The Dangers

TobaccoUse

of

Lauryn Tuttle, RDH

OralCancers

and Lesions

Overview:• What is oral cancer?• What are the signs/symptoms?• What are the dangers of tobacco?• What types of tobacco causes cancer?• Is there treatment for oral cancer?• What does oral cancer look like?• Is there means of prevention?

Evidence began to accumulate several years ago that tobacco use is an enormous threat to oral tissues and human health.

DID YOU KNOW ??

Tobacco is toxic to humans- contains 4,000 chemicals.

One of the most preventable cause of disease and PREMATURE death in the WORLD.

Almost 20% of American adults use tobacco and thousands of children/adolescents begin each day.

Life expectancy is shortened. The number of years lost is dependent on may factors.

Nicotine is the most addictive substance in tobacco, but other chemicals are more harmful.

Smoking is linked to SIDS (Sudden Infant Death Syndrome) and periodontal disease.Negative effect in bone metabolism; after menopause women smokers have a deficit in bone density thus leading to osteoporosis.

87% of lung cancers in the United States are related to smoking.

Tobacco Comes In Many Forms

CigarSnuff

Chewing TobaccoSmokeless (Spit) Tobacco

CigarettePipe Tobacco

If you use tobacco or consume alcohol you are 6 times more likely to be diagnosed with head or neck cancer than those who do not.

Who Is At Risk??

Sun exposure, poor nutrition, immune system suppression, and diseases like Plummer-Vinson syndrome and Human Papillomavirus (HPV) are all risk factors.

WhatIsHead

andNeck

Cancer??

Cancer develops when abnormal cells in a part of the body begin to grow out of control. Head and neck cancer often begin in the cells that line the mouth, sinuses, and throat. These areas include the lips, tongue, cheeks, gums, palate, voice box, and salivary glands.

Symptoms of Head/Neck Cancer

o A Change or hoarseness in your voiceo A sore throat that does not go awayo Difficulty chewing or swallowingo Open sore in the mouth or crusting lesion that does not healo A white or red patch in the mouth that does not go awayo Recurrent bleeding in the moutho Unusual pain in the mouth or jawo Numbness of tongue or areas of the moutho Lump or swelling in the mouth that does not go awayo Swelling of the jaw that causes appliances to fit poorlyo Loosening of teeth or pain around teeth

Warning Signs:Precancerous Lesions are…

Leukoplakia (White Lesions)

Erythroplakia (Red Lesions)

• Cannot be wiped off• Does not go away after 2 weeks

Leukoplakia:Verrucous Carcinoma

Results from smokeless tobacco, snuff, or chew tobacco.Sharp or blunt-like projections.Usually asymptomatic.Usually occur in those who have excessive tobacco use and or consume alcohol for many years.Treatment includes biopsy and radiotherapy.

Verruciform Carcinoma

Nicotine Stomatitis:Smoker’s patch, smoker’s palate, smoker’s keratosis..Lesions on the palate, from heat stream smoke and chemicals. Asymptomatic or mildly irritating. Most patients are unaware of lesions. Salivary glands on roof of mouth become swollen. White/red speckled effect. Prognosis is excellent, once irritant is removed, lesions go away.

Hairy Tongue:• Abnormal dark coating on the

dorsum of the tongue. • Papilla becomes

discolored contributed to poor hygiene, smoking, alcohol, antibiotics, coffee, dark tea, and some prescription strength mouthwashes.

• Treatment includes increasing hydration, brushing the tongue with a soft bristle brush or tongue scrapper and discontinue use of tobacco products.

• Non-cancerous!

Nicotine Induced Keratosis:Result of chew tobacco/spit tobacco being held in the vestibule (lower lip) over a long period of time.

• Non-Cancerous but can result in squamous cell carcinoma

• Rippling/leather like appearance• White lesion• Goes away if irritant is removed

over time

HowDoesTobacco EffectMyTeeth?? • Lowered immune factors

• Periodontal Disease• Gingival recession• Bone loss• Increased tooth loss• Increase bleeding• Xerostomia• Severe staining• Bad breath

Prevention and Treatment??• Do not start smoking• Smoking cessation• Proper oral hygiene• Annual oral cancer

screenings• Biopsy (removal)• Radiotherapy Less than half of the

population diagnosed with oral, head, or neck cancer live past 5 years. Although cancer is based upon stages (I,II,IIII,IV,V), prognoses can be positive.

TriviaQuestionsWhich of the following lesions is described as having a rippled/leathering effect on oral tissues?

A) LeukoplakiaB) Nicotine KeratosisC) Median Rhomboid GlossitisD) Verrucous

Which of the following lesions is a result of poor oral hygiene?

A) ErythroplakiaB) Nicotine StomatitisC) Hairy tongueD) Pregnancy Pyrogenic

Granuloma

DiscussionQuestionsDavid is a 60 year old male with a history of a long time use of chew tobacco. He is complaining of a white lesion on his palate that has been noticeable for about a month without any signs of healing. The lesion is asymptomatic with an appearance of a sharp-like projection, almost a cauliflower effect. David has had this area biopsied. Based on the information given what would be your diagnosis and how would you treat it?

Your 30 year old female patient has just been diagnosed with Nicotine Stomatitis. Explain what Nicotine Stomatitis looks like intraorally and how is it treated?

Bibliography• http://www.cancer.org/cancer/

oralcavityandoropharyngealcancer/detailedguide/oral-cavity-and-oropharyngeal-cancer-survival-rates

• http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm

• http://emedicine.medscape.com/article/1077117-overview• http://www.medicinenet.com/oral_cancer/article.htm• http://mydental.uw.edu/case_of_month/nov07/PGCG.html• http://www.dimensionsofdentalhygiene.com/

2004/09_September/Departments/Oral_Pathology.aspx• Wilkins, Esther M.. "The Patient Who Uses Tobacco." Clinical

practice of the dental hygienist. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009. . Print.