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Kaabi HH. Smokeless tobacco keratosis in oral mucosa with epithelial dysplasia: A case report. Medicine (Baltimore) 2024; 103:e37771. [PMID: 38608125 PMCID: PMC11018213 DOI: 10.1097/md.0000000000037771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/11/2024] [Indexed: 04/14/2024] Open
Abstract
RATIONALE Smokeless tobacco use is a risk factor for the development of various oral lesions, among which is smokeless tobacco keratosis (STK). This condition is caused by constant frictional irritation of smokeless tobacco products against the oral mucosa and appears as a White-to-gray plaque with wrinkling. PATIENT CONCERNS A 50-year-old man who had been using smokeless tobacco for 24 years visited our clinic complaining of changes in the lower right sulcus of the oral cavity for 10 days. Clinical examination revealed a unilateral, nonhomogeneous White lesion in the area of the complaint. Histopathological examination showed hyperkeratosis, areas of keratin plugging, and mild dysplastic epithelial changes. DIAGNOSIS The clinico-histopathological correlation suggested a diagnosis of STK with focal mild epithelial dysplasia. INTERVENTION AND OUTCOME A comprehensive management plan included maintaining oral hygiene, education on the detrimental effects of smokeless tobacco, advice to cease smoking, and regular follow-up to monitor the potential for malignant transformation. The patient was referred to a tobacco cessation society for tailored advice and counseling. On follow-up visits, there was an improvement in the lesion after habitual cessation. LESSONS The diagnosis of tobacco-related oral lesions is often delayed, which may result in malignant transformation. This illustrates the need to train healthcare professionals to identify tobacco-related conditions at an early stage and to educate patients regarding the harmful effects of tobacco use.
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Affiliation(s)
- Hassan Hamed Kaabi
- Assistant Professor, Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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2
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Pedroso CM, Normando AGC, Siracusa CS, Lauby-Secretan B, Nethan ST, Tomasi RA, Lopes MA, Warnakulasuriya S, Santos-Silva AR. Pan-American prevalence of smokeless tobacco use and association with oral potentially malignant disorders and head and neck cancer: a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:322-332. [PMID: 37076380 DOI: 10.1016/j.oooo.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES To determine the prevalence of smokeless tobacco (SLT) use and its association with oral potentially malignant disorders (OPMDs) and head and neck cancer (HNC) in the Pan-American Health Organization (PAHO) region. STUDY DESIGN A literature search was conducted across 9 databases and other sources. The eligibility criteria were pediatric (0-18 years old) and adult (19 years and older) populations consuming any type of SLT. Meta-analysis was performed to determine the prevalence of SLT and the association between its use and OPMDs/HNC in the PAHO region; the Grading of Recommendations Assessment, Development, and Evaluation tool was used to verify the certainty of evidence. RESULTS Fifty-nine studies from 6 PAHO countries were included, of which 51 were also subjected to quantitative analysis. The pooled SLT prevalence of use was 15% (95%CI: 11.93-18.69) overall, 17% (95%CI: 13.25-22.65) in adults, and 11% (95%CI: 8.54-14.78) in the pediatric population. The highest reported SLT prevalence of use was 33.4% (95%CI: 27.17-39.93) in Venezuela. HNC was positively associated with SLT use (OR = 1.98, 95%CI: 1.54-2.55), with a moderate certainty of evidence. Among OPMDs, only leukoplakia reported a positive association with SLT use (OR = 8.38; 95%CI: 1.05-67.25). However, the quality of the evidence was very low. CONCLUSION A high consumption of SLT use, chewing tobacco and snuff, is reported among the adult population residing in the PAHO region with a positive association with the development of oral leukoplakia and HNC.
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Affiliation(s)
- Caique Mariano Pedroso
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Ana Gabriela Costa Normando
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Cristina Saldivia Siracusa
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Béatrice Lauby-Secretan
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France
| | - Suzanne Tanya Nethan
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), Lyon, France
| | - Ramiro Alejandro Tomasi
- Department of Oral Pathology, Dental School, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Saman Warnakulasuriya
- The WHO Collaborating Centre for Oral Cancer, London, UK; Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
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3
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Miluna S, Melderis R, Briuka L, Skadins I, Broks R, Kroica J, Rostoka D. The Correlation of Swedish Snus, Nicotine Pouches and Other Tobacco Products with Oral Mucosal Health and Salivary Biomarkers. Dent J (Basel) 2022; 10:dj10080154. [PMID: 36005252 PMCID: PMC9406994 DOI: 10.3390/dj10080154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022] Open
Abstract
In society, tobacco products, such as e-cigarettes, and smokeless tobacco products, such as snus and nicotine pouches, are becoming more attractive. There is still a lack of information regarding the effects of these products on the oral mucosa and oral saliva biomarkers. The aim of this study is to evaluate oral mucosa and the presence of inflammatory biomarkers IL-6, IL-1, IL-8, TNF alpha and LRG-1 in saliva. Respondents were divided in four groups based on their tobacco product usage. Oral examination was carried out, saliva samples were taken, and the detection of IL-6, IL-8, IL-1, TNF alpha and LRG-1 levels in saliva was carried out. Out of the tobacco users, 30.8% were snus users, 48.7% were cigarette users and 20.5% were e-cigarette users. The control group was composed of respondents who did not use any tobacco products. E-cigarettes were used more by women, but snus was used more by men. Mucosal changes were seen in the group of snus users, and mucosal changes were only seen in men who had used 5–10 tobacco units per day for 5–10 years. Increased IL-6 levels in saliva were detected in respondents who also experienced mucosal changes. Mucosal changes were white, leathery and localized at the site where snus sachets were placed. Saliva, as an easily available biofluid, could be used as a first tool to detect potentially precancerous signs, but the LRG1 marker cannot be used as a prognostic marker.
