may enhance nicotine’s addictive effects. 18 Current cigarette use among youth strongly suggests that cigarette smoking among adults, and its associated morbidity and mortality, will continue to be important public health issues for the foreseeable future. 14 In recent years, the use of electronic
cigarettes has increased in popularity. Although this type of nicotine delivery system may have health consequences, those consequences are at present largely unknown, and this course will focus on the more traditional types of tobacco use.
HEALTH RISKS OF SMOKING
Smoking-attributable disease Tobacco smoking accounts for an estimated 8 million deaths a year worldwide. 19 This number is projected to increase to approximately 10 million by the year 2030. If current smoking patterns continue, there will be more than 1 billion deaths attributable to tobacco smoking in the 21st century compared with approximately 100 million deaths in the 20th century. 17 The only other causes of disease with such rapidly increasing impact are those associated with HIV and perhaps obesity in Western countries. 19 Cancer It is estimated that tobacco smoking is responsible for approximately 30% of all cancer deaths in developed countries and 80% of lung cancers. 20 Tobacco use has the potential to cause cancers of the lung, oral cavity, nasal cavity, nasal sinuses, pharynx, larynx, esophagus, pancreas, stomach, liver, lower urinary tract (renal pelvis and bladder), kidney, and uterine cervix; it can also cause myeloid leukemia. These cancers can be attributed to smoking cigarettes, pipes, cigars, and other combustible forms of tobacco. Smoking causes an even greater number of deaths from vascular, respiratory, and other diseases than from cancer. 20 Cardiovascular disease In the United States, 35% of smoking-related deaths are from cardiovascular disease, which includes ischemic heart disease (including heart attack), other heart disease, cerebrovascular disease (including stroke), atherosclerosis, aortic aneurysm, and other arterial disease. 21 People who smoke and already have heart disease reduce their risk of death by as much as half if they quit smoking. The risk of death from other chronic diseases is reduced as well. 22,23 Respiratory disease Smoking damages bronchial airways and lung alveoli (air sacs), which can lead to chronic obstructive pulmonary disease (COPD). Smokers have 10 times the risk of dying from COPD than nonsmokers. Women’s rates of dying from Oral effects of smoking The oral effects of tobacco use include an increased risk of periodontal disease, halitosis, poor wound healing, poor implant success, oropharyngeal (oral cavity and pharynx) cancers, mucosal changes, and esthetic issues. Periodontal disease Smoking is recognized as an important risk factor for periodontal disease. A recent literature review described smoking as the strongest of the modifiable risk factors for periodontal disease. 29 There is a two- to eight-fold increased risk for periodontal attachment and/or bone loss, depending on the definition of disease severity and amount and duration of smoking. 30,31 Smoking also influences an individual’s response to periodontal treatment. 32 The majority of clinical trials show greater reductions in probing depth, less bleeding on probing, and significantly greater gain of clinical attachment following nonsurgical and surgical treatment of nonsmokers as compared to smokers. The proposed mechanisms by which smoking impairs periodontal healing and treatment response include a decrease in blood flow to the tissues, a negative effect on host cells leading to
COPD have risen proportionally with increased female tobacco use. 24 Smoking-related respiratory diseases include pneumonia, influenza, chronic bronchitis, emphysema, and
chronic airway obstruction. Smoking and pregnancy
Conventional wisdom would suggest that smoking during pregnancy wouldn’t be common, but a 2016 data census by the Centers for Disease Control and Prevention (CDC) found that about 7.2% of women smoke during pregnancy with it being more common in younger females (15 to 24 years). 25 Women who smoke are approximately twice as likely to experience a delay in conception and have approximately 30% higher odds of being infertile. 24 Men who smoke are at increased risk of impotence. 26 Babies born to women who smoke during pregnancy have approximately 30% higher odds of being born prematurely and are more likely to be born with low birth weight (less than 5.5 pounds), both of which conditions increase their risk for illness or death. 27 Infants of mothers who smoke are 1.4 to 3.0 times more likely to die of sudden infant death syndrome (SIDS) than those of nonsmoking mothers. 26 Cessation of smoking during pregnancy and sustained abstinence are optimal for the health and well- being of both the mother and infant. There is currently insufficient evidence to determine whether or not nicotine replacement therapy is effective or safe when used in pregnancy for smoking cessation. Its use during pregnancy and in nursing mothers is therefore very controversial and must be evaluated on an individual basis as determined by the physician managing the pregnancy. In theory, the use of nicotine replacement therapy avoids exposure of the fetus to carcinogens and carbon monoxide. However, studies have found an increased incidence of congenital malformations and preterm labor in association with the use of nicotine replacement therapies. Patients are therefore directed to their physician for guidance. 28 alterations in the inflammatory response, and an impaired immune response. 31 Smoking has a negative effect on bone regeneration following periodontal treatment, a finding that is mirrored in similar studies in the medical literature. 33 Failure of dental implants in smokers is thought to be the result of poor healing or osseointegration, due to the exposure of peri-implant tissues to tobacco smoke. Data suggest that detrimental effects may be reduced by cessation of smoking and the use of preoperative antibiotics. 34 Oropharyngeal cancer The American Cancer Society has estimated that in 2015 there were 39,500 new cases of cancer of the oral cavity and pharynx (oropharyngeal cancer) in the United States. Males are twice as likely as females to be affected by these cancers. The American Cancer Society projected 7,500 deaths from oropharyngeal cancer for this same time period. 35 It is worth noting that, according to the current literature, another cause of the rise in oropharyngeal cancer is human papillomavirus (HPV). 36
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