oral effects of smokeless tobacco
TRANSCRIPT
-
7/28/2019 Oral Effects of Smokeless Tobacco
1/75
Oral Effects of SmokelessTobacco
Lourdes Vazquez, RDH, MS, ECP
-
7/28/2019 Oral Effects of Smokeless Tobacco
2/75
Two Main Types of SmokelessTobacco
Chewing TobaccoSnuff
http://www.maxillofacialcenter.com/images/SnuffDental.jpg -
7/28/2019 Oral Effects of Smokeless Tobacco
3/75
Smokeless Tobacco
Chewing TobaccoLoose leaf
Processed cigar type tobacco looselypacked in small strips
-
7/28/2019 Oral Effects of Smokeless Tobacco
4/75
Smokeless Tobacco
Chewing TobaccoPlug
Small oblng blocks of semi-soft tobaccoPlace tobacco next to the gingival/buccalmucosa
-
7/28/2019 Oral Effects of Smokeless Tobacco
5/75
Smokeless Tobacco
Snuff (finely ground tobacco)Moist
Used by dippingPlacing it between the gum and the cheek orunder the upper or lower lip
-
7/28/2019 Oral Effects of Smokeless Tobacco
6/75
Smokeless Tobacco
Snuff Dry
Placed in oral cavity or sniffed through thenose
-
7/28/2019 Oral Effects of Smokeless Tobacco
7/75
Smokeless Tobacco Use
The highest rate of smokelesstobacco users is found in:
8-17 year old white malePeople in the North-Central and South-Central statesBlue collar occupations
-
7/28/2019 Oral Effects of Smokeless Tobacco
8/75
Nicotine Effects on the CNS
Stimulating effectsSeen with low dose of nicotine
Affecting the brain at the cortex andLocus ceruleus
Reward like effectsSeen with high dose of nicotine levels
Affecting the brain in the Limbic system
-
7/28/2019 Oral Effects of Smokeless Tobacco
9/75
Symptoms of NicotineToxicity
NauseaVomiting
DiarrheaAbdominal painSweats
Flushdizziness
-
7/28/2019 Oral Effects of Smokeless Tobacco
10/75
Effects of Nicotine Toxicity
Perinatal ExposureHypoxemia of fetus
Spontaneous abortionPlacental disruptionPreterm deliveryDecreased milk production
-
7/28/2019 Oral Effects of Smokeless Tobacco
11/75
Nicotine Toxicity
Interferes with birth control pillsInfertility
Impotence
-
7/28/2019 Oral Effects of Smokeless Tobacco
12/75
Nicotine Dependence
PhysiologicPsychologic
Behavioral
-
7/28/2019 Oral Effects of Smokeless Tobacco
13/75
Behavioral Dependence
Social use patternsRitualistic triggers
Behavioral habits
-
7/28/2019 Oral Effects of Smokeless Tobacco
14/75
Physiologic Dependence
WithdrawalTolerance
-
7/28/2019 Oral Effects of Smokeless Tobacco
15/75
Nicotine Withdrawal Symptoms
AnxietyIrritability
Poor concentrationRestlessnessCravingGI problemsHeadachesdrowsy
-
7/28/2019 Oral Effects of Smokeless Tobacco
16/75
Adverse Medical Consequences
Many problems affecting differentsystems in the body
Central Nervous SystemHeart DiseaseHypertensionLipids
Diabetes
-
7/28/2019 Oral Effects of Smokeless Tobacco
17/75
Effects of smokeless Tobacco
Physiological effects of NicotineCardiovascular SystemCentral Nervous SystemEndocrine System
Oral cancer
Cancer risk of cheek and gum mayreach nearly fiftyfold among long-termsnuff users
-
7/28/2019 Oral Effects of Smokeless Tobacco
18/75
Central Nervous System (CNS)
Vascular DiseaseCerebrovascular Accidents
TIAs Stroke
-
7/28/2019 Oral Effects of Smokeless Tobacco
19/75
Central Nervous System
Receptors of nicotine in the CNSAdiction
-
7/28/2019 Oral Effects of Smokeless Tobacco
20/75
Dependence on Smokeless Tobacco