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Affiliation(s)
- Sintija Miluna
- Department of Prosthetic Dentistry, Riga Stradins University, LV-1007 Riga, Latvia
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
- Correspondence:
| | - Ricards Melderis
- Emergency Department, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
| | - Loreta Briuka
- Department of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
| | - Ingus Skadins
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
| | - Renars Broks
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
| | - Juta Kroica
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
| | - Dagnija Rostoka
- Department of Biology and Microbiology, Riga Stradins University, LV-1007 Riga, Latvia
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4
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Rivera AJ, Tyx RE. Microbiology of the American Smokeless Tobacco. Appl Microbiol Biotechnol 2021; 105:4843-4853. [PMID: 34110473 PMCID: PMC8190171 DOI: 10.1007/s00253-021-11382-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022]
Abstract
Smokeless tobacco products (STP) contain diverse microbial communities that contribute to the formation of harmful chemical byproducts. This is concerning since 300 million individuals around the globe are users of smokeless tobacco. Significant evidence has shown that microbial metabolic activities mediate the formation of carcinogens during manufacturing. In recent years, studies have revealed a series of additional health impacts that include lesions and inflammation of the oral mucosa and the gastrointestinal tract, as well as alterations of the endogenous microbiota. These findings are due to recent developments in molecular technologies that allowed researchers to better examine the microbial component of these products. This new information illustrates the scale of the STP microbiota and its diversity in the finished product that is sold for consumption. Additionally, the application of metagenomics and metatranscriptomics has provided the tools to look at phylogenies across bacterial, viral, and eukaryotic groups, their functional capacities, and viability. Here we present key examples of tobacco microbiology research that utilizes newer approaches and strategies to define the microbial component of smokeless tobacco products. We also highlight challenges in these approaches, the knowledge gaps being filled, and those gaps that warrant further study. A better understanding of the microbiology of STP brings vast public health benefits. It will provide important information for the product consumer, impact manufacturing practices, and provide support for the development of attainable and more meaningful regulatory goals. KEY POINTS: Newer technologies allowed quicker and more comprehensive identification of microbes in tobacco samples, encapsulating microorganisms difficult or impossible to culture. Current research in smokeless tobacco microbiology is filling knowledge gaps previously unfilled due to the lack of suitable approaches. The microbial ecology of smokeless tobacco presents a clearer picture of diversity and variability not considered before.
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Affiliation(s)
- A J Rivera
- Centers for Disease Control and Prevention, 4770 Buford Highway, NE M.S. S110-03, Atlanta, GA, 30341-3717, USA.
| | - R E Tyx
- Centers for Disease Control and Prevention, 4770 Buford Highway, NE M.S. S110-03, Atlanta, GA, 30341-3717, USA
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Rodrigues-Fernandes CI, de Cáceres CBL, Sant'Ana MSP, Soares CD, de Carvalho MGF, van Heerden WFP, Robinson L, Radhakrishnan R, Hunter KD, Gomez RS, de Almeida OP, Vargas PA, Günhan Ö, Tomasi RA, Alawi F, Pontes HAR, Fonseca FP. Oral lesions containing amyloid-like material. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:190-201. [PMID: 33737015 DOI: 10.1016/j.oooo.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/13/2021] [Indexed: 02/07/2023]
Abstract
During oral pathology daily practice, true amyloid may be identified in oral amyloidosis and several odontogenic tumors. However, histologic examination often reveals other oral and perioral diseases with similar eosinophilic, acellular, amorphous substances. These include extensive areas of collagenous sclerosis, fibrin deposition, elastic fiber degeneration, and dentinoid material, which may resemble amyloid under light microscopic examination. These materials are often termed "amyloid-like" due to their close histologic resemblance to true amyloid. The rarity of most of these conditions and their strong histologic similarity may hamper an accurate diagnosis. Definitive diagnosis of these lesions may require clinical correlation; laboratory evaluation; histochemical or immunohistochemical reactions; and, in some cases, genetic investigation. In this review, we describe the main clinicopathologic features of this group of diseases that may manifest in the oral and/or perioral regions and that have in common the presence of amyloid-like material deposition.
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Affiliation(s)
| | | | - Maria Sissa Pereira Sant'Ana
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ciro Dantas Soares
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas
| | | | - Willie F P van Heerden
- Department of Oral Pathology and Oral Biology, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Liam Robinson
- Department of Oral Pathology and Oral Biology, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Raghu Radhakrishnan
- Department of Oral Pathology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Keith D Hunter
- Department of Oral Pathology and Oral Biology, School of Dentistry, University of Pretoria, Pretoria, South Africa; Academic Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, The University of Sheffield, Sheffield, UK
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas; Department of Oral Pathology and Oral Biology, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Ömer Günhan
- Department of Pathology, TOBB ETU Medical School, Ankara, Turkey
| | - Ramiro Alejandro Tomasi
- Department of Pathology, School of Dentistry, National University of Córdoba, Córdoba, Argentina
| | - Faizan Alawi
- Division of Dermatopathology, Department of Dermatology, University of Pennsylvania, Philadelphia, PA
| | | | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Department of Oral Pathology and Oral Biology, School of Dentistry, University of Pretoria, Pretoria, South Africa.
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6
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Abstract
Oral potentially malignant disorders (OPMDs) are precursor lesions that may undergo malignant transformation to oral cancer. These lesions most commonly present clinically as white patches (leukoplakia). However, they may also be red (erythroplakia), or red and white (erythroleukoplakia). There are many risk factors associated with the development of an OPMD, and with the risk of malignant transformation of the lesion. A biopsy with subsequent microscopic examination from the lesional tissue is necessary in identification of OPMD. This article reviews the clinical appearance of OPMDs, associated risk factors, diagnosis and histologic appearance, and treatment.
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Affiliation(s)
- Stephanie L Wetzel
- Atlanta Oral Pathology, 2701 North Decatur Road, Decatur, GA 30022, USA.
| | - Jessica Wollenberg
- Randolph Oral Pathology Associates, 447 Route 10, Suite 5, Randolph, NJ 07869, USA
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7
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Tomar SL, Hecht SS, Jaspers I, Gregory RL, Stepanov I. Oral Health Effects of Combusted and Smokeless Tobacco Products. Adv Dent Res 2019; 30:4-10. [PMID: 31538806 PMCID: PMC7577287 DOI: 10.1177/0022034519872480] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The oral cavity is usually the first part of a consumer's body exposed to the constituents of tobacco products or their emissions. Consequently, the oral cavity is a frequent site for carcinogenic, microbial, immunologic, and clinical effects of tobacco use. This article summarizes 5 presentations on various aspects of oral health affected by combusted or noncombusted tobacco products from a recent conference, "Oral Health Effects of Tobacco Products: Science and Regulatory Policy," sponsored by the American Association for Dental Research and the Food and Drug Administration.
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Affiliation(s)
- S L Tomar
- College of Dentistry, University of Florida, Gainesville, FL, USA
| | - S S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - I Jaspers
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - R L Gregory
- School of Dentistry, Indiana University, Indianapolis, IN, USA
| | - I Stepanov
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
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8
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Almahdi HM, Ali RW, Åstrøm AN, Nasir EF. Perception of health professions students of their role model status in Toombak cessation: A cross-sectional study from Sudan. PLoS One 2019; 14:e0210837. [PMID: 30730905 PMCID: PMC6366877 DOI: 10.1371/journal.pone.0210837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/02/2019] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Health professionals are to play an essential and effective role in tobacco control. Toombak is a popular form of smokeless tobacco, locally made and used among Sudanese. It is associated with oral and systemic health hazards, particularly oral cancer. This study was set out to assess health professions students' perception of their status as future role models for their patients and the public regarding Toombak use cessation and to explore socio-cognitive covariates of perceived role model status. MATERIALS AND METHODS A cross-sectional study was conducted in 2013-2014 using a self-administered questionnaire among health professions students enrolled in Medicine, Pharmacy, Dentistry and Nursing colleges in Khartoum state, Sudan. A total of 1530 participants were recruited from colleges using a cluster stratified sampling procedure. RESULTS The majority of the participants (88.2%) were 19-22 year old, females showed predominance (66.1%). Most of the participants (69.7%) scored good knowledge of Toombak-related therapies. The majority (97%) had a positive attitude towards banning Toombak use in public. Half of the participants (50.4%) confirmed availability of Toombak control policy in their college, while 66% reported receiving training in Toombak cessation. Only 9.2% of the participants reported that they have ever used Toombak; among them, 69.5% were current daily users. Less than half (47.8%) reported a positive perception of their status as a role model. Logistic regression model revealed that tobacco cessation training, availability of college policy and positive attitudes towards banning Toombak use in public were strong predictors of with a positive perception of role model status. CONCLUSION Imposing Toombak control policies within colleges combined with formal training in cessation methods, would reinforce the positive perception of health professions students as a role model, particularly the students themselves seem to be ready for such systematic training.
