Many years ago I could have been considered to be a “chain smoker.”
I smoked between forty and fifty cigarettes every day. Then on June 10, 1980 I decided to quit and since that day a cigarette never touched my lips. There are currently about 270,000 citizens in Guyana who smoke. Statistics show about one quarter of all dental patients use tobacco. It is scientifically recognised that smoking is among the nation’s leading preventable health problem and is responsible for one in every six deaths. It is common knowledge there is a link between smoking, lung cancer and heart disease. Smoking also contributes to cancer of the kidney, cervix, pancreas, bladder and stomach.
From the standpoint of oral health, smoking (cigarette, pipe and cigar) is linked to cancer of the mouth, pharynx, oesophagus and larynx. Chronic use of smokeless tobacco has been directly linked to cancer of the larynx, mouth, throat and eosophagus. Chronic smokeless tobacco users are 50 more times more likely to develop oral cancer than nonusers, and the risks are greatest in intraoral locations where the tobacco is usually stored. Oral cancer is usually treated with a combination of radiation therapy, chemotherapy and surgery. If it is not diagnosed early, oral cancer may require extensive, disfiguring surgery; or worse, it may be fatal.
The overall five-year survival rate for oral cancer patients is about 50 percent, with only 23 percent of those with regional lymph node involvement surviving.
Leukoplakia is a soft-tissue lesion that is characterised by a white patch or plaque. It is usually a localized condition that is related to irritation from a badly fitting denture, broken teeth, or tobacco. High- risk sites include the floor of the mouth and the underside of the tongue. Although leukoplakia is not extensively seen in tobacco users, it is definitely associated with both smoking and smokless tobacco use. The tobacco/leukoplakia association is related to the frequency, amount, and duration of the tobacco use. It has been reported that 2 to 6 percent of leuoplakia will become malignant. Further, the lesions often heal when tobacco use is stopped.
Overwhelming scientific evidence shows periodontal (gum) disease is more likely to occur in smokers than non-smokers, and is usually more severe (often resulting in tooth loss). It is interesting to note that smokers usually have higher levels of dental plaque, but the tendency for their gums to bleed is lower. The diagnosis and treatment of periodontal disease for this group may be delayed because they don’t usually have bleeding gums.
The oral effects of smoking are stains on teeth, tooth restorations, and the tongue; calculus buildup on the teeth and bad breath. Smoking dulls a person’s ability to taste and smell; irritates tissues in the mouth; and delays healing after a tooth has been extracted (including a dry socket) or after oral surgery. Several studies have shown that smoking is the greatest barrier to tissue healing after periodontal therapy, especially when soft tissue is grafted and/or surgery is performed. Periodontal therapy is more likely to fail if the patient continues to smoke. There is a positive association between smokeless tobacco use and gingival (gum) tissue recession at the site where the tobacco is usually stored in the mouth. Smoking cessation is usually associated with a reduction in the formation of calculus.
The American Dental Association has launched an all-out effort to involve dentists in an organised intervention programme to provide tobacco-cessation services to patients. If we in Guyana should adopt such a programme it would be especially important for Dentexes and Community Dental Therapists to be active in this programme because periodontal disease, oral cancer, and wound healing are so closely linked to cigarette smoking. Trained oral health professionals are able to offer tobacco cessation counseling with minimal interruptions in patients’ daily routines. They are the most logical health professionals to provide this information to patients because they already see patients on a regular basis.
Whatever the reason people give for continuing to smoke, the reality is that nicotine, a drug found in tobacco, is addictive. It is a stimulant that increases the heart rate and blood pressure, and it acts on the pleasure centres deep within the brain. It causes both physical and emotional addiction. As smokers develop a tolerance to nicotine they need more to get the same physiological/psychological effect. This makes their addiction very difficult to overcome.
The FDA has approved prescriptive agents (such as nicotine-containing gum and transdermal patches) to be used in conjunction with tobacco-cessation programs. The American Dental Association (of which this author is a member) has also created a new code for oral health professionals to use to bill insurance companies for their counselling services.
If you don’t smoke, don’t start! If you want to stop, here are some techniques listed in a recent brochure from the ADA:
? Make a list of reasons you want to quit
? Set a date you will quit, and then do it
? Join a formal smoking-cessation support group
? Exercise
? Keep your mouth occupied with sugarless gum etc.
? Keep your hands occupied with needlepoint, woodworking etc.
? Choose a low-stress time such as your vacation to stop smoking
? Stop all at once and give yourself a reward if you succeed
? Don’t let setbacks discourage you – keep trying
? Use all available resources (audio and video tapes, books, and self-elp materials).
By Dr. BERTRAND R. STUART D.D.S