Intraoral leukoplakia, abrasion, periodontal breakdown, and tooth loss in a snuff dipper

Hormesis: wound healing and fibroblasts

Hormetic dose responses are reported here to occur commonly in the dermal wound healing process, with the particular focus on cell viability, proliferation, migration and collagen deposition of human and murine fibroblasts with in vitro studies. Hormetic responses were induced by a wide range of substances, including endogenous agents, pharmaceutical preparations, plant-derived extracts including many well-known dietary supplements, as well as physical stressor agents such as low-level laser treatments. Detailed mechanistic studies have identified common signaling pathways and their cross-pathway communications that mediate the hormetic dose responses. These findings complement and extend a similar comprehensive assessment concerning the occurrence of hormetic dose responses in keratinocytes. These findings demonstrate the generality of the hormetic dose response for key wound healing endpoints, suggesting that the hormesis concept has a fundamental role in wound healing, with respect to guiding strategies for experimental evaluation as well as therapeutic applications.

Utilization of oral check-up data of autopsy cases

The maintenance of oral health contributes to the overall health of an individual. Similar to the Adult Dental Health Survey in the UK, the Survey of Dental Diseases (SDD) is being conducted in Japan. However, our routine oral examination of autopsy cases showed that the oral cavities of the autopsied bodies were unhealthy as compared to the SDD data. Therefore, this study sought to understand the actual condition of the oral cavity and to clarify the factors related to the degradation of the oral status. This was achieved by comparing the data of the SDD subjects and autopsy cases in terms of the average number of teeth lost, the average total number of caries (number of decayed, missing, or filled teeth), percentage of people with untreated teeth, and 80-20 achievement rate (percentage of people aged 80 years with 20 or more teeth). Furthermore, this study investigated the relationship between the average number of missing teeth and smoking, psychiatric disorders, and body mass index (BMI) in autopsy cases. The oral condition of all autopsy cases was worse than that of SDD subjects. The 80-20 achievement rate was observed in more than half of the SDD subjects and only in less than 20% of the autopsy cases. Moreover, the average number of missing teeth was not significantly different depending on smoking status, BMI, and presence of psychiatric disorders in the autopsy cases. Unlike the SDD volunteers, there was no bias related to the inclusion of autopsy cases. Therefore, by analysing the data of both autopsy cases and SDD subjects, it may be possible to evaluate the oral condition more realistically. This could contribute to the realisation of improved health and quality of life.

Smokeless Tobacco and Severe Active Periodontal Disease, NHANES III

Whereas smoking is a major risk factor for periodontal disease, the role of smokeless tobacco is unclear. The purpose of this US population-based study of 12,932 adults participating in the Third National Health and Nutrition Examination Survey was to evaluate the association between smokeless tobacco use and severe active periodontal disease. Univariable and multivariable logistic regression modeling quantified the associations between tobacco use and severe active periodontal disease. All adults and never-smokers who currently used smokeless tobacco were twice as likely to have severe active periodontal disease at any site [respective odds ratios (ORAdj) and 95% confidence intervals: ORAdj = 2.1; 1.2–3.7 and ORAdj = 2.1; 1.0–4.4] or restricted to any interproximal site [respective ORAdj = 2.1; 1.0–4.2 and ORAdj = 2.3; 0.9–6.3], simultaneously adjusted for smoking, age, race, gender, diabetes, and having a dental visit in the past year. These results indicate that smokeless tobacco may also be an important risk factor for severe active periodontal disease.

Nicotine suppresses bone sialoprotein gene expression

BACKGROUND AND OBJECTIVE

Tobacco smoking is a risk factor for periodontitis and osteoporosis. Nicotine is a major component of tobacco, and has been reported to inhibit proliferation and differentiation of osteoblasts. Bone sialoprotein (BSP) is a mineralized tissue-specific protein expressed by differentiated osteoblasts that appears to function in the initial mineralization of bone. The purpose of this study was to determine the effects of nicotine on bone metabolism.