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Affiliation(s)
- Hatim Mohammed Almahdi
- University of Science and Technology, Faculty of Dentistry, Omdurman, Sudan
- King Faisal University, College of Dentistry, AlAhsa, Saudi Arabia
| | - Raouf Wahab Ali
- University of Science and Technology, Faculty of Dentistry, Omdurman, Sudan
- King Faisal University, College of Dentistry, AlAhsa, Saudi Arabia
| | - Anne Nordrehaug Åstrøm
- Centre for International Health, University of Bergen, Bergen, Norway
- Department of Clinical Dentistry, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway
| | - Elwalid Fadul Nasir
- University of Science and Technology, Faculty of Dentistry, Omdurman, Sudan
- King Faisal University, College of Dentistry, AlAhsa, Saudi Arabia
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9
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Frictional Keratosis, Contact Keratosis and Smokeless Tobacco Keratosis: Features of Reactive White Lesions of the Oral Mucosa. Head Neck Pathol 2019; 13:16-24. [PMID: 30671762 PMCID: PMC6405791 DOI: 10.1007/s12105-018-0986-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/02/2018] [Indexed: 01/20/2023]
Abstract
White lesions of the oral cavity are quite common and can have a variety of etiologies, both benign and malignant. Although the vast majority of publications focus on leukoplakia and other potentially malignant lesions, most oral lesions that appear white are benign. This review will focus exclusively on reactive white oral lesions. Included in the discussion are frictional keratoses, irritant contact stomatitis, and smokeless tobacco keratoses. Leukoedema and hereditary genodermatoses that may enter in the clinical differential diagnoses of frictional keratoses including white sponge nevus and hereditary benign intraepithelial dyskeratosis will be reviewed. Many products can result in contact stomatitis. Dentrifice-related stomatitis, contact reactions to amalgam and cinnamon can cause keratotic lesions. Each of these lesions have microscopic findings that can assist in patient management.
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Arunachalam SR, Tang KD, Punyadeera C. Isolation and Quantification of MicroRNAs from Human Saliva. Methods Mol Biol 2019; 2054:105-114. [PMID: 31482450 DOI: 10.1007/978-1-4939-9769-5_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Oral premalignant disorders (OPMD) have relatively high malignant transformation rates to Oral Cancers (OC). Oral carcinogenesis is a multistep process that originates as epithelial hyperplasia followed by epithelial dysplasia, leading to fully malignant phenotypes. Early detection can be lifesaving but is currently not possible due to the lack of early diagnostic tools. The current diagnostic methods such as biopsy sampling, tumor tissue staining, and imaging techniques require skilled personnel and are invasive, painful, time-consuming, and expensive. Saliva has gained momentum as the diagnostic fluid of the future due to its noninvasive nature, ease of sampling, multiple samples can be collected with ease and more importantly does not require skilled personnel. The use of saliva in cancer diagnostics is an emerging and an expanding field. MicroRNA (miRNA) play a role in cancer initiation and progression and the expression changes of miRNA have been investigated as a potential biomarker in cancer studies. In this chapter, we describe a robust and cost-effective protocol to isolate and enrich miRNA from saliva samples. Profiling miRNAs in saliva samples can form part of the clinical management of OPMD and OC patients in the future.
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Affiliation(s)
- Sri Ram Arunachalam
- School of Chemistry and Molecular Biosciences, University of Queensland, St Lucia, QLD, Australia
- The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Kai Dun Tang
- The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Chamindie Punyadeera
- The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia.
- Translational Research Institute, Brisbane, QLD, Australia.
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Müller S. Oral epithelial dysplasia, atypical verrucous lesions and oral potentially malignant disorders: focus on histopathology. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:591-602. [PMID: 29606637 DOI: 10.1016/j.oooo.2018.02.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/28/2018] [Accepted: 02/19/2018] [Indexed: 02/06/2023]
Abstract
The term oral potentially malignant disorders (OPMDs) describes a recognizable group of mucosal diseases that have a risk of progressing to squamous cell carcinoma. Oral leukoplakia, the most common OPMD, has a 1% prevalence and reported malignant transformation rates of 2% to 5%. Other OPMDs include erythroplakia, erythroleukoplakia, submucous fibrosis, lesions of reverse smokers, and inherited genetic disorders, such as Fanconi anemia. The histopathologic assessment of OPMDs is an area of subjectivity, and oral epithelial dysplasia (OED) is fraught with both interrater variability and intrarater variability. Both architectural and cytologic changes are utilized when developing criteria for grading OED. However, the concept of atypical verrucous lesions, particularly as it pertains to proliferative verrucous leukoplakia, suffers from lack of histopathologic diagnostic criteria. Histopathologic mimics of OPMDs, including reactive/regenerative epithelium, frictional keratosis, and infection, can result in patient mismanagement. This review will focus specifically on the histologic features of OED, including human papillomavirus-associated dysplasia, as well as the histologic features of atypical verrucous keratoses/hyperplasia, particularly those that arise in the setting of proliferative verrucous leukoplakia along with OPMD mimics.
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Affiliation(s)
- Susan Müller
- Emory University School of Medicine, Atlanta Oral Pathology, Decatur, GA, USA.
