Two Main Types of Smokeless Tobacco Chewing Tobacco Snuff
Smokeless Tobacco Chewing Tobacco Loose leaf Processed cigar type tobacco loosely packed in small strips
Smokeless Tobacco Chewing Tobacco Plug Small oblng blocks of semi-soft tobacco Place tobacco next to the gingival/buccal mucosa
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
Smokeless Tobacco Snuff Dry Placed in oral cavity or sniffed through the nose
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
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
Adverse Medical Consequences Many problems affecting different systems in the body Central Nervous System Heart Disease Hypertension Lipids Diabetes
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
Central Nervous System (CNS) Vascular Disease Cerebrovascular Accidents TIA’s Stroke
Central Nervous System Receptors of nicotine in the CNS Adiction
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”
Health Consequences of Nicotine Exposure Nicotine intoxication *Accelerated coronary and peripheral vascular disease Stroke Hypertension *Of greatest concern
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
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
Dentists Results indicate the need for further education in tobacco and cessation counseling for dentists.
ROLES OF THE DENTAL PROFESSION ORAL CANCER SCREENING Non-invasive procedure No discomfort No pain Inexpensive
Clinically…What to look for? Head and Neck examination Intraoral examination
INTRAORAL EXAMINATION Where to look? Site of Smokeless Tobacco Placement Vestibular area Attached Gingiva Oral mucosa Tongue Floor of the mouth Hard tissues
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.
DISCOVERY & DIAGNOSIS Result from Visual and manual examination Systematic visual exam of all the soft tissues of the mouth
DIGITAL PALPATION OF THE NECK INCLUDING THE THYROID AND SURROUNDING LYMPH NODES SURROUNDING THE ORAL CAVITY.
OTHER DIAGNOSTIC AIDS LIGHTS DYES OTHER TECHNIQUES APPEARING IN THE MARKET.
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
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.
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
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?
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
Referral Dental specialist: periodontist Oral medicine specialist
Confirmation of the Disease By the pathologist is obtained Referral of patient to a proper medical intervention, Oncologist
Continued help after diagnosis Preparing the patient for treatment through proper management of oral tissues before, during and after treatment.