MATERIAL AND METHODS

We used rat osteobast-like UMR106 and ROS 17/2.8 cells and rat stromal bone marrow RBMC-D8 cells. To determine the molecular basis of the transcriptional regulation of the BSP gene by nicotine, we conducted Northern hybridization, transient transfection analyses with chimeric constructs of the BSP gene promoter linked to a luciferase reporter gene and gel mobility shift assays.

RESULTS

Nicotine (250 microg/mL) decreased the BSP mRNA levels at 12 and 24 h in UMR106 and ROS 17/2.8 cells. From transient transfection assays using various sized BSP promoter-luciferase constructs, nicotine decreased the luciferase activities of the construct, including the promoter sequence nucleotides -116 to +60, in UMR106 and RBMC-D8 cells. Nicotine decreased the nuclear protein binding to the cAMP response element (CRE), fibroblast growth factor 2 response element (FRE) and homeodomain protein-binding site (HOX) at 12 and 24 h.

CONCLUSION

This study indicates that nicotine suppresses BSP transcription mediated through CRE, FRE and HOX elements in the proximal promoter of the rat BSP gene.

Periodontal diseases

The periodontal diseases are highly prevalent and can affect up to 90% of the worldwide population. Gingivitis, the mildest form of periodontal disease, is caused by the bacterial biofilm (dental plaque) that accumulates on teeth adjacent to the gingiva (gums). However, gingivitis does not affect the underlying supporting structures of the teeth and is reversible. Periodontitis results in loss of connective tissue and bone support and is a major cause of tooth loss in adults. In addition to pathogenic microorganisms in the biofilm, genetic and environmental factors, especially tobacco use, contribute to the cause of these diseases. Genetic, dermatological, haematological, granulomatous, immunosuppressive, and neoplastic disorders can also have periodontal manifestations. Common forms of periodontal disease have been associated with adverse pregnancy outcomes, cardiovascular disease, stroke, pulmonary disease, and diabetes, but the causal relations have not been established. Prevention and treatment are aimed at controlling the bacterial biofilm and other risk factors, arresting progressive disease, and restoring lost tooth support.

Disparities between public health educational materials and the scientific evidence that smokeless tobacco use causes cancer

BACKGROUND AND METHODS

We reviewed 4 dozen health education brochures on the dangers of smokeless tobacco (ST) use, printed between 1981 and 2001 and available to the public in 2002. Collectively, these brochures state that ST use causes oral leukoplakia, other oral conditions, and cancers of the oral cavity, larynx, pharynx, esophagus, stomach, pancreas, lung, breast, prostate, bladder, and kidney. We then reviewed the scientific literature to determine whether these claims were substantiated.

RESULTS

Only for oral leukoplakia and several oral conditions is the evidence persuasive for causation by ST. The evidence that ST causes oral cancer is very suggestive, whereas the evidence for causation of other cancers is either absent or contradictory.

CONCLUSIONS

Communication of the health risks of using ST must be done accurately and should be data based. Broadening the message to include additional diseases for which the evidence is inadequate could cause the message about true risks, as well as the messenger, to be discounted.

Oral cancer after using Swedish snus (smokeless tobacco) for 70 years - a case report

Whereas the smoking habit has declined significantly in Sweden in recent decades, there has been a marked increase in the consumption of 'snus' (oral moist snuff). The use of this smokeless tobacco, exposing the user locally to carcinogenic nitrosamines, raises the question - will the increasing use of snuff eventually lead to a greater incidence of oral cancer? We report the case of a 90-year-old man who developed a localized squamous cell carcinoma in the gingival fold under the upper lip, at the exact place where he had regularly placed loose oral snuff for 70 years. Although this is a reminder of a prevailing cancer risk, the time frame indicates that the risk is slight. This is consistent with recent epidemiological reports regarding the minor risk of snuff-associated cancer in the Scandinavian countries.

