01 Tobacco & its effect on oral cavity.pptx

01 Tobacco & its effect on oral cavity.pptx

1. Tobacco and its effect on oral cavity Resource Faculty : Dr. Ashish Shrestha Presented By : Abisek Kumar Sharma Roll No : 604

2. Contents : Introduction of tobacco Types of tobacco used Manufacture of tobacco Constituents of tobacco Effects of tobacco on health

3. Objectives : To know about tobacco History To know types of tobacco used Effect of different constituents over human health

4. Tobacco Derived from plant species of potato family called as Nicotiana tabacum & Nicotiana rustica After the name of island Tobago of west indies. Word derived from “Tobago/ Tobacca ”

5. Tobacco Production of tobacco in company : 5.5 trillion/ yr i.e. 1000 cigarettes for every individual Consumption of tobacco has reached the proportion of global epidemic Largest consumer : Asia, Australia & Far East

6. Developing country 1200 1000 800 600 400 200 WHO estimation of Smokers in the world No.of smokers in million Developed country Total Female Male

7. Different Forms of Tobacco Smokeless Form Smoked Form Khaini Mainpuri Tobacco Mawa Mishri / Masheri Paan Snuff Zarda Gutkha Paan Masala Gudakhu Bidi Cigarettes Chutta Dhumti Hookah Hookli

8. Khaini : sundried tobacco taken with slaked lime Mainpuri Tobacco : Tobacco , slaked lime, finely cut areca nut , camphor & cloves Zarda : Tobacco leaf boil in water with lime and spices Smokeless Form

9. Mawa : Thin shavings of areca nut with tobacco and slaked lime Mishri Roasted tobacco powder taken with katechu Paan : consist of betel leaf , arecanut lime, catechu, tobacco

10. Snuff : finely powdered air cured and fire cured tobacco leaf Guthka : consist of areca nut, tobacco , sweet, or savory flavorings Paan Masala : mixture of betel leaf with lime, arecanut , mint, cardamom & tobacco Gudakhu : paste of powdered tobacco, molasses

11. Bidi : sun dried tobacco flecks rolled in temburni / tendo leaf . Chilum : 10 to 14cm conical clay pipe used for smoking tobacco Chutta / Cigar : cured tobacco wrapped in dry tobacco leaf Cigarette : cured tobacco wrapped in paper Smoked Form

12. Dhumti : rolled tobacco leaf inside jack fruit or banana leaf Hookah : tobacco smoke is drawn through water Hookli : 7-10 cm clay pipe with a mouth piece and a bowl

13. Reverse Smoking Process of smoking cigars or cigarettes with lighted end inside the mouth. Seen specially among female in Vishakhapatnam & Srikakulam district of Andhra Pradesh In Telugu it is known as “ Adda Poga ”

14. Phases in manufacture of Tobacco 1. Planting 2. Harvesting 3. Curing 4. Manufacture

15. Constituents in Tobacco Nicotine Tar CO, NO, HCN Ni,As , Cd, Cr, Pb Radioactive compound

16. Central nervous system Pleasure Arousal, enhanced vigilance Improved task performance Anxiety relief Cardiovascular system  Heart rate  Cardiac output  Blood pressure Coronary vasoconstriction Cutaneous vasoconstriction Effects of Nicotine

17. 3. Others Appetite suppression Increased metabolic rate Skeletal muscle relaxation 4.Effect on oral cavity :

18. Irritability/frustration/anger Anxiety Difficulty of concentration Restlessness/impatience Depressed mood/depression Insomnia Impaired performance Increased appetite/weight gain Craving For tobacco Nicotine Withdrawl Effects :

19. Tar is the common name for the resinous, partially combusted particulate matter produced by the burning of tobacco and other plant material in the act of smoking. Tar is toxic and damages the smoker's lungs over time through various biochemical and mechanical processes. Tar also damages the mouth by rotting and blackening teeth, damaging gums, and desensitizing taste buds. Tar includes the majority of mutagenic and carcinogenic agents in tobacco smoke . Polycyclic aromatic hydrocarbons (PAH) eg . Benzopyrene Tar :

