Abstract
Tobacco use contributes to more mortality and morbidity globally than any other behavioral risk factor. Adverse effects do not spare the oral cavity, with many oral diseases more common, and treatments less successful, in the tobacco-using patient. Many of the oral health effects of cigarette smoking are well established, but other forms of tobacco, including cigars and smokeless tobacco, merit dental professionals' attention. Recently, an expanding variety of new or emerging tobacco and/or nicotine products has been brought to market, most prominently electronic cigarettes, but also including heated tobacco and other noncombustible nicotine products. The use of cannabis (marijuana) is increasing and also has risks for oral health and dental treatment. For the practicing periodontist, and all dental professionals, providing sound patient recommendations requires knowledge of the general and oral health implications associated with this wide range of tobacco and nicotine products and cannabis. This review provides an overview of selected tobacco and nicotine products with an emphasis on their implications for periodontal disease risk and clinical management. Also presented are strategies for tobacco use counselling and cessation support that dental professionals can implement in practice.
Highlights
Tobacco use is responsible for nearly 9 million annual global deaths
In the United States, cigars are the non–cigarette product among adults used most (4% prevalence), and use prevalence among young adults aged 18-24 years is more than threefold higher (14%).[93,94]
Dental professionals must ask their patients about all forms of tobacco use and be mindful that the oral health risks of any combustible products are likely to resemble those of cigarette smoking
Summary
Tobacco use is responsible for nearly 9 million annual global deaths (approximately 15% of all deaths worldwide). In the United States, cigars are the non–cigarette product among adults used most (4% prevalence), and use prevalence among young adults aged 18-24 years is more than threefold higher (14%).[93,94] Dental professionals must ask their patients about all forms of tobacco use and be mindful that the oral health risks of any combustible products are likely to resemble those of cigarette smoking. Formulated heated tobacco products create an inhalable aerosol by heating tobacco-containing material to a temperature below the combustion threshold and are reported by their manufacturers to deliver lower levels of harmful chemicals than conventional cigarettes.[145] At least one clinical trial, sponsored by a heated tobacco product manufacturer, has announced plans to assess potential periodontal effects.[146] Nicotine pouches have been introduced by large tobacco manufacturers as a "tobacco-free" portioned, flavored oral nicotine product.[15] Novel nicotine lozenges, gums, mints, and even nicotine-infused toothpicks may resemble nicotine replacement therapies but are not marketed for cessation. Using such strategies helps dental professionals guide the conversation while allowing the patient to draw on their
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