Effects of nicotine on cultured cells suggest that it can influence the formation and resorption of bone

The acute effects of nicotine [1-methyl-2-(3-pyridyl)pyrrolidine] on the formation and resorption of bone were examined in cultures of clonal rat calvarial osteogenic cells (ROB-C26) and clonal mouse calvarial preosteoblastic cells (MC3T3-E1), as well as in osteoclast-like cells formed during coculture of mouse bone marrow cells and clonal stromal cells from mouse bone marrow, ST2 cells, at concentrations that occur in the saliva of smokeless tobacco users. Nicotine stimulated the rate of deposition of Ca(2+) by ROB-C26 cells, as well as the alkaline phosphatase activity of these cells, in a dose-dependent manner. However, both activities decreased in MC3T3-E1 cells that had been exposed to nicotine. These results indicate that nicotine affected osteoblastic differentiation in osteoblast-like cells. By contrast, nicotine reduced, in a dose-dependent manner, the formation of tartrate-resistant acid phosphatase (TRAP)-positive multinucleated cells (MNCs) and the formation of pits on slices of dentine, both of which are typical characteristics of osteoclasts. Our results suggest that nicotine might have critical effects on bone metabolism.

Inhibition of neutrophil and monocyte defensive functions by nicotine

To learn more about the effects of smokeless tobacco on the defensive functions of neutrophils, we studied the influence of nicotine on these cells in vitro, looking at their bactericidal activity against oral pathogens, and at their ability to produce microbicidal reactive oxygen species (oxygen radicals). Exposure of human blood neutrophils to nicotine (0.01% to 0.1%) inhibited their ability to kill Actinomyces naeslundii, Actinobacillus actinomycetemcomitans, and Fusobacterium nucleatum. Although these concentrations of nicotine are high, such concentrations are relevant to phagocytes in the gingival sulcus, because smokeless tobacco contains 0.5% to 3.5% nicotine by dry weight. Nicotine had no such inhibitory effect when the killing assay was performed in an anaerobic environment, implying that nicotine preferentially affected oxygen-dependent killing mechanisms. To further investigate the effects of nicotine on production of oxygen radicals, neutrophils were primed with lipopolysaccharide and triggered with f-met-leu-phe or phorbol ester in the presence of nicotine. Nicotine inhibited production of superoxide anion (measured by reduction of cytochrome c) and hydrogen peroxide (measured by oxidation of phenol red). Nicotine inhibition of superoxide production was reversible by washing away the nicotine. By observing that nicotine inhibited the reduction of cytochrome c by reagent potassium superoxide, we determined that nicotine directly absorbed superoxide. In addition, by examining nicotine inhibition of the uptake of oxygen by neutrophils, we determined that nicotine also interfered with the production of oxygen radicals by these cells. Nicotine also inhibited production of superoxide and interleukin-1 beta by monocytes. Nicotine did not affect the viability of neutrophils and monocytes, as determined by their ability to exclude trypan blue dye. Inhibition of the aerobic antimicrobial functions of neutrophils and monocytes by nicotine may alter the microbial ecology of the oral cavity, and this might be one mechanism by which nicotine compromises the oral health of users of tobacco products.

Effects of nicotine on proliferation and extracellular matrix production of human gingival fibroblasts in vitro

