A cigarette a day keeps a dentist at pay


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A cigarette a day keeps a dentist at pay

  1. 1. Indian Journal of Dental Sciences.June 2012 Issue:2, Vol.:4 www.ijds.in Review ArticleAll rights are reserved Indian Journal of Dental Sciences E ISSN NO. 2231-2293 P ISSN NO. 0976-4003 1 Dipika GargA Cigarette A Day, Keeps The Doctor In Pay 2 Sidharth Narula 3 Varun JindalAbstract 1Smoking is one of the most common forms of recreational drug use. Tobacco smoking is today by St. Louis (MO) U.S.A. 2 Professor,far the most popular form of smoking and is practiced by over one billion people in the majority of all Darshan Dental College, Udaipur.human societies. The history of smoking can be dated to as early as 5000 BC, and has been 3 Sr. Lectrecorded in many different cultures across the world. Only relatively recently, and primarily in Bhojia Dental College, Baddiindustrialized Western countries, has smoking come to be viewed in a decidedly negative light. Address For Correspondence:Today medical studies have proven that smoking tobacco is among the leading causes of many Dr. Dipika Garg MDS,diseases such as lung cancer, heart attacks, COPD, erectile dysfunction and can also lead to birth St. Louis (MO) U.S.A.defects. The inherent health hazards of smoking have caused many countries to institute high Email : drdipikagarg@gmail.comtaxes on tobacco products and anti-smoking campaigns are launched every year in an attempt to Submission : 17th December 2011curb tobacco smoking. Smoking cessation, referred to as "quitting", is the action leading towardsabstinence of tobacco smoking. There are a number of methods such as nicotine replacement Accepted : 14th May 2012therapy, antidepressants, hypnosis, self-help, and support groups. Quick Response CodeKey WordsSmoking, Drug, Tobacco, CancersIntroduction knowledge that cigarette smoking is theThe main tobacco killers in both sexes are single major cause of cancer andcancers, especially lung cancer, heart cardiovascular disease in the Uniteddisease and chronic bronchitis. However, States, contributing to hundreds of social pressures and psychological needsin developing countries with higher level thousands of premature deaths each year, including environmental influenceof traditional tobacco use, such as yet one-fourth to one-third of American ,school and peer influence, personalchewing or smoking with the lit end of the adults continue to smoke. factors and knowledge, attitude andchutta inside the mouth, tobacco use is Before examining the negative health beliefs about smoking.associated with high level of oral cancer. effects of tobacco use, we would remind The tobacco market is dependent on aFor example, the highest reported rate of the reader that a popular emphasis on mass market. As smokers die or quit, theymouth cancer in the world is among negative aspects is a rather new are keen to recruit new young smokers towomen in Bangalore. In India indeed it is phenomenon. Since the Middle Ages maintain their profits, particularly inestimated that tobacco use causes around tobacco leaves have been used as new markets such as developingone in five of all cancers in women. (1) medicinal herbs in ointments, poultices, countries. They tailor a product to appealThis article aims to explore the reasons mouth rinses and smoke. Oral ulcers, to specific target groups by altering itsand consider why more attention needs to caries and "toothache" were all treated price, availability and image throughbe paid to issues around smoking both in with this wonder drug. A product is still packaging, advertisement and promotionterms of research and action. It will not readily available today, called "Dental using images and messages beingrevisit the pathology associated with Snuff" which was advertised more than a glamorous, sophisticated, romantic,smoking. century ago as a cure for toothache, healthy, sporty, fun, relaxing, liberated, gingivitis, facial neuralgia, caries, and rebellious and, last but not least,History scurvy. Given this positive image slimming. Young teenagers who smokeTobacco has been variously hailed as a throughout most of its history its are more appreciative of cigarettegift from the gods, a miraculous cure-all universal popularity is not surprising. It is advertisements than non smokers and thefor lifes physical ills, a solace to the surprising, rather, that some persons have most heavily advertised brands are morelonely soldier or sailor, a filthy habit, a always been moved to speak out against often bought by teenagers than adultcorrupting addiction, and the greatest it, even to the extent of proclaiming its smokers. How smoking is portrayed indisease-producing product known to use a capital offense in some European the media more generally also affects theman. This diversity of opinion has and Asian countries as early as the way in which young people view thecontinued unchanged for centuries and sixteenth century. habit. Glamorous models, femalehas appeared until very recently to be personalities, teenage pop idols and filmlittle affected by research results from How smoking spreads stars featuring in magazines, TV soaps,more than 900,000 papers thus far The initiation of smoking among plays and films depict smoking as beingpublished on the topic. It is common adolescence is heavily influenced by part and parcel of their success. However,©Indian Journal of Dental Sciences. (June 2012 Issue:2, Vol.:4) All rights are reserved. 128
