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

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Presentation on theme: "Oral Effects of Smokeless Tobacco Lourdes Vazquez, RDH, MS, ECP."— Presentation transcript:

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 Central Nervous System Heart Disease Hypertension Lipids Diabetes

17 Effects of smokeless Tobacco  Physiological effects of Nicotine Cardiovascular System 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


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



63 BIOPSY  ONLY MEANS OF DIAGNOSIS OF ORAL CANCER MAY BE THROUGH BIOPSY.  How long has the suspicious lesion been present? Herpes simplex 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.



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