U.S. SurgeonGeneral(1986):Geven the nicotinecontent of smokeless tobacco, itsability to produce high andsustained blood levels of nicotine,and the well-established dataimplicating nicotine as an addictivesubstance, one may deduce thatsmokeless tobacco is capable of producing addiction in users
-
7/28/2019 Oral Effects of Smokeless Tobacco
21/75
Health Consequences of NicotineExposure
Nicotine intoxication*Accelerated coronary andperipheral vascular diseaseStrokeHypertension
*Of greatest concern
-
7/28/2019 Oral Effects of Smokeless Tobacco
22/75
Complications
Delayed wound healing*Reproductive or perinatal disorders
(low birth weight, prematurity,spontaneous abortion)Peptic ulcer diseaseEsophageal reflux
*Of great concern
-
7/28/2019 Oral Effects of Smokeless Tobacco
23/75
Heart Disease
Smokeless tobacco causes similareffects as those seen in smoking
Increase in heart rate (30% higher)Increase in blood pressureLess cardiovascular risk than smokingpossibly due to lack of carbon
monoxide and related compounds
-
7/28/2019 Oral Effects of Smokeless Tobacco
24/75
*Cardiovascular Disease
Heart rate accelerationPromote atherosclerotic vascular
diseaseAggravate hypertension by causingvasoconstrictionAcute cardiac ischemia (angina,myocardial infarction, even suddendeath)
-
7/28/2019 Oral Effects of Smokeless Tobacco
25/75
Hypertension
Blood pressure levels are affectedby:
High sodium levelsNicotineLicorice , which causes sodiumretention
-
7/28/2019 Oral Effects of Smokeless Tobacco
26/75
Lipids
According to an article published inthe American Journal of PublicHealth (1989)
Smokeless tobacco users had 2.5 timesincrease in cholesterol
-
7/28/2019 Oral Effects of Smokeless Tobacco
27/75
Diabetes
Smokeless tobacco as well asCigarette smokers have increaseinsulin levels which suggests a linkwiht insulin resistance
-
7/28/2019 Oral Effects of Smokeless Tobacco
28/75
MAJOR RISK
HEAD AND NECK DISEASE
-
7/28/2019 Oral Effects of Smokeless Tobacco
29/75
SMOKELESS TOBACCO LESIONS(STLs)
Appear as changes in color andtexture of the oral mucosa
Are the most prevalent oral softtissue lesions among adolescents inthe U.S.
-
7/28/2019 Oral Effects of Smokeless Tobacco
30/75
HARD TISSUES
Effects on teeth:Discoloration of the teeth and
receding gingiva
-
7/28/2019 Oral Effects of Smokeless Tobacco
31/75
ATTACHED GINGIVA
Recession of gingival marginLoss of attachmentTooth abrasionHyper keratinizedsoft tissues
-
7/28/2019 Oral Effects of Smokeless Tobacco
32/75
Periodontal Disease3-5% of diseased gingival andperiodontal tissue becomes oralcancer
-
7/28/2019 Oral Effects of Smokeless Tobacco
33/75
Potent Carcinogens
NitrosaminesPolycyclic aromatic hydrocarbons
Radiation-emitting polonium
-
7/28/2019 Oral Effects of Smokeless Tobacco
34/75
Abnormal Changes at Cancerizationsite
Clinically:LeukoplakiaErythroplasiaDysplasiaCarcinoma in situ
-
7/28/2019 Oral Effects of Smokeless Tobacco
35/75
Hyper Keratosis
-
7/28/2019 Oral Effects of Smokeless Tobacco
36/75
Oral Leukoplakia
http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/derm/images/Large/2674der2.jpg&template=izoom2 -
7/28/2019 Oral Effects of Smokeless Tobacco
37/75
Leukoplakia
Under the tongue
http://www.maxillofacialcenter.com/images/LeukTongue.jpg -
7/28/2019 Oral Effects of Smokeless Tobacco
38/75
Oral leukoplakia/Cancer under theupper lip
A portion of leukoplakias canunder go
transformation todysplasia andfurther to cancer.
