Smoking and dental health are more intimately connected than you would imagine

Imagine losing a portion of your cheek at the age of 18? Medical research indicates that smokers are six times more likely than nonsmokers to develop oral cancers. Even those addicted to smokeless tobacco (snuff or chewing tobacco) can develop cancers of the cheek, gums and lining of the lips, increasing the risk by about 50 times. Oral cancer is in fact one of the most devastating effects of smoking. In fact, the death rate from oral cancers (which includes cancers of the tongue, mouth, gums, tonsils and pharynx) exceeds the death rate from cervical cancer, according to experts.

Who is at risk?

Its believed that the adolescents are at the maximum risk. Over the last 10 years the number of kids under 18 who become daily smokers increased by 70 per cent. Roughly 3,000 kids become regular smokers every day. Worse, almost 1/3 of them will die from a tobacco-related illness (Dental Health Foundation, http://www.dentalhealth.ie/whatsnew/index.tmpl?_eqRIDdatarq=20040224175004) The susceptibility to smoking starts around age 10 years and peaks by age 14 years in close to 60 per cent of the population. And once thy have experimented, approximately half continue to smoke and become addicted to the nicotine content in cigarettes. An adolescent, who thinks that the health problems of smoking can be alleviated, provided he or she can stop smoking before the age of 35, appears to be at much greater risk of experimentation. Furthermore, older the habit and more the number of cigarettes smoked in a day, harder is it to quit.

The risk of oral cancer in adolescents?

Approximately 75% of all oral cancers are associated with tobacco use or alcohol consumption. In fact, about 3 per cent of male and 2 per cent of female cancer sufferers have oral cancer. The death rate from oral cancer is also high. Only about 50 percent of people who get oral cancer survive for five years or more, in part because the disease often is not discovered until it is more advanced, according to a study carried in Community Dentistry and Oral Epidemiology.

Early warning signs:

o Sticky tar deposits or brown staining on the teeth. Heavy smokers will have almost brown teeth.
o 'Smoker's palate' - red inflammation on the roof of the mouth
o Delayed healing of the gums
o Increased severity of gum disease
o Bad breath or halitosis
o Black hairy tongue
o Oral lesions
o Gum recession - with chewing tobacco at the site of the tobacco "wad", the gums react by receding along the tooth root, exposing the root
o Oral cancer

Why do young people smoke?

There are a number of complex and inter-relating factors that predispose young people to smoke, and these vary among individuals and among populations. However, years of research have identified certain factors that commonly play a role in smoking initiation. These include high levels of social acceptability for tobacco products, exposure and vulnerability to tobacco marketing efforts, availability and ease of access, role modeling by parents and other adults, and peer group use. A study in the United States found that among teens who smoke, 85 per cent chose the three most heavily advertised brands of cigarettes, compared to only 35 per cent of adults. Data suggest that children are more responsive than adults to the messages and images contained in tobacco advertisements. Past studies have also shown that influence by their peers is likely the biggest motivator leading to adolescents experimentation with smoking. Girls in fact are more susceptible to such influences, a trend that carries over to high school according to past findings.

dentists and dental associations can do?

Small wonder that the American Dental Hygienists' Association (ADHA) has now constituted a task force to push its three-step approach to smoking cessation intervention: "Ask. Advise. Refer." Efforts are meanwhile afoot to develop protocols, scripts, and a toolkit to facilitate smoking cessation intervention by dental hygienists. In November 2003, ADHA also received a grant from the Robert Wood Johnson Foundation's Smoking Cessation Leadership Center at the University of California, San Francisco to launch a nationwide effort by dental hygienists to promote smoking cessation.

Smoking is no doubt a serious health problem for our adolescents. However, since abstinence is a long-drawn process, our cessation services need to be made more attractive to teens. So far, interventions with the youth have been relatively brief, without focus and without any longer term support systems. It would also be helpful to know what motivates adolescents to want to quit smoking. Ready to quit smoking?

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