Each day in the US tobacco companies spend $26 million on marketing cigarettes and smokeless tobacco, which is distressing as smoking is the leading cause of preventable disease and death. It affects every organ of the body and causes inflammation and impaired immune function. Most people know that smoking affects your overall health but many forget that it also affects your oral health. As a dental hygienist part of my job is to do an intra-oral exam, and discuss any oral habits you have that could affect your oral health. I recently read an article about the use of tobacco, and other forms of smoking. The article contained a lot of significant information on many different types of tobacco, in addition to how it affects your oral health. I felt it was important to share some of the key information especially with the increase concerns of E-cigarette use. “Smoking” is now a term used to describe many forms of tobacco use including; cigarettes, cigars, hookahs, smokeless tobacco, E-cigarettes/ vaping, and marijuana.
The main ingredient in tobacco products is nicotine. Nicotine itself is what makes tobacco products addictive. Although nicotine is not illegal, it’s the most commonly abused addictive substance on the market. Nicotine works by activating the reward pathways that regulate feelings of pleasure. These are the same reward centers that are stimulated by other commonly abused addictive drugs.
As many of you already know cigarettes are the most common form of smoking. They are extremely addicting, even more now as they contain 15% more nicotine than they did in 1999 (1). About 90% of people who become addicted to cigarette do so before the age of 18, and children of mothers who smoke while pregnant are more likely to become smokers (1). Although numbers have shown a decrease in cigarette sales, other forms of tobacco use have increased, especially Electronic Nicotine Delivery Systems, commonly known as E-Cigarettes.
E- Cigarettes “Vaping “is a battery powered product that delivers nicotine in the form of an aerosol. I was in shock when I read in the article that the use of these increased 900% from 2011- 2015 among high school students. The Surgeon General is calling a major public health concern to E- Cigarette use among the youth and young adults. They are also now banded for public use or sales in Massachusetts for at least the next 4 months. This comes as no surprise especially with the most recent deaths, and severe lung disease that has occurred with the use of these E-Cigarettes. The deaths that have occurred are still being investigated to find out what went wrong, but they are encouraging everyone to stop using them at this time. The problem started because E-Cigarettes were/ are being marketed in such a way that young adults are thinking they are safe, and won’t lead to addiction. They are designed to be compact making them easier to hide from parents and teachers. Studies have shown that E-cigarettes are a gateway to cigarette smoking and other forms of smoking. It’s important to know that data shows two sides to E-cigarettes. The 1st is for those who have never smoked and start using because it’s “cool”, these youth are 6.17 times more likely to start smoking cigarettes than those who never use an e-cigarette. The 2nd side is for those who are trying to quit smoking, E-cigarettes have shown to be helpful in decreasing the nicotine amount allowing them to reduce withdrawals and craving leading to quitting smoking all together.
Another commonly smoked substance is Marijuana which is made up of dried leaves, flowers, stems and seeds from the hemp plant Cannabis sativa. The mind- altering substance that causes people to get “high” is delta-9 tetrahdrocannabinol, commonly known as THC. Marijuana can be smoked or mixed into foods. When it is smoked, the THC passes quickly though the bloodstream, brain, and other organs which result in a high within minutes. When consumed through eating your body absorbs the THC slower so the effects occur within 30- 60 minutes, be aware with a delayed on set you have an increased risk of over consumption of THC. Marijuana has become more potent over the years as higher amounts of THC have been found in it. There has been a vast increase in the use of Marijuana since 2001 and it’s been said that 3 out of 10 users meet the criteria for addiction (1). The average user is between the age of 18 and 29. Most states within the United States have legalized it for medical use, even though the FDA has not approved marijuana as a safe and effective drug. Before they will approve it, clinical trials need to be done to evaluate its safety and effectiveness. This is important to know because without FDA approval the purity and potency of medical marijuana can vary, so make sure you know what you are buying.
Have you ever been to a Hookah bar? Hookahs are a very common group activity especially in college. I included this because I think many people do not realize what they are exposing their organs to when using a Hookah. I felt it was important to share with young adults. Hookahs are thought to be less harmful than cigarettes, but one single use is exposing you to 1.7 times more nicotine, 8.4 times more carbon dioxide, and 36 times more tar than a cigarette, equaling about ten cigarettes per day. That’s a lot and even that small amount of exposure can have an effect on your health.
Cigar bars or rooms are a common meeting place for men and some women which is why they are the 2nd most common form of smoking. Most people feel they are a safer way of smoking and a enjoy them with an evening night cap, or to celebrate a special occasion. Be aware that cigars are still a health risk, even if not inhaled, the nicotine from cigars is absorbed though the oral mucosa (tissues in your mouth) instead of the lungs and can lead to oral cancers which you can die from.
The final concern is smokeless Tobacco, commonly known as “dip” which is also absorbed though the oral mucosa, and like cigars can cause oral cancers. Many users think it’s less harmful than cigarettes, but it actually contains 28 cancer-causing chemicals in addition to the nicotine (1). Here is an example they used in the article; if you pack an average size “dip” in your mouth for 30 minutes that is equal to about 3 cigarettes. If you use two cans a week that equals smoking one and a half packs a day. The tobacco companies have now come out with dissolvable “dip”. This dip does not need to be spit out, making it more convenient to use. Parents need to be aware they are also making flavored smokeless tobacco, making this product more attractive to the younger audience. It’s also important to be aware of this because younger children may think its candy which could lead to accidental nicotine poisoning.
As we all know all, smoking affects our overall health and increases the risk for many health problems but they also can affect your oral health, which in full circle, affects your overall health. Now that I have reviewed the key information about the different types of smoking here are the most common ways smoking affects your oral health; People who smoke tobacco or marijuana are more likely to develop periodontal disease than nonsmokers. Smokers also have a higher risk of implant failure. Oropharyngeal cancers are commonly diagnosed in those who smoke as well as those who use smokeless tobacco products. Those who are exposed to second hand smoke are also more prone to have an increased risk in periodontal disease and most important, children who are exposed have a higher risk of decay especially in baby teeth. They have also found in a recent study that the aerosols produced by e-cigarettes were toxic to oral epithelial cells in vitro (1). It’s important to remember that people who smoke when others are present are exposing those people to second hand smoke, even those using E-Cigarettes are exposing people to nicotine and chemicals through the aerosols. If you choose to smoke be aware of the short and long term effects not only for you, but your loved ones. If you’re a young adult and start smoking because you think it’s cool and your friends are doing it; ask yourself if it’s worth it, and who is going to be paying your medical bills. Your health is your wealth, and you are the one in control of it.
1. Trends in Smoking and Tobacco Use; Written by Carol A. Jahn, RDH, MS