Normal function of gingival fibroblasts is essential for maintenance of the gingival extracellular matrix (ECM), but under inflammatory conditions in gingival tissue which may occur with tobacco use, they can also act in its destruction. The purpose of this study was to determine the effects of nicotine, a major component of tobacco, on gingival fibroblast proliferation, the production of fibronectin (FN), and the production and breakdown of type I collagen to elucidate its role in periodontal destruction associated with its use. A human gingival fibroblast strain derived from a healthy individual with non-inflamed gingiva was used in this study. Nicotine at concentrations > 0.075% caused cell death, and at 0.075% and 0.05% it caused transient vacuolization of the fibroblasts. At concentrations of 0.001% to 0.075%, nicotine significantly inhibited proliferation (P < or = 0.03), measured by the incorporation of [3H]-thymidine into DNA. The production of FN and type I collagen was significantly inhibited by nicotine at > or = 0.05% (P < or = 0.001), measured using specific ELISAs. On the other hand, nicotine at > or = 0.025% significantly increased collagenase activity (P < or = 0.008), using [3H]-gly and [14C]-pro-labeled type I collagen gels as substrate. The results show that, in vitro, nicotine inhibits the growth of gingival fibroblasts and their production of FN and collagen, while also promoting collagen breakdown. This suggests that nicotine itself may augment the destruction of the gingival ECM occurring during periodontal inflammation associated with smokeless tobacco use.

The effects of smokeless tobacco extract on bone nodule formation and mineralization by chick osteoblasts in vitro

Short-term exposure to smokeless tobacco extracts (STE) reportedly inhibits osteoblast metabolism. The objective of this study was to determine the effects of serial dilutions of a water-soluble extract of smokeless tobacco on osteoblast proliferation and their potential to form and mineralize bone nodules. STE significantly stimulated cell proliferation when diluted 10(2)-10(4) times; 10(3) and 10(4) dilutions produced the greatest effect. 10(2)-10(4) STE dilutions significantly increased alkaline phosphatase activity at day 7 but 10(6) STE dilutions significantly decreased it. 10(3) and 10(4) dilutions significantly increased bone nodule formation, but inhibited their mineralization. In contrast, 10(5) and 10(6) dilutions significantly decreased bone nodule formation, but increased their mineralization. Stimulation of in vitro bone nodule formation by STE was similar to that produced by 10(-7) M insulin-like growth factor 1 (IGF-1) in vivo. Heat and acid treatment of STE significantly reduced its beneficial effect on cell proliferation, suggesting that a peptide within STE may be responsible for enhancement of osteogenic cell proliferation. Thus, STE may contain a peptide capable of significantly stimulating osteoblast proliferation, differentiation and metabolism, similar to the effects of IGF-1. This peptide could have potential therapeutic benefits.

Smokeless tobacco contains an inhibitor of prolyl hydroxylase activity

The effects of smokeless tobacco extract (STE) and various constituents of STE on prolyl hydroxylase activity were determined using enzyme extracted from chick embryos. STE inhibited prolyl hydroxylase activity in a concentration-dependent manner, but nicotine and anabasine had essentially no effect. Enzymatic activity was inhibited by zinc, but not by the other inorganic elements in STE; however, the zinc concentration in STE was not high enough to produce the observed inhibition. The inhibition by STE was diminished by increasing concentrations of 2-oxoglutarate, but not by increasing concentrations of other cofactors. Thus, STE contains an inhibitor of prolyl hydroxylase which may be competitive with 2-oxoglutarate.

Smokeless tobacco abstinence effects and nicotine gum dose

There were two experiments on abstinence from smokeless tobacco. The purpose of the first experiment was to determine abstinence effects from smokeless tobacco. The purpose of the second experiment was to examine the effects of different doses of nicotine gum on smokeless tobacco abstinence effects. The subjects were male Copenhagen smokeless tobacco users who underwent 3 days of baseline measurement while continuing to use smokeless tobacco ad libitum, and 5 days of the experimental condition. In the first experiment, the subjects were assigned randomly to one of two groups and compared: continuous smokeless tobacco users (n = 10), and deprivation plus no nicotine gum (n = 10). In the second experiment, subjects were assigned randomly and in a double-blind fashion to one of three groups and compared: (1) deprivation plus 0 mg nicotine gum (n = 20); (2) deprivation plus 2 mg nicotine gum (n = 20); and (3) deprivation plus 4 mg nicotine gum (n = 20). The first experiment showed significant increases upon abstinence for the following variables: (1) craving; (2) difficulty concentrating; (3) restlessness; (4) excessive hunger; (5) eating; (6) reaction time; (7) variability of reaction time and (8) total withdrawal scores for both the self-rated and the observer-rated forms. The second experiment showed that nicotine gum failed to significantly reduce smokeless tobacco abstinence effects, although those with high cotinine levels may receive some benefit from nicotine gum.