  2. 2. adolescent smokers are more likely to be Smoking is directly responsible for 80 in reducing nicotine reinforcement inunder achievers in schools with low percent of lung cancer deaths in women clinically used doses. The NRTs areacademic goals. Using smoking to in the U.S. each year.(4) Smoking is effective in relieving tobacco withdrawalbolster self confidence stems from the directly responsible for more than 90 and making abstinence easier in smokerswide spread belief that smoking can help percent of chronic obstructive pulmonary trying to quit. NRTs approximatelycalm nerves, control moods and alleviate disease (COPD), or emphysema and double the success rate of quittingstress- all important concerns during chronic bronchitis deaths each year.(4) smoking relative to placebo. NRTs can beadolescence. Postmenopausal women who smoke classified as short-acting (gum, lozenge, have lower bone density than women inhaler, and spray) and longer-actingParticularly about women who never smoked. Women who smoke (patch) products. Short-acting NRTSmoking kills over half a million women have an increased risk for hip fracture products are especially effective in acuteeach year and is the most important compared to never smokers. Cigarette management of tobacco withdrawal andpreventable cause of female premature smoking also causes skin wrinkling that craving. An important consideration fordeath in several advanced countries. could make smokers appear less NRT treatment is titration of the doseWomen take up cigarette smoking as a attractive and prematurely old.(5) based on the smokers nicotine intake,widespread habit later than men, mainly determined roughly by the number ofdue to socio- cultural factors, such as it Smokeless Tobacco cigarettes smoked per day (CPD). (7,8)not being socially acceptable for women Like cigarettes, smokeless tobaccoto be seen smoking in public, religious products contain a variety of toxins Sustained-Release Bupropionattitudes and women being generally less associated with cancer. At least 28 Bupropion, an atypical antidepressant, isaffluent than men. Smoking affects cancer-causing chemicals have been approved for treatment of smokingwomens health in ways which specific to identified in smokeless tobacco products. cessation. In preclinical studies,them. Research has shown women who Smokeless tobacco is known to cause bupropion reduced nicotines rewardingsmoke (i) have a 10 times higher risks of cancers of the mouth, lip, tongue, and effects and attenuated nicotineheart disease and an increased risks of pancreas. Users also may be at risk for withdrawal symptoms. Its mechanism ofstoke if they also use oral contraceptives cancer of the voice box, esophagus, colon action is thought to be mediated by its(ii) have a two fold associated higher and bladder, because they swallow some ability to block the reuptake ofrisks of cervical cancer and (iii) of the toxins in the juice created by using norepinephrine and DA in theexperience detrimental affects on their smokeless tobacco.Smokeless tobacco mesolimbic system and nucleusreproductive health, including can irritate your gum tissue, causing accumbens, a key area for nicotinedysmenorrhoea, reducing fertility and an periodontal (gum) disease. Sugar is often reinforcement. Additionally, bupropionearly menopause. Women who smoke added to enhance the flavor of smokeless antagonizes brain nicotinic receptors andduring pregnancy also increase by a tobacco, increasing the risk for tooth blocks the reinforcing effects of nicotine.quarter their risks of mis-carriage and by decay. Smokeless tobacco also typically (9)a third the risks of the infants prenatal contains sand and grit, which can weardeath, they are twice as likely to have down your teeth. (6) Varenicline (CHANTIX)premature labour and 3 times more likely Varenicline is a partial agonist for theto have a low birth weight baby. In Treating The Addiction á4â2 subtype of nAChRs, which aredeveloping countries where the health of Nicotine, the main addictive chemical in associated with the addictive effects ofmother and baby is already jeopardized tobacco smoke, is essential in continued nicotine. Varenicline is also a full agonistthrough poverty and malnutrition, the and compulsive tobacco use. Seven at the á7 nAChR. In smokers, vareniclineeffects of smoking are likely to have even medications are currently US Food and attenuates the subjective rewardinggreater impact on birth weight and Drug Administration (FDA) approved responses and heart rate increasesprenatal mortality. Smoking is more for smoking cessation: five nicotine induced by intravenous nicotine.common among these in low income, r e p l a c e m e n t t h e r a p i e s ( N RTs ) , Varenicline also improves tobaccowho have low status jobs or are bupropion, and varenicline. In addition, withdrawal symptoms, mood, andunemployed, are single parents or clonidine and nortriptyline are effective cognitive performance in abstinentdivorced, have low level of academic for smoking cessation but are not FDA smokers. All these effects may contributeachievement and are from under approved for this indication. to vareniclines efficacy for smokingprivileged ethnic groups.