Tobacco: Bad News in Every Form

I can’t believe I still have to write about this. Because friends it does not matter if you’re smoking it, how you’re smoking it or if you’re chewing it. There is nearly nothing good that comes out of this, other than maybe a little aftertaste of green apple. But at what expense?

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Tobacco doesn’t only harm the oral health, which is admittedly what we’ll be focusing on, but it also does it’s work on the heart and lungs and is associated with cancer and diabetes.

WHO data shows that tobacco use kills nearly six million people in a year. Some of the most lethal components of tobacco are:

  • Nicotine
  • Carbon monoxide
  • Tar

Various forms of tobacco have emerged considering people just want new ways to hurt themselves:

  1. Smoking: cigarettes, cigars, bidi
  2. Smokeless tobacco
  3. Chewing tobacco
  4. Water pipe smoking
  5. E-cigarettes or “vape”

No matter the form, the damage is more or less the same.

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Fig. 1 A type of chewing tobacco

On the body:

Before we get into details of the effect on the mouth, let’s start with the body in general. Tobacco could lead to constricting or the bursting of blood vessels in the brain, which could lead to a stroke. 

As for the heart, the decrease in blood supply can lead to ischemic heart disease, and in turn cause cardiac arrest.

Symptoms on the respiratory system include coughing, wheezing or dyspnea and are what contribute to chronic obstructive pulmonary disease. 

These are signs noticeable at a clinical level, but at a molecular level, lots of changes take place too, including an increase in inflammation and impairment of the immune system. (2)

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On the mouth:

Tobacco use has been linked with an adverse effect on your gums, implant failure and risk of oral cancers. Both smoking and chewing tobacco have their set of detrimental negative effects on the mouth.

Periodontal Tissues:

We mean your gums, essentially. And the jaw bone that goes under it. The bacterial diseases that can affect these are called gingivitis, which is the inflammation of the gums and periodontitis which involves the bone as well. It has been proven that smoking can lead to the development of periodontal diseases, and increased smoking leads to increased disease severity. (3, 4, 5)

Smoking causes a condition called ‘peri-implantitis’, which is bad news for implant wearers, as pockets form around the implant, which could lead to failure of the implant. 

Smokeless tobacco keratosis:

A translucent looking lesion can form on the gums or cheeks, depending on the placement or use of smokeless or chewing tobacco. These can sometimes indicate the changes at a molecular level of the skin into cancer. Yes, I said cancer.

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Fig. 2: Smokeless tobacco keratosis

Oral Cancer

Use of tobacco in its many forms, including reverse smoking, chewing of betel quid (a mix of areca nut, slaked lime and tobacco wrapped in betel leaf) and the use of smokeless tobacco can lead to oral cancer. 

Components of tobacco, like tobacco specific N-nitrosamines, interact with the molecular environment to produce the change that leads to cancer. 

This incorporates all our methods of tobacco intake, but the new hip ways should be drawn further light on: 

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Hookah/water pipe smoking

The smoke from water-pipes contains high levels of toxic elements. What’s more, a hookah smoking session can often last longer, and the user can have inhaled smoke the equivalent of 100-200 cigarettes! (6)

Vapes/e-cigarettes

Vapes could be considered an aid in cessation of smoking, since they don’t actually contain tobacco. However, the aerosol or ‘vapor’ that is smoked contains its own set of toxins that are harmful on inhalation. 

So why be fully aware, and yet choose to harm yourselves? 

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Fig. 3: Types of e-cigarettes

References:

  1. https://www.nhp.gov.in/effects-of-tobacco-on-health_pg
  2. https://www.ncbi.nlm.nih.gov/books/NBK310413/
  3. Bergstrom J. Cigarette smoking as risk factor in chronic periodontaldisease. Community Dent Oral Epidemiol 1989;17:245-7.
  4. Amarasena N, Ekanayaka AN, Herath L, Miyazaki H. Tobacco useand oral hygiene as risk indicators for periodontitis. Community DentOral Epidemiol 2002;30:115-23.
  5. Haber J, Kent RL. Cigarette smoking in a periodontal practice. JPeriodontol 1992;63:100-6
  6. https://www.health.nsw.gov.au/tobacco/Factsheets/water-pipe-smoking.pdf