Survey Findings

73-item survey mailed to 1,064dentists in Central Ohio529 responded9% were effective at gettingpatients to quit71% willing to provide educational

pamphlets6% would consider to prescribenicotine gum


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Dentists

Results indicate the need for furthereducation in tobacco and cessationcounseling for dentists.


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ROLES OF THE DENTALPROFESSION

ORAL CANCER SCREENINGNon-invasive procedure

No discomfortNo pain

Inexpensive


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ClinicallyWhat to look for?

Head and Neck examinationIntraoral examination


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INTRAORAL EXAMINATION

Where to look? Site of SmokelessTobacco Placement

Vestibular areaAttached GingivaOral mucosaTongue

Floor of the mouthHard tissues


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Oral Examination
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Intra-oral examination
http://images.search.yahoo.com/search/%20http:/images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fei%3DUTF-8%26p%3DOral%2BExamination%26fr%3Dyfp-t-471%26b%3D41&w=307&h=196&imgurl=www.infocompu.com%2Fadolfo_arthur%2Fimages%2Festudio2.jpg&rurl=http%3A%2F%2Fwww.infocompu.com%2Fadolfo_arthur%2Fingles%2Fexamen.htm&size=37.3kB&name=estudio2.jpg&p=Oral+Examination&type=jpeg&no=52&tt=646&oid=b60d6405f717a326&ei=UTF-8


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Base and borders of the tongue
http://images.search.yahoo.com/search/%20http:/images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fei%3DUTF-8%26p%3DOral%2BExamination%26fr%3Dyfp-t-471%26b%3D41&w=291&h=194&imgurl=www.infocompu.com%2Fadolfo_arthur%2Fimages%2Festudio13.jpg&rurl=http%3A%2F%2Fwww.infocompu.com%2Fadolfo_arthur%2Fingles%2Fexamen.htm&size=36.5kB&name=estudio13.jpg&p=Oral+Examination&type=jpeg&no=53&tt=646&oid=54193b15db46dcb4&ei=UTF-8


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Pharynx, Soft Palate, Pilars.
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Buccal Mucosa
http://images.search.yahoo.com/search/%20http:/images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fei%3DUTF-8%26p%3DOral%2BExamination%26fr%3Dyfp-t-471%26b%3D41&w=301&h=195&imgurl=www.infocompu.com%2Fadolfo_arthur%2Fimages%2Festudio6.jpg&rurl=http%3A%2F%2Fwww.infocompu.com%2Fadolfo_arthur%2Fingles%2Fexamen.htm&size=31.7kB&name=estudio6.jpg&p=Oral+Examination&type=jpeg&no=57&tt=646&oid=9bd87d07210d4562&ei=UTF-8


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Ventral
http://images.search.yahoo.com/search/%20http:/images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fei%3DUTF-8%26p%3DOral%2BExamination%26fr%3Dyfp-t-471%26b%3D61&w=293&h=190&imgurl=www.infocompu.com%2Fadolfo_arthur%2Fimages%2Festudio14.jpg&rurl=http%3A%2F%2Fwww.infocompu.com%2Fadolfo_arthur%2Fingles%2Fexamen.htm&size=35kB&name=estudio14.jpg&p=Oral+Examination&type=jpeg&no=64&tt=646&oid=d2f4011366b563f8&ei=UTF-8


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Vermillion Borders
http://images.search.yahoo.com/search/%20http:/images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fei%3DUTF-8%26p%3DOral%2BExamination%26fr%3Dyfp-t-471%26b%3D61&w=300&h=204&imgurl=www.infocompu.com%2Fadolfo_arthur%2Fimages%2Festudio.jpg&rurl=http%3A%2F%2Fwww.infocompu.com%2Fadolfo_arthur%2Fingles%2Fexamen.htm&size=34.8kB&name=estudio.jpg&p=Oral+Examination&type=jpeg&no=63&tt=646&oid=89d810692abafa12&ei=UTF-8


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Discovery and Diagnosis

Any sore, discoloration, induration,prominent tissue, horseness whichdoes not resolve within a twoweeks period on its own, with orwithout treatment, should beconsidered for further examination

or referral.


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DISCOVERY & DIAGNOSIS

Result from Visual and manualexamination

Systematic visual exam of all the softtissues of the mouth


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DIGITAL PALPATION OF THE NECK

INCLUDING THE THYROID ANDSURROUNDING LYMPH NODESSURROUNDING THE ORAL CAVITY.


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OTHER DIAGNOSTIC AIDS

LIGHTSDYES

OTHER TECHNIQUES APPEARING INTHE MARKET.


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BIOPSY

ONLY MEANS OF DIAGNOSIS OFORAL CANCER MAY BE THROUGHBIOPSY.How long has the suspicious lesionbeen present?

Herpes simplex ulceration

Aphthous lesions14 days


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BIOPSY BRUSH

Easy, painless, accurate diagnosisof soft tissue abnormalities.Not designed to provide theinformation, specifically cellulararchitecture that a punch orincisional biopsy would provide.Will allow us to know whether amalignancy exists or not throughminimal 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 brushbiopsy needs to be followed by aconventional biopsy.Often the only way to diagnose orallesions and diseasesMost are performed at a hospital


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POINTS TO CONSIDER PRIOR TOMUCOSAL BIOPSY

Why is biopsy being taken?What information is required from thepathologist?

Is the biopsy to exclude malignancy?Is the biopsy incisional or excisional?Will the specimen be required to beorientated?Is a fresh specimen required?

f l


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Information to accompany mucosalbiopsies

Patient demographic dataDescription of the clinical appearance of the lesion and suspected diagnosis

The site of the biopsyThe relationship of the lesion torestorations, particularly amalgamA detailed drug historyMedical history including blood dyscrasiasSmoking and alcohol consumption


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Referral

Dental specialist: periodontistOral medicine specialist


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Confirmation of the Disease

By the pathologist is obtainedReferral of patient to a propermedical intervention, Oncologist


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Continued help after diagnosis

Preparing the patient for treatmentthrough proper management of oraltissues before, during and aftertreatment.


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ALTERNATIVES TO QUITING

PROGRAMS AND SUPPORT


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PROGRAMS AND SUPPORTGROUPS