Report on Smoking Includes Oral Health Risks

***UPDATED: April 30, 2014*** A new study out of the University of Michigan has linked the combination of tobacco and alcohol use to an increased risk of developing esophageal squamous cell carcinoma (ESCC), according to a recent Dental Tribune article.  Researchers discovered that either tobacco or alcohol use (independently) resulted in a 20-30% increased risk when compared to non-use.  Individuals who used both tobacco and alcohol together nearly doubled their risk of developing ESCC.  The World Health Organization claims that this type of esophageal cancer occurs more frequently in Eastern countries, with high incidence rates in Iran, Central China, South Africa, and Southern Brazil.  They estimate that nearly 90% of squamous cell carcinoma cases can be attributed to tobacco and alcohol use.

In early American history, cigarette smoking and other forms of tobacco use were not associated with any health risks, and were perfectly acceptable in all social circles.  It wasn’t until the 1950s that evidence suggesting that cigarette smoking was a health hazard began to be documented.  By 1959, the exact relationship between smoking and health was being investigated by the Royal College of Physicians in Britain, who later published a report in 1962 linking the habit to both lung cancer and bronchitis, and further suggesting its role in cardiovascular disease.  Soon after the research’s release, the United States followed suit, with Dr. Luther Terry’s establishment of the Surgeon General’s Advisory Committee on Smoking and Health, which produced a similar report.  Published in 1964, the study concluded that lung cancer and chronic bronchitis are causally related to cigarette smoking, and suggested a causative role in other illnesses such as emphysema, cardiovascular disease, and various types of cancer.  The committee concluded that cigarette smoking was a health hazard.  Fast forward to today, and millions of Americans still choose to smoke despite the evidence on tobacco’s negative effects.  The 50th anniversary of the review of tobacco has sparked an interest in updating the information.  Reported on in a recent American Dental Association (ADA) article, the new 998-page report expands the list of illnesses “causally associated” with smoking, including implications for oral health.  The following is a brief summary of the updates related to oral health.

  • There is evidence of a relationship between cigarette smoking and dental caries.
  • There is evidence of a relationship between exposure to tobacco smoke and dental caries in children.
  • In developed nations, smoking is associated with socio-demographic characteristics and a large range of health behaviors that also are strongly associated with a higher risk for caries.
  • There is evidence of a relationship between cigarette smoking and failure of dental implants.
  • There is evidence of a relationship between maternal smoking in early pregnancy and orofacial clefts.

Further research is needed on long-term exposure to nicotine from alternative products (e-cigarettes and smokeless tobacco).  Cancer, cardiovascular, and neuro-cognitve outcomes are of concern. There is enough evidence to warrant caution to pregnant women and women of reproductive age as well as adolescents.  The latest report concludes with a call for significant action to reduce tobacco use.  According to acting Surgeon General Dr. Boris Lushniak, unless tobacco use rates fall significantly, we can expect another 5.6 million U.S. kids to die prematurely.  The Centers for Disease Control and Prevention report that smoking causes more deaths each year than HIV, illegal drug use, alcohol use, motor vehicle injuries, and firearm-related incidents combined.  In the 50 years, it is estimated that smoking has killed more than 20 million Americans.

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