-
7/28/2019 Oral Effects of Smokeless Tobacco
39/75
TONGUE
Cancer under thetongue
-
7/28/2019 Oral Effects of Smokeless Tobacco
40/75
FLOOR OF THE MOUTH
Cancer behind the teeth
-
7/28/2019 Oral Effects of Smokeless Tobacco
41/75
Papillary Squamous Cell Carcinoma of lower gingiva
-
7/28/2019 Oral Effects of Smokeless Tobacco
42/75
Precancerous Lesion
-
7/28/2019 Oral Effects of Smokeless Tobacco
43/75
Cancerous Lesion/Vestibule
-
7/28/2019 Oral Effects of Smokeless Tobacco
44/75
Vericous Carcinoma
http://www.emedicine.com/cgi-bin/foxweb.exe/makezoom@/em/makezoom?picture=/websites/emedicine/derm/images/Large/2673der1.jpg&template=izoom2 -
7/28/2019 Oral Effects of Smokeless Tobacco
45/75
Cancer of the cheek with erosion of tissue
-
7/28/2019 Oral Effects of Smokeless Tobacco
46/75
Cancer/Smokeless Tobacco
-
7/28/2019 Oral Effects of Smokeless Tobacco
47/75
Role of Oral Health Professionals inCessation Counseling: Survey Findings
73-item survey mailed to 1,064dentists in Central Ohio529 responded9% were effective at gettingpatients to quit71% willing to provide educational
pamphlets6% would consider to prescribenicotine gum
-
7/28/2019 Oral Effects of Smokeless Tobacco
48/75
Dentists
Results indicate the need for furthereducation in tobacco and cessationcounseling for dentists.
-
7/28/2019 Oral Effects of Smokeless Tobacco
49/75
ROLES OF THE DENTALPROFESSION
ORAL CANCER SCREENINGNon-invasive procedure
No discomfortNo pain
Inexpensive
-
7/28/2019 Oral Effects of Smokeless Tobacco
50/75
ClinicallyWhat to look for?
Head and Neck examinationIntraoral examination
-
7/28/2019 Oral Effects of Smokeless Tobacco
51/75
INTRAORAL EXAMINATION
Where to look? Site of SmokelessTobacco Placement
Vestibular areaAttached GingivaOral mucosaTongue
Floor of the mouthHard tissues
-
7/28/2019 Oral Effects of Smokeless Tobacco
52/75
Oral Examination
http://images.search.yahoo.com/search/%20http:/images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fei%3DUTF-8%26p%3DOral%2BExamination%26fr%3Dyfp-t-471%26b%3D21&w=430&h=559&imgurl=www.stevedds.com%2Fcancerexam.jpg&rurl=http%3A%2F%2Fwww.stevedds.com%2Foral.htm&size=72.2kB&name=cancerexam.jpg&p=Oral+Examination&type=jpeg&no=28&tt=646&oid=4b41756dc4a065f4&ei=UTF-8 -
7/28/2019 Oral Effects of Smokeless Tobacco
53/75
Intra-oral examination
http://images.search.yahoo.com/search/%20http:/images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fei%3DUTF-8%26p%3DOral%2BExamination%26fr%3Dyfp-t-471%26b%3D41&w=307&h=196&imgurl=www.infocompu.com%2Fadolfo_arthur%2Fimages%2Festudio2.jpg&rurl=http%3A%2F%2Fwww.infocompu.com%2Fadolfo_arthur%2Fingles%2Fexamen.htm&size=37.3kB&name=estudio2.jpg&p=Oral+Examination&type=jpeg&no=52&tt=646&oid=b60d6405f717a326&ei=UTF-8 -
7/28/2019 Oral Effects of Smokeless Tobacco
54/75
Base and borders of the tongue
http://images.search.yahoo.com/search/%20http:/images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fei%3DUTF-8%26p%3DOral%2BExamination%26fr%3Dyfp-t-471%26b%3D41&w=291&h=194&imgurl=www.infocompu.com%2Fadolfo_arthur%2Fimages%2Festudio13.jpg&rurl=http%3A%2F%2Fwww.infocompu.com%2Fadolfo_arthur%2Fingles%2Fexamen.htm&size=36.5kB&name=estudio13.jpg&p=Oral+Examination&type=jpeg&no=53&tt=646&oid=54193b15db46dcb4&ei=UTF-8 -
7/28/2019 Oral Effects of Smokeless Tobacco
55/75
Pharynx, Soft Palate, Pilars.
