House of Commons - Health - Appendices to the Minutes of Evidence

Select Committee on Health Appendices to the Minutes of Evidence

APPENDIX 8

Memorandum by the British Dental Association (TB 16)

The British Dental Association is one of the largest dental associations in Europe. It is the trade union and professional association representing over 20,000 dentists in the UK. The BDA works to promote the oral health of the public. It advises dentists on scientific and clinical issues. Dentists advise patients on the risks of smoking particularly with respect to oral health, and can help them to try to quit.

There is considerable scientific evidence showing that tobacco can affect oral health in a number of ways, from minor aesthetic changes, to gum disease, and fatal cancers¹. In addition to the harmful pathological effects of tobacco use (both smoking and chewing), smoking is also associated with a range of unpleasant physical changes in the mouth and teeth. The largely reversible and easily observed nature of the oral health effects provide a unique means of monitoring the positive effects of smoking cessation. There is increasing concern about the sale of sweetened chewing tobacco (Gutka) to underage children, especially in the ethnic communities.

Table 1 summarises oral health conditions known to be induced or associated with tobacco use.

ORAL CANCER

Using the BDA's definition, sites where oral cancer can occur are the lip, tongue, gum, floor of the mouth, other unspecified parts of the mouth, oropharynx, hypopharynx and other and ill-defined sites within lip, oral cavity and pharynx². This excludes cancers of the salivary glands and nasopharynx². There are currently around 3,400 new cases of oral cancer each year in the UK and about 1,600 deaths (similar to the number of deaths from cancer of the uterine cervix which receives much more public attention), although early detection significantly increases the chance of survival. The major risk factors for oral cancer are well established—excess tobacco (both smoking and chewing) and alcohol use. Between 75 per cent and 90 per cent of all cases are linked to the combined effects of smoking and alcohol use. Potentially malignant lesions such as leukoplakia occur six times more frequently in smokers than in non-smokers.

PERIDONTAL (GUM) DISEASE

Smokers have an increased prevalence and severity of peridontis, including greater marginal bone loss, deeper periodontal pockets, tooth mobility and tooth loss³. These adverse effects are independent of any other risk factors such as poor oral hygiene, plaque, calculus and socio-economic factors. Risk assessments suggest that smokers are at between 2.5 and 6 times more likely to develop periodontal disease than non-smokers. A recent study³ has shown that there is a lethal synergy between nicotine and a bacterial toxin and it may also interact with other toxins produced by bacteria which cause periodontis. Nicotine also affects how the immune system reacts which could exacerbate the effects of the toxin-producing bacteria, as well as causing localised tissue damage thereby increasing the severity of the periodontal disease.

CANDIDIASIS

Thrush, or more chronic fungal infections of the mouth, are common and severe in smokers, and more difficult to treat.

SMOKERS' PALATE

Heavy pipe smokers often develop a pale or white hard palate, often combined with multiple red dots⁴. This can reverse after stopping smoking.

SMOKERS' MELANOSIS

Increased melanin pigmntation can occur on the cheeks and attached gums due to heavy smoking⁴. This is asymptomatic but can take up to a year before the colour returns to normal.

OTHER EFFECTS

Smoking causes staining of teeth, dental restorations and dentures. It also affects taste thresholds, especially for salt—heavy smokers have been shown to have a 12-14 times greater salt threshold compared with non-smokers⁴. Smoking is also a common cause of bad breath. Smoking has also been shown to adversely affect wound healing following surgery.

REFERENCES

1 EU Working Group on Tobacco and Oral Health (1998). Tobacco and oral health. Facts for the dental profession. A tool for development of information materials and guidelines.

2 `Oral cancer—Guidelines for early detection'. (1998) BDA. Occasional paper. No. 5.

3 Sayers NM, Gomes BPFA, Drucker DB and Blinkhorn AS. (1997) Possible lethal enchancement of toxins from putative periodontopathogens by nicotine; implications for periodontal disease. J Clin Pathol 50:245-249.

4 Watt R and Robinson M (1999) Helping smokers to stop: a guide for the dental team. Health Education Authority.

5 Johnson NWJ (1997) Oral cancer: Prevention. FDJ World 6(6) 10-16.

Table 1

TOBACCO INDUCED AND ASSOCIATED CONDITIONS

ORAL CANCER

Leukoplakia

Other tobacco-induced oral mucosal conditions:

Tobacco-associated effects on the teeth and supporting tissues

Other tobacco associated oral conditions:

Possible association with tobacco

September 1999