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12
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Shearston JA, Shah K, Cheng E, Moosvi R, Park SH, Patel N, Spielman AI, Weitzman ML. Dental, Dental Hygiene, and Advanced Dental Students' Use, Knowledge, and Beliefs Regarding Tobacco Products. J Dent Educ 2017; 81:1317-1326. [PMID: 29093145 DOI: 10.21815/jde.017.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/29/2017] [Indexed: 11/20/2022]
Abstract
Using cigarettes and alternative tobacco products (ATPs) is associated with negative oral health outcomes, and dental health professionals are poised to help patients quit. The aim of this study was to determine dental, dental hygiene, and advanced dental students' use, knowledge, and beliefs about cigarettes and ATPs, including perceptions about their education in tobacco dependence treatment and counseling experience. All 1,783 students enrolled in the dental, dental hygiene, and postdoctoral dental programs at the New York University College of Dentistry were invited to participate in the survey in 2016. A total of 708 students at least partially completed the survey, for a response rate of 39.7%. In the results, 146 of the students (20.1%) reported ever using cigarettes, while 253 (35.7%) reported ever using any ATP. Regarding tobacco use intervention, the students reported they had not received enough training on ATPs, were neutral about cigarettes, and were somewhat confident and not so confident counseling a cigarette smoker or ATP user, respectively. By their fourth year, 77.8% of the dental students reported they had counseled someone to stop smoking cigarettes, but only 40.7% had counseled someone to stop using ATPs. Overall, all groups of students reported feeling more confident and had received more education on interventions for cigarettes than for ATPs (p<0.001). These students reported low confidence in helping people quit tobacco and did not perceive they had received enough training on intervening with patients on use of cigarettes and ATPs. These findings call for a revised tobacco education curriculum for dental, dental hygiene, and advanced dental students, focused on building knowledge and confidence for promoting tobacco dependence treatment.
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Affiliation(s)
- Jenni A Shearston
- Ms. Shearston is Project Manager, Department of Population Health, New York University School of Medicine and Abu Dhabi Public Health Research Center; Dr. Shah is Program Coordinator, Department of Environmental Medicine, New York University School of Medicine; Mr. Cheng is a dental student, New York University College of Dentistry; Mr. Moosvi is a dental student, New York University College of Dentistry; Dr. Park is Research Scientist, Department of Population Health, New York University School of Medicine; Dr. Patel is a Master's of Public Health student, Long Island University; Dr. Spielman is Associate Dean for Academic Affairs, New York University College of Dentistry; and Dr. Weitzman is Professor, New York University School of Medicine, Abu Dhabi Public Health Research Center, and New York University College of Global Public Health.
| | - Krina Shah
- Ms. Shearston is Project Manager, Department of Population Health, New York University School of Medicine and Abu Dhabi Public Health Research Center; Dr. Shah is Program Coordinator, Department of Environmental Medicine, New York University School of Medicine; Mr. Cheng is a dental student, New York University College of Dentistry; Mr. Moosvi is a dental student, New York University College of Dentistry; Dr. Park is Research Scientist, Department of Population Health, New York University School of Medicine; Dr. Patel is a Master's of Public Health student, Long Island University; Dr. Spielman is Associate Dean for Academic Affairs, New York University College of Dentistry; and Dr. Weitzman is Professor, New York University School of Medicine, Abu Dhabi Public Health Research Center, and New York University College of Global Public Health
| | - Eric Cheng
- Ms. Shearston is Project Manager, Department of Population Health, New York University School of Medicine and Abu Dhabi Public Health Research Center; Dr. Shah is Program Coordinator, Department of Environmental Medicine, New York University School of Medicine; Mr. Cheng is a dental student, New York University College of Dentistry; Mr. Moosvi is a dental student, New York University College of Dentistry; Dr. Park is Research Scientist, Department of Population Health, New York University School of Medicine; Dr. Patel is a Master's of Public Health student, Long Island University; Dr. Spielman is Associate Dean for Academic Affairs, New York University College of Dentistry; and Dr. Weitzman is Professor, New York University School of Medicine, Abu Dhabi Public Health Research Center, and New York University College of Global Public Health
| | - Rizvan Moosvi
- Ms. Shearston is Project Manager, Department of Population Health, New York University School of Medicine and Abu Dhabi Public Health Research Center; Dr. Shah is Program Coordinator, Department of Environmental Medicine, New York University School of Medicine; Mr. Cheng is a dental student, New York University College of Dentistry; Mr. Moosvi is a dental student, New York University College of Dentistry; Dr. Park is Research Scientist, Department of Population Health, New York University School of Medicine; Dr. Patel is a Master's of Public Health student, Long Island University; Dr. Spielman is Associate Dean for Academic Affairs, New York University College of Dentistry; and Dr. Weitzman is Professor, New York University School of Medicine, Abu Dhabi Public Health Research Center, and New York University College of Global Public Health
| | - Su Hyun Park
- Ms. Shearston is Project Manager, Department of Population Health, New York University School of Medicine and Abu Dhabi Public Health Research Center; Dr. Shah is Program Coordinator, Department of Environmental Medicine, New York University School of Medicine; Mr. Cheng is a dental student, New York University College of Dentistry; Mr. Moosvi is a dental student, New York University College of Dentistry; Dr. Park is Research Scientist, Department of Population Health, New York University School of Medicine; Dr. Patel is a Master's of Public Health student, Long Island University; Dr. Spielman is Associate Dean for Academic Affairs, New York University College of Dentistry; and Dr. Weitzman is Professor, New York University School of Medicine, Abu Dhabi Public Health Research Center, and New York University College of Global Public Health
| | - Naiya Patel
- Ms. Shearston is Project Manager, Department of Population Health, New York University School of Medicine and Abu Dhabi Public Health Research Center; Dr. Shah is Program Coordinator, Department of Environmental Medicine, New York University School of Medicine; Mr. Cheng is a dental student, New York University College of Dentistry; Mr. Moosvi is a dental student, New York University College of Dentistry; Dr. Park is Research Scientist, Department of Population Health, New York University School of Medicine; Dr. Patel is a Master's of Public Health student, Long Island University; Dr. Spielman is Associate Dean for Academic Affairs, New York University College of Dentistry; and Dr. Weitzman is Professor, New York University School of Medicine, Abu Dhabi Public Health Research Center, and New York University College of Global Public Health
| | - Andrew I Spielman
- Ms. Shearston is Project Manager, Department of Population Health, New York University School of Medicine and Abu Dhabi Public Health Research Center; Dr. Shah is Program Coordinator, Department of Environmental Medicine, New York University School of Medicine; Mr. Cheng is a dental student, New York University College of Dentistry; Mr. Moosvi is a dental student, New York University College of Dentistry; Dr. Park is Research Scientist, Department of Population Health, New York University School of Medicine; Dr. Patel is a Master's of Public Health student, Long Island University; Dr. Spielman is Associate Dean for Academic Affairs, New York University College of Dentistry; and Dr. Weitzman is Professor, New York University School of Medicine, Abu Dhabi Public Health Research Center, and New York University College of Global Public Health
| | - Michael L Weitzman