Comparison of the effects of smokeless tobacco extract with the effects of prolyl hydroxylase inhibitors on collagenous and noncollagenous protein synthesis by osteoblasts

The effects of smokeless tobacco extract (STE) and prolyl hydroxylase inhibitors on protein synthesis by isolated osteoblast-like cells were compared. STE and 2,2'dipyridyl markedly inhibited alkaline phosphatase (Alpase) and [3H]proline hydroxylation without affecting glycolysis (lactate production). However, pyridine 2,5-dicarboxylate (2,5-PDC) did not inhibit [3H] proline hydroxylation, Alpase activity, or glycolysis at moderate concentrations. The [3H]hydroxyproline to [3H]proline ratio in the cell layers demonstrated a concentration-dependent decrease with increasing STE and inhibitor concentrations. In the cell layers, the collagenous protein (CP) content was decreased after exposure to STE, 2,2'dipyridyl, and 2,5-PDC and the noncollagenous protein (NCP) content was decreased after exposure to STE and 2,5-PDC. However, the effects on CP were at least twofold greater than on NCP. Similar results were observed regarding protein released to the culture medium. These data demonstrate that STE, like 2,2'dipyridyl, inhibits the hydroxylation of proline and the synthesis of collagenase-digestible protein.

An individual tooth wear index and an analysis of factors correlated to incisal and occlusal wear in an adult Swedish population

The aim of the study was to introduce an individual tooth wear index and to use this index to investigate factors correlated to occlusal wear. The material consisted of 585 randomly selected dentate individuals from the community of Jönköping, Sweden, who in 1983 reached the age of 20, 30, 40, 50, 60, 70, or 80 years. The degree of incisal and occlusal wear was evaluated for each single tooth in accordance with criteria presented earlier. An individual tooth wear index, which made it possible to rank individuals in accordance with incisal and occlusal wear, was used as dependent variable to investigate factors related to incisal and occlusal wear. Of all factors analyzed, the following were found to correlate significantly with increased incisal and occlusal wear: number of existing teeth, age, sex, occurrence of bruxism, use of snuff, and saliva buffer capacity. Stepwise multiple regression analysis gave a total explanation factor of R2 = 0.41. It was also possible to distinguish well between groups of individuals with and without tooth wear by means of these factors.

Periodontal effects associated with the use of smokeless tobacco

This report describes periodontal findings from a comprehensive study of smokeless tobacco use in professional baseball players. Subjects consisted of 1,094 players, coaches, and training staff of seven major league and their associated minor league teams. Before being examined, subjects completed questionnaires on patterns of smokeless tobacco use (validated by blood chemistry studies), rinsed their mouths under supervision, and were cautioned not to discuss their use of tobacco with the dental examiners. They then received a complete oral examination that included recording of all mucosal abnormalities, missing teeth, caries, extrinsic stain, attrition, Plaque Index, Gingival Index, pocket depth, attachment loss, and gingival recession. More than 50% of team members reported using smokeless tobacco, and 39% reported use during the current week. Among current week users, 46% had oral mucosal lesions, located primarily in the mandible at sites where the smokeless tobacco quid was placed. The use of smokeless tobacco was not necessarily associated with severe forms of periodontal disease, and the presence of poor oral hygiene and gingivitis in these users was not related to the development of oral lesions. However, sites adjacent to mucosal lesions in smokeless tobacco users showed significantly greater recession and attachment loss than in sites not adjacent to lesions in users or comparable sites in non-users.

