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Oral Health Risks of Smokeless Tobacco


Is Smokeless Tobacco Safer Than Cigarettes?

Tobacco risks include tooth decay and cancer.

Regardless of what you may have heard, smokeless tobacco (chewing tobacco or snuff) causes cancer that kills. The use of smokeless tobacco products may lead to cancer of the mouth, pharynx, larynx, esophagus, pancreas and urinary tract. The use of smokeless tobacco products can also result in periodontal (gum) destruction, tooth loss, tooth decay, tooth abrasion, dental stains and loss of sense of taste and smell. Smokeless tobacco delivers the addicting drug nicotine into the body. For habitual users, the dose is similar to a one-pack-a-day-cigarette smoker. One can of snuff per day is equal to the amount of nicotine from three to four packs of cigarettes.

Unlike cigarette smoking, chewing tobacco remains in contact with delicate oral tissues (lips, cheek, gum and tongue) for long periods. At best, users of smokeless tobacco have irritated oral tissues, increased tooth decay and increased tooth loss. At worst, they develop oral cancers that can result in the surgical removal of oral tissue and jaw and cheek bone. Tobacco is linked to high blood pressure, stroke, heart attack, oral cancer and cancer of the pharynx

Smokeless tobacco products usually contain 2,500 different chemical compounds, including sand, grit, sugar, sodium, tobacco, nicotine and metallic and radioactive compounds.

Chewing Tobacco, Tooth Decay Linked

People who chew tobacco have more decay on the crowns and roots of their teeth than non-chewers, according to a new study.

Deborah Winn, Ph.D., from the National Institute of Dental Research, and Scott Tomar, D.D.S., University of California San Francisco, studied data provided by 14,807 people who participated in the "Third National Health and Nutrition Examination Survey."

Only 135 of the participants said they continued to use chewing tobacco. These participants had an average of 40.9 decayed, missing or filled surfaces in the crowns of their teeth. Non-chewers by contrast had an average of 36.9 decayed, missing or filled surfaces.

Moreover, the average of filled or decayed root surfaces was 3.7 for tobacco chewers, but just one for non-chewers.

Scientists say the research suggests a link between chewing tobacco and caries on all tooth surfaces. They also noted that tobacco poses a double hazard to tooth roots. First, tobacco products in general appear to promote periodontal disease, which puts roots at risk for decay. Second, the sugar often found in chewing tobacco threatens further damage to the roots as well as the crowns.

Surgeon General's Recommendation to Require Health Warnings on Cigars

The Chicago Dental Society supports a recommendation by the U.S. Surgeon General and other federal health officials to require a mandatory national warning label on cigars.

Requiring health warnings on cigarettes and smokeless tobacco but not cigars sends the wrong message, said previous Surgeon General David Satcher, when he reviewed a report by the inspector general of the Department of Health and Human Services recommending such labels. In an interview in the New York Times, the surgeon general said that the absence of labels on cigars implies cigars are different and don't carry the same risk.

Top officials at the health department say they hope that the report will push the Federal Trade Commission to require such warning labels. The commission has been considering the matter since April 1998, and while it has the power to require the labels on its own, it plans to report to Congress on the issue this spring.

Most cigar boxes, but not individual cigars, already include a label required under a settlement of a California court case. Advocates of tougher rules on labeling argue that the California labels are not strong enough or consistently used. Pipe tobacco also carries no warning labels.

Many cigar smokers discount the health risks of cigars, or believe them to be less harmful than cigarettes. The National Cancer Institute reported that although cigar smokers inhaled less smoke than cigarette smokers, cigars could be just as toxic because they contain up to 90 times as much of some carcinogenic elements as cigarettes. And with higher quantities of such toxins, cigars can create even more harmful secondhand smoke.

Regular cigar smokers greatly increase their risk of mouth, lung and throat cancer, according to medical and dental research.

New Pack-a-Week Smokers Aren't Fooling Anybody

Intermittent smokers who light up a pack a week or less still face a plethora of healthcare woes, even though they may not smoke every day.

"Concern over health issues, as well as social restrictions on smoking, have resulted in a growing class of occasional or intermittent smokers who sneak a few cigarettes every other day or every third day," explains Astrid Schroetter, D.D.S., a general dentist who practices in Chicago's Loop. "Some used to be heavy smokers; some are new smokers."

It was believed that intermittent smokers consisted of a small number of people. However, a recent study conducted by the Centers for Disease Control and Prevention's Office on Smoking and Health shows otherwise.

About 6% of smokers, or roughly three million Americans, can be called intermittent, meaning that they don't smoke every day. On average, they smoke four or five cigarettes every third day, although smoking patterns vary. This category does not include people who smoke several cigarettes every day. The rate of intermittent smoking is twice as high among African-Americans, Hispanics and Asian-Americans. Those between 18 to 29 years of age or highly educated people (those with some post-graduate education) also are more likely to be intermittent smokers. In an earlier study, about 60% of intermittent smokers had been smoking for at least one year.

Because no one expected this many people to be intermittent smokers, there is very little research on this group. One study showed that men who smoked anywhere from one to nine cigarettes daily had a nearly five times greater risk of dying from lung cancer than nonsmokers; for those smoking 10 to 19 cigarettes the risk rose to nine times greater.

In addition, there is some evidence that how long a person has smoked may be a stronger risk factor for lung cancer than the number of cigarettes smoked. Some of the adverse cardiovascular effects of smoking are acute, rather than cumulative, meaning that the first cigarette may be as dangerous as the fiftieth, in some instances.

"The exact amount of risk depends not only on how many cigarettes you smoke each day, but also on how long you've smoked and how deeply you inhale, as well as genetic factors," explains Dr. Schroetter. "However, there is always risk and people who think they will avoid the risks just because they don't smoke as often are only fooling themselves. They are still courting risk as long as they smoke one cigarette per week."

Plus, says Dr. Schroetter, they are taking the chance of becoming long-term smokers. "They may think they can control a light smoking habit, but there's a strong chance that they'll end up smoking one or two packs a day eventually," she says. "That's what happens with the majority of smokers."

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