20. Saliva,caries , staining of tooth,halitosis,abrasion,erosion,plaque Periodontal dz , keratosis, acanthosis OPMD Cancer Increasing exposure of tobacco and increasing time

21. Increase salivation Taste Derangement Halitosis Staining of teeth and restorations Increase in blood pressure Immediate Effects : Caries Abrasion Erosion Others :

22. Mucous Membrane Changes : Nicotine palatinus Smokeless Tobacco Keratosis Smoker’s Melanosis Hairy Tongue Leukoedema Oral Submucous Fibrosis Oral Cancer

23. Damage to gingiva and alveolar bone : Gingivitis Periodontitis Acute Necrotizing Ulcerative Gingivitis Delayed alveolar wound healing Oral Potentially Malignant Disease : Leukoplakia Erythroplakia Oral Lichen Planus

24. Damage to gingiva and alveolar bone : Gingivitis Periodontitis Acute Necrotizing Ulcerative Gingivitis Delayed alveolar wound healing Others : Caries Abrasion Erosion

25. Nicotine Palatinus (stomatitis) : Also k/a smoker’s palate It is inflammation of mouth and lips with or without oral ulceration Mainly cause due to high temperature rather than the chemical composition of the smoke Doesn’t appear to have premalignant nature

26. Smokeless Tobacco Keratosis : Also k/a Snuff Pouch, Snuff Dipper’s Lesion, Tobacco Pouch Keratosis. Presence of thin , gray or gray-white, almost translucent plaque With a border blending gradually into surrounding mucosa. Altered mucosa with soft velvety on palpation and pouch on stretching.

27. Smoker’s Melanosis : Brown to black pigmentation of oral tissue. Most often seen in lower labial gingiva process completely.

28. Hairy Tongue : Marked accumulation of keratin on the filiform papillae with hair like appearance. Cause d/t decrease in normal keratin desquamation or increase in keratin production.

29. Leukoedema : Diffuse, gray white, milky, opalescent appearance of mucosa. Surface : appears folded resulting in wrinkles or whitish streaks. Usually bilateral presentation. Lesion do not rub off.

30. Oral cancer : Is a type of head and neck cancer 11 th most common cancer of the world. May originate in any of the tissue of mouth. Histologic types : Teratoma Adenocarcinoma Lymphoma Melanoma

31. Role of Tobacco in cancer :

32.   ANUG is strongly correlated with tobacco use. 98% of ANUG patients are smokers, and persons who smoke more than 10 cigarettes per day have a tenfold increase in ANUG prevalence.  It occurs most frequently in teenagers and young adults and may result from defective neutrophil function allowing bacterial and possibly viral (cytomegalovirus) invasion of gingival tissues.  The vaso -constrictive action of nicotine and other tobacco components is thought to contribute strongly to the painful tissue necrosis and ulceration seen in this disease. Acute Necrotizing Ulcerative Gingivitis :

33. HALITOSIS :   Both smoked and smokeless tobacco usage produce unpleasant breath odors or "bad breath". With smoking the halitosis is produced predominantly by the retention and subsequent exhalation of inhaled smoke in the lungs.  Pipe and cigar tobacco contains more sulfur than cigarettes, hence users tend to have a more offensive halitosis than cigarette smokers.

34. 5 A’S ASK-patients about their use of tobacco at every visit. ADVICE- Non users to never use tobacco and users to quit. ASSESS- Patient's readiness to quit ASSIST- With quitting ARRANGE- For follow ups Guide to counselling for tobacco cessation:

35. Summary:

36. References Shafer’s Textbook of Oral Pathology-8 th edition Oral and Maxillofacial Pathology 3 rd edition by Neville, Damm , Allen,Bouquot Essentials of public health dentistry by Soben Peter.