- Ms. Shearston is Project Manager, Department of Population Health, New York University School of Medicine and Abu Dhabi Public Health Research Center; Dr. Shah is Program Coordinator, Department of Environmental Medicine, New York University School of Medicine; Mr. Cheng is a dental student, New York University College of Dentistry; Mr. Moosvi is a dental student, New York University College of Dentistry; Dr. Park is Research Scientist, Department of Population Health, New York University School of Medicine; Dr. Patel is a Master's of Public Health student, Long Island University; Dr. Spielman is Associate Dean for Academic Affairs, New York University College of Dentistry; and Dr. Weitzman is Professor, New York University School of Medicine, Abu Dhabi Public Health Research Center, and New York University College of Global Public Health
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Dagli AF, Sahin N, Bozdag Z, Ucer O, Akatli AN, Artas G, Sahin İ, Yardim M, Dalkilic S, Akkoc RF, Simsek S, Aydin S. Cytological and cytomorphometric characteristics of buccal mucosa cells from smokeless tobacco users. Diagn Cytopathol 2017; 45:976-982. [DOI: 10.1002/dc.23803] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nurhan Sahin
- Department of Pathology; Inonu University; Malatya 44280 Turkey
| | - Zehra Bozdag
- Department of Pathology; Gaziantep University; Gaziantep 27310 Turkey
| | - Ozlem Ucer
- Department of Pathology; Firat University; Elazig 23190 Turkey
| | - Ayse Nur Akatli
- Department of Pathology; Inonu University; Malatya 44280 Turkey
| | - Gokhan Artas
- Department of Pathology; Firat University; Elazig 23190 Turkey
| | - İbrahim Sahin
- Department of Medical Biochemistry (Firat Hormones Research Group); School of Medicine, Firat University; Elazig 23190 Turkey
- Department of Histology and Embryology; Erzincan University; Erzincan 24100 Turkey
| | - Meltem Yardim
- Department of Medical Biochemistry (Firat Hormones Research Group); School of Medicine, Firat University; Elazig 23190 Turkey
| | - Semih Dalkilic
- Department of Molecular Biology and Genetic; Firat University; Elazig 23119 Turkey
| | - Ramazan Fazil Akkoc
- Department of Anatomy; Faculty of Medicine, Firat University; Elazig 23190 Turkey
| | - Sercan Simsek
- Department of Pathology; Firat University; Elazig 23190 Turkey
| | - Suleyman Aydin
- Department of Medical Biochemistry (Firat Hormones Research Group); School of Medicine, Firat University; Elazig 23190 Turkey
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Liu M, Jin J, Pan H, Feng J, Cerniglia CE, Yang M, Chen H. Effect of smokeless tobacco products on human oral bacteria growth and viability. Anaerobe 2016; 42:152-161. [PMID: 27756619 DOI: 10.1016/j.anaerobe.2016.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 01/25/2023]
Abstract
To evaluate the toxicity of smokeless tobacco products (STPs) on oral bacteria, seven smokeless tobacco aqueous extracts (STAEs) from major brands of STPs and three tobacco-specific N-nitrosamines (TSNAs) were used in a growth and viability test against 38 oral bacterial species or subspecies. All seven STAEs showed concentration-dependent effects on the growth and viability of tested oral bacteria under anaerobic culture conditions, although there were strain-to-strain variations. In the presence of 1 mg/ml STAEs, the growth of 4 strains decreased over 0.32-2.14 log10 fold, while 14 strains demonstrated enhanced growth of 0.3-1.76 log10 fold, and the growth of 21 strains was not significantly affected. In the presence of 10 mg/ml STAEs, the growth of 17 strains was inhibited 0.3-2.11 log10 fold, 18 strains showed enhanced growth of 0.3-0.97 log10 fold, and 4 strains were not significantly affected. In the presence of 50 mg/ml STAEs, the growth of 32 strains was inhibited 0.3-2.96 log10 fold, 8 strains showed enhanced growth of 0.3-1.0 log10 fold, and 2 strains were not significantly affected. All seven STAEs could promote the growth of 4 bacterial strains, including Eubacterium nodatum, Peptostreptococcus micros, Streptococcus anginosus, and Streptococcus constellatus. Exposure to STAEs modulated the viability of some bacterial strains, with 21.1-66.5% decrease for 4 strains at 1 mg/ml, 20.3-85.7% decrease for 10 strains at 10 mg/ml, 20.0-93.3% decrease for 27 strains at 50 mg/ml, and no significant effect for 11 strains at up to 50 mg/ml. STAEs from snuffs inhibited more tested bacterial strains than those from snus indicating that the snuffs may be more toxic to the oral bacteria than snus. For TSNAs, cell growth and viability of 34 tested strains were not significantly affected at up to 100 μg/ml; while the growth of P. micros was enhanced 0.31-0.54 log10 fold; the growth of Veillonella parvula was repressed 0.33-0.36 log10 fold; and the cell viabilities of 2 strains decreased 56.6-69.9%. The results demonstrate that STAEs affected the growth of some types of oral bacteria, which may affect the healthy ecological balance of oral bacteria in humans. On the other hand, TSNAs did not significantly affect the growth of the oral bacteria.
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Affiliation(s)
- Min Liu
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, 72079, United States; Institute of Tropical Bioscience and Biotechnology, Chinese Academy of Tropical Agricultural Sciences, Haikou, 571101, China
| | - Jinshan Jin
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, 72079, United States
| | - Hongmiao Pan
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, 72079, United States; Key Laboratory of Marine Ecology & Environmental Sciences, Institute of Oceanology, Chinese Academy of Sciences, Qingdao, 266071, China
| | - Jinhui Feng
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, 72079, United States; National Engineering Laboratory for Industrial Enzymes, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, Tianjin, 300308, China
| | - Carl E Cerniglia
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, 72079, United States
| | - Maocheng Yang
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, United States.
| | - Huizhong Chen
- Division of Microbiology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, 72079, United States.
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15
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Bacterial Populations Associated with Smokeless Tobacco Products. Appl Environ Microbiol 2016; 82:6273-6283. [PMID: 27565615 DOI: 10.1128/aem.01612-16] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/10/2016] [Indexed: 01/01/2023] Open
Abstract
There are an estimated 8 million users of smokeless tobacco products (STPs) in the United States, and yet limited data on microbial populations within these products exist. To better understand the potential microbiological risks associated with STP use, a study was conducted to provide a baseline microbiological profile of STPs. A total of 90 samples, representing 15 common STPs, were purchased in metropolitan areas in Little Rock, AR, and Washington, DC, in November 2012, March 2013, and July 2013. Bacterial populations were evaluated using culture, pyrosequencing, and denaturing gradient gel electrophoresis (DGGE). Moist-snuff products exhibited higher levels of bacteria (average of 1.05 × 106 CFU/g STP) and diversity of bacterial populations than snus (average of 8.33 × 101 CFU/g STP) and some chewing tobacco products (average of 2.54 × 105 CFU/g STP). The most common species identified by culturing were Bacillus pumilus, B. licheniformis, B. safensis, and B. subtilis, followed by members of the genera Oceanobacillus, Staphylococcus, and Tetragenococcus. Pyrosequencing analyses of the 16S rRNA genes identified the genera Tetragenococcus, Carnobacterium, Lactobacillus, Geobacillus, Bacillus, and Staphylococcus as the predominant taxa. Several species identified are of possible concern due to their potential to cause opportunistic infections and reported abilities to reduce nitrates to nitrites, which may be an important step in the formation of carcinogenic tobacco-specific N'-nitrosamines. This report provides a microbiological baseline to help fill knowledge gaps associated with microbiological risks of STPs and to inform potential regulations regarding manufacture and testing of STPs. IMPORTANCE It is estimated that there 8 million users of smokeless tobacco products (STPs) in the United States; however, there are limited data on microbial populations that exist within these products. The current study was undertaken to better understand the potential microbiological risks associated with STP use and provide a baseline microbiological profile of STPs. Several bacterial species were identified that are of possible concern due to their potential to cause opportunistic infections. In addition, some species have abilities to reduce nitrates to nitrites, which may be an important step in the formation of carcinogenic tobacco-specific N'-nitrosamines. Overall, this report provides a microbiological baseline to help fill knowledge gaps related to the microbiological risks of STPs and to inform potential regulations regarding the manufacture and testing of STPs.
