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Oral effects of_smokeless_tobacco


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Oral effects of_smokeless_tobacco

  1. 1. Oral Effects of SmokelessTobaccoLourdes Vazquez, RDH, MS, ECP
  2. 2. Two Main Types of SmokelessTobacco Chewing Tobacco Snuff
  3. 3. Smokeless Tobacco Chewing Tobacco  Loose leaf  Processed cigar type tobacco loosely packed in small strips
  4. 4. Smokeless Tobacco Chewing Tobacco  Plug  Small oblng blocks of semi-soft tobacco  Place tobacco next to the gingival/buccal mucosa
  5. 5. 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
  6. 6. Smokeless Tobacco Snuff  Dry  Placed in oral cavity or sniffed through the nose
  7. 7. 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
  8. 8. 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
  9. 9. Symptoms of NicotineToxicity Nausea Vomiting Diarrhea Abdominal pain Sweats Flush dizziness
  10. 10. Effects of Nicotine Toxicity Perinatal Exposure  Hypoxemia of fetus  Spontaneous abortion  Placental disruption  Preterm delivery  Decreased milk production
  11. 11. Nicotine Toxicity Interferes with birth control pills Infertility Impotence
  12. 12. Nicotine Dependence Physiologic Psychologic Behavioral
  13. 13. Behavioral Dependence Social use patterns Ritualistic triggers Behavioral habits
  14. 14. Physiologic Dependence Withdrawal Tolerance
  15. 15. Nicotine Withdrawal Symptoms Anxiety Irritability Poor concentration Restlessness Craving GI problems Headaches drowsy
  16. 16. Adverse Medical Consequences Many problems affecting different systems in the body  CentralNervous System  Heart Disease  Hypertension  Lipids  Diabetes
  17. 17. Effects of smokeless Tobacco Physiological effects of Nicotine  CardiovascularSystem  Central Nervous System  Endocrine System  Oral cancer  Cancer risk of cheek and gum may reach nearly fiftyfold among long-term snuff users
  18. 18. Central Nervous System (CNS) Vascular Disease Cerebrovascular Accidents  TIA’s  Stroke
  19. 19. Central Nervous System Receptors of nicotine in the CNS Adiction
  20. 20. 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”
  21. 21. Health Consequences of NicotineExposure Nicotine intoxication *Accelerated coronary and peripheral vascular disease Stroke Hypertension *Of greatest concern
  22. 22. Complications Delayed wound healing *Reproductive or perinatal disorders (low birth weight, prematurity, spontaneous abortion) Peptic ulcer disease Esophageal reflux *Of great concern
  23. 23. 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
  24. 24. *Cardiovascular Disease Heart rate acceleration Promote atherosclerotic vascular disease Aggravate hypertension by causing vasoconstriction Acute cardiac ischemia (angina, myocardial infarction, even sudden death)
  25. 25. Hypertension Blood pressure levels are affected by:  High sodium levels  Nicotine  Licorice , which causes sodium retention
  26. 26. Lipids According to an article published in the American Journal of Public Health (1989)  Smokeless tobacco users had 2.5 times increase in cholesterol
  27. 27. Diabetes Smokeless tobacco as well as Cigarette smokers have increase insulin levels which suggests a link wiht insulin resistance
  29. 29. SMOKELESS TOBACCO LESIONS(STL’s) Appear as changes in color and texture of the oral mucosa Are the most prevalent oral soft tissue lesions among adolescents in the U.S.
  30. 30. HARD TISSUES Effects on teeth: Discoloration of the teeth and receding gingiva
  31. 31. ATTACHED GINGIVA Recession of gingival margin Loss of attachment Tooth abrasion Hyper keratinized soft tissues
  32. 32. Periodontal Disease 3-5% of diseased gingival and periodontal tissue becomes oral cancer
  33. 33. Potent Carcinogens Nitrosamines Polycyclic aromatic hydrocarbons Radiation-emitting polonium
  34. 34. Abnormal Changes at Cancerizationsite Clinically:  Leukoplakia  Erythroplasia  Dysplasia  Carcinoma in situ
  35. 35. Hyper Keratosis
  36. 36. Oral Leukoplakia
  37. 37. Leukoplakia Under the tongue
  38. 38. Oral leukoplakia/Cancer under theupper lip A portion of leukoplakias can under go transformation to dysplasia and further to cancer.
  39. 39. TONGUE Cancer under the tongue
  40. 40. FLOOR OF THE MOUTH Cancer behind the teeth
  41. 41. Papillary Squamous Cell Carcinoma oflower gingiva
  42. 42. Precancerous Lesion
  43. 43. Cancerous Lesion/Vestibule
  44. 44. Vericous Carcinoma
  45. 45. Cancer of the cheek with erosion oftissue
  46. 46. Cancer/Smokeless Tobacco
  47. 47. Role of Oral Health Professionals inCessation 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
  48. 48. Dentists Results indicate the need for further education in tobacco and cessation counseling for dentists.
  49. 49. ROLES OF THE DENTALPROFESSIONORAL CANCER SCREENING Non-invasive procedure No discomfort No pain Inexpensive
  50. 50. Clinically…What to look for? Head and Neck examination Intraoral examination
  51. 51. INTRAORAL EXAMINATION Where to look? Site of Smokeless Tobacco Placement  Vestibular area  Attached Gingiva  Oral mucosa  Tongue  Floor of the mouth  Hard tissues
  52. 52. Oral Examination
  53. 53. Intra-oral examination
  54. 54. Base and borders of the tongue
  55. 55. Pharynx, Soft Palate, Pilars….
  56. 56. Buccal Mucosa
  57. 57. Ventral
  58. 58. Vermillion Borders
  59. 59. 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.
  60. 60. DISCOVERY & DIAGNOSIS Result from Visual and manual examination  Systematic visual exam of all the soft tissues of the mouth
  63. 63. BIOPSY  ONLY MEANS OF DIAGNOSIS OF ORAL CANCER MAY BE THROUGH BIOPSY.  How long has the suspicious lesion been present?  Herpessimplex ulceration  Aphthous lesions  14 days
  64. 64. 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.
  65. 65. Brush Biopsy
  66. 66. Tissue sample
  67. 67. Early Cancerous Lesions
  68. 68. 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
  69. 69. POINTS TO CONSIDER PRIOR TOMUCOSAL 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?
  70. 70. Information to accompany mucosalbiopsies 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
  71. 71. Referral Dental specialist: periodontist Oral medicine specialist
  72. 72. Confirmation of the Disease By the pathologist is obtained Referral of patient to a proper medical intervention, Oncologist
  73. 73. Continued help after diagnosis Preparing the patient for treatment through proper management of oral tissues before, during and after treatment.