The smokeless tobacco 'time bomb'

All healthcare professionals need to become aware of the extent and seriousness of smokeless tobacco use. In this article, the authors briefly review the current status of smokeless tobacco and describe its usage patterns and practices, pharmacologic (addictive) aspects, and associated health problems. They also suggest ways that primary care physicians can discover or prevent smokeless tobacco use in their patients.

Abrasives in snuff?

The purpose of this study was to determine and calculate the inorganic contents of four brands of snuff. Visual inspection of wet snuff showed fairly large, yellow crystal-like particles. Scanning electron microscopy and X-ray dispersive (EDX) analyses were used to study both wet snuff and ashes of snuff, whereas light emission spectrography was used to determine elements in the ashes. The crystal-like particles did not dissolve in distilled water or in ethanol heated to 60 degrees C. EDX analyses showed that most elements remained in the particles after washing. The total weight percentage of inorganic material in snuff was calculated after burning dried snuff until constant weight was obtained. The ashes of snuff did not contain any crystal-like particles but consisted of a small-grained amorphous mass. The following elements were detected: Ag, Al, Ba, Ca, Co, Cr, Cu, Fe, K, Li, Mg, Mn, Na, P, Pb, Si, Sr, Ti, Va, and Zr. Other elements such as rare earths were not searched for. The weight percentage of inorganic elements ranged between 12.35 +/- 0.69 and 20.95 +/- 0.81. Provided snuff is used in the same manner as chewing tobacco, and some people admit to doing so, there is a risk that its relatively high contents of inorganic material and heavily soluble salts may be conducive to excessive abrasion of teeth and restorations.

Oral health effects of smokeless tobacco use in Navajo Indian adolescents

Recent reports have suggested that the use of smokeless tobacco is increasing in adolescents, and is particularly high in Native Americans, causing concern about possible effects on oral health. In this study, 226 Navajo Indians, aged 14-19, were interviewed regarding their use of smokeless tobacco (ST), cigarettes, and alcohol. Midbuccal and mesiobuccal sites on all fully erupted permanent teeth (excluding third molars) were examined for the presence of gingival bleeding, gingival recession, calculus, and loss of periodontal attachment. The oral mucosa was examined for evidence of leukoplakia. 64.2% (145) of the subjects (75.4% of the boys and 49.0% of the girls) were users of ST. Of these, over 95% used snuff alone or in combination with chewing tobacco. 55.9% used ST one or more days per week. 52.2% consumed alcohol, usually beer or wine, and 54.0% smoked cigarettes. 25.5% (37) of the users and 3.7% (3) of the non-users had leukoplakia. The duration (in years) and frequency of ST use (days per week) were highly significant risk factors associated with leukoplakia. However, the concomitant use of alcohol or cigarettes did not appear to increase the prevalence of these lesions. No consistent relationship was observed between the use of ST and gingival bleeding, calculus, gingival recession, or attachment loss, either when comparing users to non-users or when comparing the segment where the tobacco quid was habitually placed to a within-subject control segment. In view of these results, there is little doubt that smokeless tobacco is significantly related to the etiology of leukoplakia. As some evidence exists that smokeless tobacco use is a significant risk factor associated with oral carcinoma, intervention programs to discourage the use of smokeless tobacco by adolescents should be a public health priority.

Understanding and deterring tobacco use among adolescents

This article discusses the addictiveness of tobacco and the health consequences of chronic tobacco use. Personality, environmental, and behavioral factors that promote the initiation of cigarette smoking by adolescents are identified. Age-specific interventions are suggested.

