Statistics show about one quarter of all dental patients use tobacco. It is scientifically recognized that smoking is among Guyana’s leading preventable health problem. It may surprise you that for every six persons who die the effect of smoking kills one. 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 and cigar) is linked to cancer of the mouth, pharynx, esophagus and larynx. Chronic use of smokeless tobacco has been directly linked to cancer of the larynx, mouth, throat and esophagus. 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 characterized 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 smokeless 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 leukoplakia 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 nonsmokers, 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.

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 Food and Drug Department 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 (ADA) (of which this author is a member) has also recently created a new code for oral health professionals to use to bill insurance companies for their conselling 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 help materials).