http://images.search.yahoo.com/search/%20http:/images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fei%3DUTF-8%26p%3DOral%2BExamination%26fr%3Dyfp-t-471%26b%3D41&w=300&h=197&imgurl=www.infocompu.com%2Fadolfo_arthur%2Fimages%2Festudio8.jpg&rurl=http%3A%2F%2Fwww.infocompu.com%2Fadolfo_arthur%2Fingles%2Fexamen.htm&size=37.5kB&name=estudio8.jpg&p=Oral+Examination&type=jpeg&no=50&tt=646&oid=4a8980fbfdea68c2&ei=UTF-8 -
7/28/2019 Oral Effects of Smokeless Tobacco
56/75
Buccal Mucosa
http://images.search.yahoo.com/search/%20http:/images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fei%3DUTF-8%26p%3DOral%2BExamination%26fr%3Dyfp-t-471%26b%3D41&w=301&h=195&imgurl=www.infocompu.com%2Fadolfo_arthur%2Fimages%2Festudio6.jpg&rurl=http%3A%2F%2Fwww.infocompu.com%2Fadolfo_arthur%2Fingles%2Fexamen.htm&size=31.7kB&name=estudio6.jpg&p=Oral+Examination&type=jpeg&no=57&tt=646&oid=9bd87d07210d4562&ei=UTF-8 -
7/28/2019 Oral Effects of Smokeless Tobacco
57/75
Ventral
http://images.search.yahoo.com/search/%20http:/images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fei%3DUTF-8%26p%3DOral%2BExamination%26fr%3Dyfp-t-471%26b%3D61&w=293&h=190&imgurl=www.infocompu.com%2Fadolfo_arthur%2Fimages%2Festudio14.jpg&rurl=http%3A%2F%2Fwww.infocompu.com%2Fadolfo_arthur%2Fingles%2Fexamen.htm&size=35kB&name=estudio14.jpg&p=Oral+Examination&type=jpeg&no=64&tt=646&oid=d2f4011366b563f8&ei=UTF-8 -
7/28/2019 Oral Effects of Smokeless Tobacco
58/75
Vermillion Borders
http://images.search.yahoo.com/search/%20http:/images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fei%3DUTF-8%26p%3DOral%2BExamination%26fr%3Dyfp-t-471%26b%3D61&w=300&h=204&imgurl=www.infocompu.com%2Fadolfo_arthur%2Fimages%2Festudio.jpg&rurl=http%3A%2F%2Fwww.infocompu.com%2Fadolfo_arthur%2Fingles%2Fexamen.htm&size=34.8kB&name=estudio.jpg&p=Oral+Examination&type=jpeg&no=63&tt=646&oid=89d810692abafa12&ei=UTF-8 -
7/28/2019 Oral Effects of Smokeless Tobacco
59/75
Discovery and Diagnosis
Any sore, discoloration, induration,prominent tissue, horseness whichdoes not resolve within a twoweeks period on its own, with orwithout treatment, should beconsidered for further examination
or referral.
