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An Introduction to Substance Use Disorders for Dental Professionals

Course Number: 545

Oral Implications of Chewing Tobacco Use/Abuse

The use of smokeless tobacco products poses significant oral health risks. The more common manifestations are discussed below:

Leukoplakia: These can lead to aggressive oral cancers if left unchecked. The lesion pictured below (Figure 7) is a very early lesion with a rather thin coating of leukoplakia which should resolve with cessation of snuff use.

Photo showing leukoplakia at chewing tobacco site.

Figure 7. Leukoplakia at Chewing Tobacco Site.

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Verrucous Carcinoma: The longer snuff is used, the thicker and whiter the leukoplakia becomes and the more likely the lesion is to transform into an aggressive form of squamous cell carcinoma known as verrucous carcinoma. In most cases, cessation of the habit prior to the development of the cancer results in the disappearance of the lesion and a return to normal mucosa.

Periodontal Disease: When tobacco products are held in the mouth, patients may have less time to perform daily oral hygiene, allowing bacteria to flourish. Typically, bleeding is an indicator of gingival inflammation. With nicotine use and abuse, vasoconstriction in oral tissues can lead to reduced bleeding upon probing which may give a false clinical indication. Keep this in mind while probing the sulcus of smokers.

Dental Caries: If the user chooses a tobacco product flavored or sweetened with a fermentable carbohydrate, there is an increase in caries, especially near the placement site.

Gingival Recession: Due to the irritating nature of the tobacco itself as well as the toxic chemicals released, there is a higher incidence of recession, especially adjacent to the placement site (Figure 8).

Photo showing chewing tobacco recession.

Figure 8. Chewing Tobacco Recession.

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