Oral Cancer and Tobacco

What is the link between tobacco and oral cancer?

Tobacco use is a known as a major risk factor for oral and other cancers. All tobacco products, including cigarettes, cigars, pipe tobacco, chewing tobacco, and snuff, contain toxins (poisonous substances), carcinogens (cancer-causing agents), and nicotine (an addictive substance). Each tobacco product is linked to an increased risk for specific cancers:

Cigarettes Cigarettes, the most common form of tobacco used, causes 87 percent of all lung cancer cases, according to the American Lung Association. In addition, smokers are six times more likely than nonsmokers to develop some form of oral cancer in the oral cavity. Cigarettes contain more than 43 cancer-causing agents.
Cigars and pipes Cigars and pipes are often perceived as the less harmful way to smoke tobacco. However, even when not inhaling, cigar and pipe smokers are at increased risk for cancer of the oral cavity and lungs. Pipe smokers also are at increased risk for lip cancers in areas where the pipestem rests. In addition, cigars take longer to burn and contain more tobacco than cigarettes, increasing the amount of secondhand smoke exposure.

Cigar smoking can lead to tooth loss, jaw bone loss, and other periodontal diseases.

Chewing tobacco and snuff

Smokeless tobacco is available primarily in three forms, chewing tobacco, moist snuff and dry snuff. Chewing tobacco is coarsely shredded leaf tobacco that has been treated with sweet flavoring solutions; this is sold in foil pouches. Moist snuff is finely chopped tobacco available in loose form and also in small teabag-like pouches. Dry snuff is tobacco which has been dried and pulverized into a powder. In the US moist snuff is the most commonly used product by men, followed by chewing tobacco. Dry snuff use is much less common, primarily by women in southern states. All products are placed in the mouth in the area of the cheek or gum, where nicotine is absorbed directly across the mouth lining into the bloodstream.

The nicotine availability from smokeless tobacco products is very similar as that from cigarette smoking. Nicotine in either form is addictive but does not cause any of the diseases related to tobacco use.

Epidemiologic studies have demonstrated that smokeless tobacco use is far safer than cigarette smoking. However, there are health effects, mainly involving a small risk of mouth cancer with long-term use. Users often develop a white patch (or leukoplakia), which represents a local reaction to irritation from the tobacco. Users of chewing tobacco may develop tooth decay due to the high sugar content of this product; users of moist snuff are not affected by tooth decay. Some retraction of the gum tissue in the area of tobacco placement is also noted. All users of smokeless tobacco are counseled to have regular dental checkups.


How do cigarettes and cigars compare?

Cigars became a trend in the 1990s, attracting the young and the old. Although perceived as less detrimental to one's health, cigars actually pose the same risk as cigarettes for oral cancer. Although many cigar smokers do not inhale, the risk for oral, throat, and esophageal cancers is the same as for cigarette smokers. Consider these facts:

  • Compared with nonsmokers, cigar smokers are four to 10 times more likely to develop oral cancer, esophageal cancer, and laryngeal cancer.

  • Cigar smokers may spend an hour or more smoking one large cigar - which can contain the same amount of nicotine as a full pack of cigarettes. Furthermore, even unlit cigars, when held in the mouth for an extended period of time, promote nicotine absorption.

  • Secondhand smoke from cigars contain toxins and cancer-causing agents (carcinogens) similar to secondhand cigarette smoke, but in higher concentrations.
Quitting tips for persons who use tobacco products:

The American Academy of Otolaryngology and the American Lung Association offer the following tips to persons who use tobacco products and are trying to quit:

  • Think about why you want to quit.

  • Pick a stress-free time to quit.

  • Ask for support and encouragement from family, friends, and colleagues.

  • Start doing some exercise or activity each day to relieve stress and improve your health.

  • Get plenty of rest and eat a well-balanced diet.

  • Join a stop-smoking program, or other support group.
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