-
7/28/2019 Oral Effects of Smokeless Tobacco
60/75
DISCOVERY & DIAGNOSIS
Result from Visual and manualexamination
Systematic visual exam of all the softtissues of the mouth
-
7/28/2019 Oral Effects of Smokeless Tobacco
61/75
DIGITAL PALPATION OF THE NECK
INCLUDING THE THYROID ANDSURROUNDING LYMPH NODESSURROUNDING THE ORAL CAVITY.
-
7/28/2019 Oral Effects of Smokeless Tobacco
62/75
OTHER DIAGNOSTIC AIDS
LIGHTSDYES
OTHER TECHNIQUES APPEARING INTHE MARKET.
-
7/28/2019 Oral Effects of Smokeless Tobacco
63/75
BIOPSY
ONLY MEANS OF DIAGNOSIS OFORAL CANCER MAY BE THROUGHBIOPSY.How long has the suspicious lesionbeen present?
Herpes simplex ulceration
Aphthous lesions14 days
-
7/28/2019 Oral Effects of Smokeless Tobacco
64/75
BIOPSY BRUSH
Easy, painless, accurate diagnosisof soft tissue abnormalities.Not designed to provide theinformation, specifically cellulararchitecture that a punch orincisional biopsy would provide.Will allow us to know whether amalignancy exists or not throughminimal and inexpensive procedure.
-
7/28/2019 Oral Effects of Smokeless Tobacco
65/75
Brush Biopsy
http://images.search.yahoo.com/search/%20http:/images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3DBrush%2BBiopsy%26ei%3DUTF-8%26fr%3Dyfp-t-471%26x%3Dwrt&w=150&h=150&imgurl=www.deltadentalwi.com%2Fdynamic%2Fbrushbiopsy.jpg&rurl=http%3A%2F%2Fwww.deltadentalwi.com%2Fdentist%2Foralcancer%2Foralcancerinitiative&size=4.5kB&name=brushbiopsy.jpg&p=Brush+Biopsy&type=jpeg&no=5&tt=42&oid=cfaaabd100e4bb62&ei=UTF-8 -
7/28/2019 Oral Effects of Smokeless Tobacco
66/75
Tissue sample
-
7/28/2019 Oral Effects of Smokeless Tobacco
67/75
Early Cancerous Lesions
-
7/28/2019 Oral Effects of Smokeless Tobacco
68/75
Conventional biopsy
A positive result from the brushbiopsy needs to be followed by aconventional biopsy.Often the only way to diagnose orallesions and diseasesMost are performed at a hospital
-
7/28/2019 Oral Effects of Smokeless Tobacco
69/75
POINTS TO CONSIDER PRIOR TOMUCOSAL BIOPSY
Why is biopsy being taken?What information is required from thepathologist?
Is the biopsy to exclude malignancy?Is the biopsy incisional or excisional?Will the specimen be required to beorientated?Is a fresh specimen required?
f l
-
7/28/2019 Oral Effects of Smokeless Tobacco
70/75
Information to accompany mucosalbiopsies
Patient demographic dataDescription of the clinical appearance of the lesion and suspected diagnosis
The site of the biopsyThe relationship of the lesion torestorations, particularly amalgamA detailed drug historyMedical history including blood dyscrasiasSmoking and alcohol consumption
-
7/28/2019 Oral Effects of Smokeless Tobacco
71/75
Referral
Dental specialist: periodontistOral medicine specialist
-
7/28/2019 Oral Effects of Smokeless Tobacco
72/75
Confirmation of the Disease
By the pathologist is obtainedReferral of patient to a propermedical intervention, Oncologist
-
7/28/2019 Oral Effects of Smokeless Tobacco
73/75
Continued help after diagnosis
Preparing the patient for treatmentthrough proper management of oraltissues before, during and aftertreatment.
-
7/28/2019 Oral Effects of Smokeless Tobacco
74/75
ALTERNATIVES TO QUITING
PROGRAMS AND SUPPORT
-
7/28/2019 Oral Effects of Smokeless Tobacco
75/75
PROGRAMS AND SUPPORTGROUPS