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Exposure and response to current text-only smokeless tobacco health warnings among smokeless tobacco users aged ≥18years, United States, 2012-2013. Prev Med 2016; 87:200-206. [PMID: 26892913 DOI: 10.1016/j.ypmed.2016.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 02/02/2016] [Accepted: 02/04/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION We assessed US adult smokeless tobacco (SLT) users' exposure and response to SLT health warnings, which are currently in text-only format, covering 30% of the two primary surfaces of SLT containers and 20% of advertisements. METHODS Data were from the 2012-2013 National Adult Tobacco Survey. Past 30-day exposure to SLT health warnings among past 30-day SLT users (n=1626) was a self-report of seeing warnings on SLT packages: "Very often," "Often," or "Sometimes" (versus "Rarely" or "Never"). We measured the association between SLT health warning exposure and perceptions of SLT harmfulness and addictiveness using logistic regression. RESULTS Of past 30-day SLT users, 77.5% reported exposure to SLT health warnings, with lower prevalence reported among females and users of novel SLT products (snus/dissolvable tobacco). Furthermore, exposure reduced linearly with reducing education and annual household income (p<0.01). Among exposed past 30-day SLT users, 73.9% reported thinking about the health risks of SLT, while 17.1% reported stopping SLT use on ≥1 occasion within the past 30days. Exposure to SLT warnings was associated with perceived SLT harmfulness (AOR=2.16; 95% CI=1.15-4.04), but not with perceived SLT addictiveness. CONCLUSION Socioeconomic disparities found in exposure and response to SLT health warnings can be addressed through implementation of large pictorial warnings.
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Agaku IT, Awopegba AJ, Filippidis FT. The impact of inter-survey differences in the definition of current smokeless tobacco use on comparability of US national and state-specific prevalence estimates, 2009-2011. Prev Med 2015; 74:86-92. [PMID: 25625692 DOI: 10.1016/j.ypmed.2015.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 01/14/2015] [Accepted: 01/18/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND We assessed how varying definitions of adult current smokeless tobacco (SLT) use affected overall prevalence estimates. METHODS National prevalence estimates were from five surveys: 2009-2010 National Health and Nutrition Examination Survey (NHANES), 2009-2010 National Adult Tobacco Survey (NATS), 2010-2011 Tobacco Use Supplement of the Current Population Survey (TUS-CPS), 2010 National Survey on Drug Use and Health (NSDUH), and 2010 National Health Information Survey (NHIS). State-specific prevalence estimates were from three surveys: 2009-2010 NATS, 2010-2011 TUS-CPS, and 2010 Behavioral Risk Factor Surveillance System (BRFSS). Current SLT use definitions were as follows: past 5-day use (NHANES), past 30-day use (NATS and NSDUH), and "every day" or "some days" use (TUS-CPS, NHIS, and BRFSS). Inter-survey variations further existed in number and types of SLT products assessed. RESULTS National prevalence estimates of current SLT use were as follows: NATS (3.9%), NSDUH (3.6%), NHIS (2.8%), NHANES (2.3%), and TUS-CPS (1.6%). State-specific prevalence estimates of SLT use were generally lower for TUS-CPS (median=2.1%, range: 0.5% in California and New York, to 7.2% in Wyoming) compared to either BRFSS (median=4.0%: range: 0.9% in Washington D.C., to 8.2% in Wyoming) or NATS (median=4.7%; range: 1.3% in New Jersey, to 9.8% in Wyoming). CONCLUSION Concerted efforts are needed among interagency groups to harmonize SLT definition within different surveys.
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Affiliation(s)
- Israel T Agaku
- Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, MA, USA.
| | - Ayodeji J Awopegba
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Abstract
Oral and oropharyngeal cancer (OPC) is a complex and often relentless malignancy prone to local invasion and dissemination. Despite advances in understanding of the disease and improved therapeutic interventions, it continues to be diagnosed at an advanced stage and the survival rate remains poor. The financial cost of treating OPC may be the highest of all cancers in the United States and survivors often experience major detriments to quality of life. Major risk factors for OPC are tobacco, alcohol, areca nut, and human papillomavirus infection. This article updates medical practitioners on the causes, presentation, diagnosis, and management of OPC.
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Affiliation(s)
- Michaell A Huber
- Department of Comprehensive Dentistry, University of Texas Health Science Center, School of Dentistry, 7703 Floyd Curl Drive, Mail Code 7919, San Antonio, TX 78229, USA.
| | - Bundhit Tantiwongkosi
- Department of Radiology, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, Mail Code 7800, San Antonio, TX 78229, USA; Department of Otolaryngology, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, Mail Code 7800, San Antonio, TX 78229, USA
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Agaku IT, Ayo-Yusuf OA. A global assessment of knowledge of dental students about nicotine replacement therapy: findings from 43 countries. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2014; 18:154-161. [PMID: 24330036 DOI: 10.1111/eje.12072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/14/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Knowledge of nicotine replacement therapy (NRT) is a competency that is expected from receiving training in the treatment for tobacco dependence. This study therefore assessed the knowledge of dental students in 43 countries about NRT. METHODS The 2005-2011 dental Global Health Professions Student Survey data were analysed for 13,040 third-year dental students from 43 countries. Knowledge about NRT was self-reported and country-specific prevalence estimates were calculated. To assess for correlates of knowledge about NRT amongst dental students, a multivariate logistic regression model was fitted (P < 0.05), with pooled data from all 43 countries. The model assessed for geographical location, gross national income, tobacco cessation training in school, sex, current tobacco use and survey year. RESULTS Amongst all dental students, the proportion that knew about NRT ranged from 37.0% (Mongolia) to 97.6% (Slovakia). The odds of knowing about NRT were lower amongst dental students in the Eastern Mediterranean region (aOR = 0.52; 95% CI: 0.34-0.79) compared to those in the European region. Dental students in upper-middle-income (aOR = 2.46; 95% CI: 1.57-3.85) and high-income countries (aOR=4.55; 95% CI: 2.28-9.09) both had higher odds of knowing about NRT compared to dental students in low-income countries. Also, current use of any tobacco product and receipt of tobacco cessation training in school were both associated with higher likelihood of knowing about NRT. No significant gender differences in knowledge of NRT were observed. CONCLUSIONS A large proportion of dental students in several countries knew about NRT. However, disparities in knowledge existed across regions. Enhanced efforts are needed to formally train dental students on tobacco cessation techniques.
