Ask the dentist: Smokeless tobacco

Editor's note: The Summit Daily News provides the Rocky Mountain Remedies section for health care providers who advertise in the Health and Fitness section; it is a venue for them to share personal and professional viewpoints and tips. Dr. Jeff Gourley and Dr. Bob Faucett bring this article to you from Ten Mile Dental in Frisco.



Q: My boyfriend uses smokeless tobacco. I think it is disgusting but safer than smoking. Does smokeless tobacco cause any problems?

A: We are glad to hear some females consider "chewing" disgusting. Smokeless tobacco causes sores in the mouth, receding gums, tobacco stained teeth, bad breath and a higher degree of cavities. And that is the good news.

Smokeless tobacco is very addictive and carries a big risk.

It comes in two forms: moist snuff and chew. Snuff is a finely ground tobacco and, in the United States, it is the most popular type of smokeless tobacco. Users put a pinch of snuff (also called a "dip" or a "rub") between the cheek and gum in the mouth and hold it there. Chewing tobacco, which comes in leaf and plug forms, is bulkier than snuff and, as its name suggests, is chewed.

Smokeless tobacco is addictive. It contains nicotine, the same drug that makes cigarettes addictive. If you hold an average size dip or chew in your mouth for 30 minutes, you get as much nicotine as you do from about three cigarettes.

Smokeless tobacco can cause permanent gum recession, mouth sores, precancerous lesions in the mouth and cancers of the mouth and throat.

Sores, white patches, red patches and lumps inside your mouth are signs of damage caused by chewing and dipping. Changes inside your mouth can be seen microscopically as soon as seven days after starting to use smokeless tobacco. White patches, also called leukoplakias (loo-ko-play-kee-uhs), can turn into cancer over time. Red patches, also called erythroplakias (eth-row-play-kee-uhs), have a high potential to become cancerous.

Oral cancer includes cancers of the mouth, parts of the throat and pharynx or voice box. It can spread to other parts of the body quickly. Surgery needed to treat oral cancer is often extensive and disfiguring. On average, only half of those with the disease will survive more than five years.

About 30,000 new cases of oral cancer (mouth, oral cavity, and pharynx) are diagnosed every year. More than 8,000 die from mouth cancer every year. It is clear that smokeless tobacco use is one of the risk factors for developing oral cancer, but it is not known how many of these cases or deaths are directly caused by smokeless tobacco use. However, some research shows users of smokeless tobacco are at four times the risk of developing oral cancer than nonusers. In addition to using smokeless tobacco, many other behaviors, such as smoking and drinking alcohol, put you at greater risk for developing oral cancer.

Smokeless tobacco also has other health implications. If you have hypertension (increased blood pressure), use of smokeless tobacco may make your hypertension more severe because nicotine narrows veins.

The nicotine in smokeless tobacco can increase your risk of acute cardiac ischemia (not enough oxygen to the heart), angina pectoris (severe constricting pain in the chest) and acute myocardial infarction (nonreversible damage to the heart muscle).



More facts

-- Like cigars and cigarettes, smokeless tobacco contains a variety of toxins associated with cancer. At least 28 cancer-causing chemicals have been identified in smokeless tobacco products.

-- Smokers are six times more likely than nonsmokers to develop oral cancer. Smokeless tobacco users increase the risk of oral cancer by 50 times, according to the American Dental Association.

-- Oral cancer, 75 percent of which is caused by tobacco products, kills one American every hour.

-- Of people using smokeless tobacco products, one out of three will develop leukoplakia. Leukoplakia is a white, leathery change of the tissues in the mouth. This change is considered precancerous. Once leukoplakia starts and a person continues to use smokeless tobacco products, one out of 20 will develop oral cancer.

So smokeless tobacco is not safer than cigarettes. The reality of using smokeless tobacco versus smoking is like asking yourself, "Is it better to shoot myself in the chest or the head?" Either way, you are playing Russian roulette with your life.

Stopping the use of smokeless tobacco before the precancerous leukoplakia turns cancerous usually allows the tissue to return to normal. In a young adult, this requires a minimum of six weeks to return to health.