The effect of smokeless-tobacco extracts on the growth of oral bacteria of the genus Streptococcus

Aqueous tobacco extracts were used to supplement a basic salts solution (BSS) and a microbial medium. Thin-layer chromatography revealed sucrose in only one of four extracts. Discs saturated with extracts (0.1-50 mg/ml) failed to inhibit growth of any of the micro-organisms. Supplementation (10 mg/ml) of BSS with the tobaccos lacking sucrose resulted in augmented growth of Streptococcus mutans, Streptococcus salivarius and Streptococcus sanguis whereas the sucrose-containing brand augmented only Strep. sanguis growth. Thus extracts of these smokeless tobaccos would serve as a growth substrate for three species of oral streptococci which are frequently associated with human dental caries.

Is Smokeless Tobacco a Wolf in Sheep's Clothing?

For several years, smokeless tobacco has been promoted as a safe alternative to cigarette smoking. A massive ad campaign has resulted in an alarming increase in use in recent years.

Recent evidence has related the use of smokeless tobacco to oral and pharyngeal cancers as well as other gum and tooth disorders. The habit-forming properties of smokeless tobacco are similar to those found with other tobacco products.

A double standard is apparent when the use of smokeless tobacco is condoned. There is an implied acceptance of the use of this potentially dangerous, but legal, psychoactive substance. This article is a review and commentary about the status of this growing drug problem.

Promotion of oral health and prevention of common pediatric dental problems

Many effective methods currently are available for preventing oral diseases and promoting oral health. The responsibility for ensuring the optimal use of these approaches is shared by members of the dental profession and other primary care providers in the present health care delivery system. Recognition of each provider's role and greater collaborative efforts could enhance the gains that already have been made with respect to improving the oral health status of children and adolescents.

The reemergence of smokeless tobacco

Smokeless tobacco (snuff and chewing tobacco) is reemerging as a popular form of tobacco, particularly among male adolescents. In different regions of the United States, from 8 to 36 percent of male high-school students are regular users. The use of smokeless tobacco has been shown to cause oral-pharyngeal cancer. The strongest link is with cancers of the cheek and gum. White mucosal lesions (leukoplakia) are found in 18 to 64 percent of users, often at the site where the tobacco was held. Other associations have been suggested for cancers of the esophagus, larynx, and pancreas. Nitrosamines, found in high concentrations in smokeless tobacco, most likely have a role in its carcinogenicity. Other health problems include periodontal disease, acute elevations of blood pressure, and dependence. In early 1986, after action at the state level, Congress enacted a federal law requiring health-warning labels on packages of smokeless tobacco and a ban on electronic advertising. Other regulatory measures under consideration include raising state and federal excise taxes, tightening controls on advertising, and prohibiting sales to minors. In view of the recent growth of this problem, policy makers are taking the opportunity to intervene with preventive measures to protect a new generation of tobacco users.

Smokeless tobacco use among adolescents: demographic differences, other substance use, and psychological correlates

Survey data on smokeless tobacco and other substance use were obtained from 2,926 seventh, ninth, and eleventh graders in Ventura County, California public schools. Patterns of smokeless tobacco use were examined relative to other drug use, particularly cigarette smoking. Few females used smokeless tobacco regularly, as compared to 4.7 percent of the males. The data supported the view that the recent increases in smokeless tobacco use were related to male tobacco users' belief that smokeless tobacco was less harmful to physical health than cigarette smoking. A Guttman scalogram analysis showed that tobacco use, either cigarette smoking or smokeless tobacco use, occurred after marijuana use rather than before. Perceived parental attitudes toward marijuana use predicted both cigarette smoking and use of smokeless tobacco, whereas perceived parental attitudes toward alcohol use was only related to use of cigarettes. Quality of life measures were inversely related to both cigarette smoking and smokeless tobacco use, but mood state measures predicted only cigarette smoking. Implications of the results for a historical hydraulic model of aggregate drug use are discussed with recommendations for improved approaches to the prevention of drug abuse.

Correlates of use and expected use of smokeless tobacco among kindergarten children

Kindergarten children ( n = 112) were interviewed concerning recognition, use, and expected use of smokeless tobacco. Analysis of the data indicated significant relationships between personal use of smokeless tobacco and (1) knowing someone who used smokeless tobacco, (2) sex of the student, (3) expected use, and (4) having seen the product used at home. Significant relationships also existed between expected use and knowing someone who used the product, sex of the student, and having seen the product used at home.