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Affiliation(s)
- I T Agaku
- Department of Social and Behavioural Sciences, Centre for Global Tobacco Control, Harvard School of Public Health, Boston, MA, USA
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20
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Stepanov I, Biener L, Yershova K, Nyman AL, Bliss R, Parascandola M, Hatsukami DK. Monitoring tobacco-specific N-nitrosamines and nicotine in novel smokeless tobacco products: findings from round II of the new product watch. Nicotine Tob Res 2014; 16:1070-8. [PMID: 24604020 DOI: 10.1093/ntr/ntu026] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Analysis of novel smokeless tobacco products purchased in Round I of the New Product Watch (NPW)-a national tobacco monitoring network-demonstrated that some tobacco constituents vary not only across various brands but also regionally and over time within the same product. In this study, we analyzed snus and dissolvable tobacco products that were purchased in Round II of the NPW. METHODS We analyzed tobacco-specific N-nitrosamines (TSNA) and nicotine in snus and dissolvable tobacco products that were purchased in various regions of the country during the spring and summer of 2011. The results were compared against the Round I data, across different U.S. regions, and among products. RESULTS A total of 216 samples were received from different states representing 6 regions of the country. Compared with the previous analyses, TSNA levels increased significantly in Marlboro and Camel Snus and some dissolvable Camel products. The levels of unprotonated nicotine in Marlboro Snus and Camel Snus in this study were not different from Round I but varied significantly by regions; the differences between the highest and the lowest average regional levels were ~3.2-fold in Marlboro Snus ~1.7-fold in Camel Snus. CONCLUSIONS Our results indicate that some novel smokeless tobacco products contain TSNA at the levels found in the conventional moist snuff. Observation of regional variations in unprotonated nicotine content in both Round I and Round II of NPW suggest that manufacturers may tailor the levels of this constituent consistently to different regions.
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Affiliation(s)
- Irina Stepanov
- Division of Environmental Health Sciences and Masonic Cancer Center, University of Minnesota, Minneapolis, MN;
| | - Lois Biener
- Center for Survey Research, University of Massachusetts Boston, Boston, MA
| | | | - Amy L Nyman
- Center for Survey Research, University of Massachusetts Boston, Boston, MA
| | - Robin Bliss
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Mark Parascandola
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Dorothy K Hatsukami
- Masonic Cancer Center and Tobacco Research Programs, University of Minnesota, Minneapolis, MN
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Agaku IT, Ayo-Yusuf OA, Vardavas CI, Connolly G. Predictors and patterns of cigarette and smokeless tobacco use among adolescents in 32 countries, 2007-2011. J Adolesc Health 2014; 54:47-53. [PMID: 24060573 PMCID: PMC3872244 DOI: 10.1016/j.jadohealth.2013.07.037] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/30/2013] [Accepted: 07/30/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE This study compared data from 32 countries to assess predictors and patterns of cigarette and smokeless tobacco (SLT) use among students aged 13-15 years old. METHODS Data from the 2007-2008 Global Youth Tobacco Surveys were analyzed for students aged 13-15 years in 31 countries located in all six World Health Organization regions. In addition, the 2011 National Youth Tobacco Survey was analyzed for U.S. students aged 13-15 years. Country-specific prevalence of current smoking, current SLT use, and concurrent use patterns were assessed. RESULTS The national prevalence of current cigarette smoking among students aged 13-15 years ranged from 1.8% (Rwanda) to 32.9% (Latvia), whereas current SLT use ranged from 1.1% (Montenegro) to 14.4% (Lesotho). In the U.S. and most European countries surveyed, current smoking prevalence was significantly higher than SLT prevalence, in contrast to patterns observed in low- and middle-income countries. Also, in most of the surveyed countries outside of Europe and the United States, SLT use among girls was as common as their use of cigarettes, and not significantly different from use by boys. When compared with U.S. adolescents, the odds of SLT use were highest among African adolescents (adjusted odds ratio = 3.98; 95% CI: 2.19-7.24) followed by those in the Southeast Asian region (adjusted odds ratio = 2.76; 95% CI: 1.38-5.53). CONCLUSIONS Region-specific patterns of tobacco use were noticed. Furthermore, it is alarming that in several low- and middle-income countries, the prevalence of SLT use among females did not differ from that among males, suggesting the possibility of a future shared burden of disease between both males and females.
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Affiliation(s)
- Israel T Agaku
- Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, Massachusetts.
| | - Olalekan A Ayo-Yusuf
- Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, Massachusetts; Department of Community Dentistry, University of Pretoria, South Africa
| | - Constantine I Vardavas
- Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, Massachusetts
| | - Gregory Connolly
- Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, Massachusetts
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22
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Fumo, alcol e salute orale. DENTAL CADMOS 2013. [DOI: 10.1016/s0011-8524(13)70086-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Nemeth JM, Liu ST, Klein EG, Ferketich AK, Kwan MP, Wewers ME. Factors influencing smokeless tobacco use in rural Ohio Appalachia. J Community Health 2013; 37:1208-17. [PMID: 22427033 DOI: 10.1007/s10900-012-9556-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The burden of smokeless tobacco (ST) use disproportionally impacts males in rural Ohio Appalachia. The purpose of this study was to describe the cultural factors contributing to this disparity and to articulate the way in which culture, through interpersonal factors (i.e. social norms and social networks) and community factors (i.e. marketing and availability), impacts ST initiation and use of ST among boys and men in Ohio Appalachia. Fifteen focus groups and 23 individual qualitative interviews were conducted with adult (n = 63) and adolescent (n = 53) residents in Ohio Appalachian counties to ascertain factors associated with ST use and the impact of ST marketing. Transcriptions were independently coded according to questions and themes. ST use appears to be a rite of passage in the development of masculine identity in Ohio Appalachian culture. Interpersonal factors had the greatest influence on initiation and continued use of ST. Ohio Appalachian boys either emulated current ST users or were actively encouraged to use ST through male family and peer networks. Users perceived their acceptance into the male social network as predicated on ST use. Community factors, including ST advertisement and access to ST, reinforced and normalized underlying cultural values. In addition to policy aimed at reducing tobacco marketing and access, interventions designed to reduce ST use in Ohio Appalachia should incorporate efforts to (1) shift the perception of cultural norms regarding ST use and (2) address male social networks as vehicles in ST initiation.