(2) As one starts cessation. (9)to smoke regularly, his/ her body gets Nicotine Replacement Therapyused to regular nicotine doses and In the US market, five NRT products are Nortriptylinebecomes physiologically dependant. currently available: nicotine patch, Nortriptyline, a tricyclic antidepressant,There are no consistent patterns or trends nicotine chewing gum, nicotine lozenge, has been found to be effective foramong women. Prevalence rates vary nicotine nasal spray, and nicotine vapor smoking cessation. The underlyingfrom as much as 58% in Nepal and over a inhaler. Nicotine gum, patch, and lozenge mechanism of nortriptylines efficacy forthird in European countries, such as are available as over-the-counter (OTC) smoking cessation might be throughDenmark and Poland, to barely products, whereas nasal spray and vapor norepinephrine reuptake inhibition indetectable levels in many African inhaler are available by prescription only. central synapses or through nAChRcountries, such as the Ivory Coast and Although initially thought to be a antagonism. In clinical trials for smokingGuinea. (3) "substitution" treatment, similar to cessation, the dose of nortriptyline was methadone treatment for opioid 75 to 100 mg/d, and the length ofIn the U.S.A. addiction, the NRTs have limited efficacy treatment was 8 to 12 weeks. Compared©Indian Journal of Dental Sciences. (June 2012 Issue:2, Vol.:4) All rights are reserved. 129
  3. 3. with placebo, nortriptyline Conclusion 4. Centers for Disease Control andapproximately doubles the rates of Mark Twain once said "Quitting smoking Prevention. National Center forsmoking abstinence. (9) is easy. I have done it a thousand times". Health Statistics. National Vital Smoking cessation programs are useful Statistics Reports. Births: Final DataClonidine in helping smokers to quit, but smoking is for 2005. December 5, 2007; 56(10).Clonidine, an antihypertensive agent, a very difficult addiction to break and the 5. Smokeless tobacco as a nicotinereduces central sympathetic activity by need for novel and effective approaches delivery device: harm or harmstimulating the á2-adrenergic receptors. to smoking cessation interventions is reduction?Benowitz NL. ClinClonidine is not FDA approved for unquestionable. Cigarette smoke harms Pharmacol Ther. 2011 Oct;90(4):491-smoking cessation and is a second-line nearly every system of the human body, 3. doi: 10.1038/clpt.2011.191. Epuboption. It effectively suppresses the acute thus causing a broad range of diseases, 2011 Aug 10. Review.symptoms of nicotine withdrawal, such many of which are fatal.The risk of 6. T h e a s s e s s m e n t o f t o b a c c oas tension, irritability, anxiety, cravings, serious disease diminishes rapidly after dependence in young users ofand restlessness. (9) quitting and life-long abstinence. Firm smokeless tobacco. Difranza JR, action needs to be taken now to halt and Sweet M, Savageau JA, UrsprungElectronic Cigarette ultimately reverse this epidemic. WW. Tob Control. 2011 Jun 28.The E-cigarette is a battery-powered 7. The clinical practice guidelines areelectronic nicotine delivery device References the main resource for treating(ENDD), often resembling a cigarette. It 1. Oral premalignant lesions: from a individuals with tobacco use andis designed to deliver nicotine to the clinical perspective. Amagasa T, dependence. The guidelines are basedrespiratory system, where neither Yamashiro M, Uzawa N. Int J Clin on the review of literature for mosttobacco nor combustion are necessary for Oncol. 2011 Feb;16(1):5-14. Epub evidence-based treatments. Fioreits operation. Consequently, it is likely 2011 Jan 12. Review. MC, Jaén CR, Baker TB, et al.that this product may be considered as a 2. An overview of principles of Clinical Practice Guideline.lower risk substitute for factory-made effective treatment of substance use Rockville, MD: US Department ofcigarettes. disorders and their potential Health and Human Services, Public application to pregnant cigarette Health Service; 2008. TreatingAn important aspect that needs to be smokers. Heil SH, Linares Scott T, Tobacco Use and Dependence: 2008highlighted in relation to the findings of Higgins ST. Drug Alcohol Depend. Update.the present case series is the putative risk 2009 Oct 1;104 Suppl 1:S106-14. 8. Comparison of Available Treatmentsof E-cigarettes. In June 2009, the US 3. Lung cancer in never smokers. Torok for Tobacco Addiction Aryeh I.Food and Drug Administration (FDA) S, Hegedus B, Laszlo V, Hoda MA, Herman and Mehmet Sofuoglu. Currannounced in a press conference that a Ghanim B, Berger W, Klepetko W, Psychiatry Rep. 2010 October ;laboratory analysis of electronic cigarette Dome B, Ostoros G. Future Oncol. 12(5): 433-440samples has found that they contain 2011 Oct;7(10):1195-211. Review. 9. M o o n e y M E , S o f u o g l u M .carcinogens and toxic chemicals such as U.S Department of Health and Bupropion for the treatment ofdiethylene glycol (DEG), an ingredient Human Services. Health nicotine withdrawal and craving.used in antifreeze. Consequences of Smoking: A Report Expert Rev Neurother. 2006;6:965- of the Surgeon General. 2004. 981. Source of Support : Nill, Conflict of Interest : None declared©Indian Journal of Dental Sciences. (June 2012 Issue:2, Vol.:4) All rights are reserved. 130