Hemodynamic effects of oral smokeless tobacco in dogs and young adults

Oral smokeless tobacco (snuff) is increasingly used among the young male population. To determine cardiovascular effects of an oral smokeless tobacco product, 10 anesthetized dogs were instrumented to measure blood pressure, heart rate, left ventricular end diastolic pressure, and circumflex coronary, renal, and femoral flows. After a 5-min baseline, a 2.5-g, approximately 1.2% nicotine bolus dose was placed in the buccal space, and measurements were made for 20 min. Significant increases were seen in heart rate, blood pressure, left ventricular pressure, left ventricular end diastolic pressure, and left ventricular dP/dt. Significant decreases in flow were noted in the coronary circumflex, renal, and femoral arteries. The flow reduction was thought to have been mediated by an alpha-adrenergic mechanism. Additionally, 20 human males, mean age 20 years, without nicotine exposure for 72 hr, were given a 2.5-g dose of the same oral smokeless product. From baseline to 20 min, heart rate increased from 69 to 88 beats/min (P less than 0.05), blood pressure from 118/72 to 126/78 mm Hg (P less than 0.05). Thus, oral smokeless tobacco use can produce significant hemodynamic changes in both dogs and normal humans.

Oral tissue alterations associated with the use of smokeless tobacco by teen-agers. Part I. Clinical findings

The use of smokeless tobacco appears to be finding its way onto middle school, high school and college campuses as a socially acceptable and popular habit. Numerous reports in the literature have described the oral changes that appear to be associated with the use of smokeless tobacco in adults. Such information is unavailable for the lower age groups. A study was therefore undertaken to determine the prevalence and frequency of oral hard- and soft-tissue alterations associated with the use of smokeless tobacco in a teen-age population. High school students in grades 9 to 12 were evaluated on a random basis. From a total sample of 1,119 students, 117 users of smokeless tobacco were identified. Four distinct lesions associated with smokeless tobacco use were identified clinically: (1) hyperkeratotic or erythroplakic lesions of the oral mucosa, (2) gingival or periodontal inflammation, (3) a combination of oral mucosal lesions and periodontal inflammation, and (4) cervical erosion of the teeth. Among the smokeless tobacco users, 113 were boys and 4 were girls. Fifty-seven (48.7 percent) of the users had soft-tissue lesions and/or periodontal inflammation or erosion of dental hard tissues. Ninety-nine of the 117 users were Caucasian, 6 were Hispanic, 1 was black, 1 was Asian, 1 was an American Indian, and 6 failed to identify an ethnic origin. Use ranged from one to twenty "dips" per day, with an average time per dip of 30 minutes. Most users had been dipping for an average of 2 years, and twelve different tobacco brands were identified.

Just a pinch between the cheek & gum

At least in part, through a skillful manipulation of the public by the tobacco industry, the use of smokeless tobacco is rapidly increasing, especially among young male athletes and students in high school and colleges. Advertising implies that smokeless tobacco habits are innocuous and safe, but existing scientific evidence indicates that dipping and chewing are potentially harmful to one's health. Health professionals are urged to advise patients and students concerning the potential hazards of using smokeless tobacco. Further, health professionals should take a strong public stance in opposition to the current dipping and chewing advertising campaigns aimed at youth. These advertisements totally ignore the possible health hazards of smokeless tobacco. If the tobacco companies are allowed to continue to advertise smokeless tobacco in the same manner that they use to promote cigarette smoking, then some effort should be directed to require health warnings in these advertisements. In fact, some serious consideration should most likely be given to banning this new wave of tobacco marketing in the interest of public health, just as was the case with cigarette advertisements, especially in light of the fact that these ads are primarily targeted to young boys and men.