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Affiliation(s)
- Julianna M Nemeth
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
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24
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Abstract
Evidence-based tobacco-cessation guidelines when used by clinicians are effective in reducing tobacco use and obtaining successful quits by patients. Dentists have been encouraged to provide instruction and intervention on tobacco cessation in the dental office. The dental provider is in the unique position to relate oral findings to the patient and to provide advice to tobacco-using patients to quit. In addition, dentists are able to assess patients' self-addiction and level of readiness to quit tobacco use. With this information, dentists can assist in helping patients to stop using tobacco by providing appropriate pharmacotherapeutic aid and thus improve their oral and overall health.
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Affiliation(s)
- David Albert
- Division of Community Health, Section of Social and Behavioral Sciences, Columbia University College of Dental Medicine, New York, NY 10032, USA.
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25
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Stepanov I, Jensen J, Biener L, Bliss RL, Hecht SS, Hatsukami DK. Increased pouch sizes and resulting changes in the amounts of nicotine and tobacco-specific N-nitrosamines in single pouches of Camel Snus and Marlboro Snus. Nicotine Tob Res 2012; 14:1241-5. [PMID: 22259150 PMCID: PMC3457708 DOI: 10.1093/ntr/ntr292] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 11/06/2011] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Initial analyses of the novel smokeless tobacco products Camel Snus and Marlboro Snus demonstrated that these products contain relatively low amounts of nicotine and the carcinogenic tobacco-specific nitrosamines N'-nitrosonornicotine (NNN) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), as compared with traditional smokeless products. It is unknown whether the modifications in packaging, flavors, and pouch sizes that occurred for both Camel Snus and Marlboro Snus since their first introduction to the market were accompanied by any changes in nicotine or nitrosamine levels. METHODS We examined the available data on nicotine and NNN and NNK levels in 60 samples of Camel Snus and 87 samples of Marlboro Snus that were analyzed in our laboratory between 2006 and 2010. RESULTS Due to the increase in pouch size, the amounts of total nicotine, unprotonated nicotine, and the sum of NNN and NNK present in the large Camel Snus pouches released in 2010 are 1.9-fold, 2.4-fold, and 3.3-fold higher, respectively, than in the original smaller pouches that entered the market in 2006. Total and unprotonated nicotine content in the current version of Marlboro Snus pouches are 2.1-fold and 1.9-fold higher, respectively, and the sum of NNN and NNK is 1.5-fold lower than in the original version. CONCLUSIONS We observed an increase in nicotine content in single portions of Camel Snus and Marlboro Snus, and an increase in tobacco-specific N-nitrosamine content in single portions of Camel Snus, due to the increases in pouch size that occurred between 2006 and 2010. This finding stresses the importance of tobacco product regulation and ingredient disclosures.
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Affiliation(s)
- Irina Stepanov
- Masonic Cancer Center, University of Minnesota, 420 Delaware Street SE-MMC 806, Minneapolis, MN 55455, USA.
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Bhattacharyya N. Trends in the use of smokeless tobacco in United States, 2000-2010. Laryngoscope 2012; 122:2175-8. [PMID: 22777912 DOI: 10.1002/lary.23448] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 04/20/2012] [Accepted: 04/26/2012] [Indexed: 12/31/2022]
Abstract
OBJECTIVES/HYPOTHESIS To quantify trends in the use of smokeless tobacco in the United States. STUDY DESIGN Longitudinal analysis of national population database. METHODS The National Health Interview Surveys for 2000, 2005, and 2010 were analyzed for adult responses to specific questions regarding smokeless tobacco use, which includes chewing tobacco and snuff. Smokeless tobacco lifetime exposure, current use, and frequency of use were determined according to each sampled year, examining for trends over the past decade. Subset analysis for young adults (ages 18-44 years) was conducted. Demographic factors associated with smokeless tobacco use were also determined. RESULTS A total of 86,270 adults were surveyed. Among all adults, the proportions of those who had ever tried chewing tobacco were 7.1 ± 0.2%, 8.5 ± 0.2%, and 9.2 ± 0.2% for 2000, 2005, and 2010, respectively (P < .001). Similarly, the proportions of those who had ever tried snuff were 4.4 ± 0.2%, 7.5 ± 0.2%, and 8.4 ± 0.3%, respectively (P < .001). In aggregate, the proportions who were regular users of chewing tobacco remained stable over the survey years: 1.3 ± 0.1%, 1.1 ± 0.1%, and 1.2 ± 0.1%, respectively (P = .382). In contrast, the percentages who were regular users of snuff tobacco increased significantly over the survey years: 1.4 ± 0.1%, 1.6 ± 0.1%, and 2.0 ± 0.1% (P < .001). The proportion of young adults regularly using snuff rose to 2.8 ± 0.2% (P < .001) in 2010. Male sex, non-Hispanic ethnicity, white race, and less than a high school education were characteristics that were strongly associated with smokeless tobacco use. CONCLUSIONS There was a trend toward increased smokeless tobacco use, mainly snuff, in the United States in the past decade. This trend was more prominent among young adults and likely will have future health-care implications.
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Affiliation(s)
- Neil Bhattacharyya
- Division of Otolaryngology, Brigham and Women's Hospital, Boston, Harvard Medical School, Boston, Massachusetts, USA.
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Stepanov I, Biener L, Knezevich A, Nyman AL, Bliss R, Jensen J, Hecht SS, Hatsukami DK. Monitoring tobacco-specific N-nitrosamines and nicotine in novel Marlboro and Camel smokeless tobacco products: findings from Round 1 of the New Product Watch. Nicotine Tob Res 2012; 14:274-81. [PMID: 22039075 PMCID: PMC3281237 DOI: 10.1093/ntr/ntr209] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 08/11/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Information on chemical composition of the new oral "spitless" smokeless tobacco products is scarce, and it is not clear whether there is some variability as a function of purchase place or time due to either unintended or intended manufacturing variations or other conditions. METHODS We analyzed tobacco-specific N-nitrosamines (TSNA) and nicotine in Marlboro Snus, Camel Snus, and dissolvable Camel products Orbs, Sticks, and Strips that were purchased in various regions of the country during the summer of 2010. RESULTS A total of 117 samples were received from different states representing six regions of the country. Levels of unprotonated nicotine in Marlboro Snus and Camel Snus varied significantly by regions, with the differences between the highest and the lowest average regional levels being relatively small in Marlboro Snus (∼1.3-fold) and large in Camel Snus (∼3-fold). Some regional variations in TSNA levels were also observed. Overall, Camel Snus had significantly higher TSNA levels than Marlboro Snus, and Camel Strips had the lowest TSNA levels among all novel products analyzed here. The amount of unprotonated nicotine in the dissolvable Camel products was comparable to the levels found in Marlboro Snus. CONCLUSIONS Our study demonstrates some regional variations in the levels of nicotine and TSNA in Marlboro and Camel novel smokeless tobacco products. Continued monitoring of this category of products is needed as the existing products are being test marketed and modified, and new products are being introduced. This information is particularly important given its relevance to Food and Drug Administration regulation of tobacco products.
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Affiliation(s)
- Irina Stepanov
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA.
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