The Oral Effects of Tobacco Use- Recognition and Patient Management
|9232||September 10, 2012||1|
Tobacco use is a primary cause of preventable morbidity and mortality worldwide. In the U.S. alone, tobacco - related diseases kill approximately 500,000 people per year. Tobacco exerts its affects on numerous body systems in a dose-dependent manner. The initial interaction of tobacco with the human body occurs in the mouth. Because of the oral cavity’s natural environment (rapid cell turnover, bacterial load etc.) and its vascularity, it is not unexpected that the reaction to tobacco is quite active here and that resulting exposure to tobacco can be most intense. Both the soft tissues and hard tissues of the oral and maxillofacial complex are affected by the use of smoking tobacco and smokeless (spit) tobacco. Therefore, it is important for health care practitioners to understand the effects of tobacco on the oral and maxillofacial complex in order to identify and manage such oral adverse effects. This teaching module includes a complete set of lecture slides with instructor notes, along with 30 assessment items for students to assess their comprehension of the content subsequent to engaging the presentation.
Romito L, Christen A, Coan L. The Oral Effects of Tobacco Use- Recognition and Patient Management. MedEdPORTAL Publications; 2012. Available from: https://www.mededportal.org/adea/publication/9232 http://dx.doi.org/10.15766/mep_2374-8265.9232
Contains time-sensitive information that will likely be inaccurate, obsolete, or irrelevant by August 22, 2015
Contains Information Suitable for Patient Education
- To describe the relationship of tobacco use and periodontal health.
- To describe the relationship of tobacco use and dental caries.
- To identify and describe soft and hard tissue lesions of the oral and maxillofacial complex associated with tobacco use.
- To describe communication techniques, utilizing the 5As tobacco intervention to address tobacco use in their patients, particularly in whom oral manifestations of tobacco use are identified.
- Tobacco Use Cessation, Caries, Smoking, Nicotine, Cigarette, Building Oral Health Capacity (BOHC) Collection
- Family Medicine
Oral and Maxillofacial Pathology
- Oral and Maxillofacial Pathology
Interpersonal & Communication Skills
Knowledge for Practice
Promote health prevention
- Promote health prevention
Practice-based Learning & Improvement
- Incorporate feedback
- Clinical Exam
- Dental Student
Authors & Co-Authors
Sponsorship or Funding Source
This project is sponsored in part by funding from the Health Resources and Services Administration/Maternal Child Health Bureau grant #U44MC20223.
Effectiveness and Significance
The module has been utilized as a lecture for several oral health professions audiences and student evaluations have deemed it to be an effective presentation due to the use of images of the lesions being discussed and the accompanying explanations. The content is significant for learners about to enter the clinical setting, or already involved in patient care because they can readily apply the material to a clinical encounter. After completion of the module, the student is better prepared to detect and manage oral tobacco–related lesions. In addition, they have a stronger appreciation of the complexity and broad scope of consequences from tobacco use that can be found in the oral and maxillofacial complex. As such, it is anticipated that they may be more likely to engage their tobacco-using patients in education and cessation counseling.
Special Implementation Guidelines or Requirements
The module will require students to have computer access, with adequate connectivity speed for viewing the presentation.
Prerequisites for this module include a basic understanding of head and neck anatomy and pathology. Typically, the module precedes more detailed information on nicotine addiction, and tobacco dependence treatment strategies. This module has been successfully deployed in two primary ways: as an in-person presentation and in an online program of self-study. As a lecture of 60-90 minutes, the module has been given to oral health professions students during regular class sessions and to private dental/medical practitioners as a continuing education course. In both teaching formats we have found the module to be quite self-contained, that is, students grasp the material easily and require little if any additional support for comprehensive understanding. However, even in the online program which students complete on their own, and at their convenience, the instructor is available via email should questions arise. Last year, one student asked additional questions which went beyond the depth of the material presented and the student was referred to several specific resources from the References list which fulfilled the desire for greater detail on the particular subtopic of interest. Therefore, it is recommended that instructors consider their learners when utilizing this teaching module, and make adjustments if needed, to best suit their intended audience.
We have used Adobe Presenter as a vehicle for delivering this module, as well as in-person lectures and both have been well received. However, we learned that students preferred to have access to both the slides and the verbatim notes. The Adobe Presenter format did not allow for easy printing of slides and notes, so we posted slides and notes separately for the students that preferred to print all materials. In addition, some students also preferred an audio narration in the form of a podcast. Software for lecture capture has been used for this purpose and allows the lecture to be reviewed by students via podcast as many times as they want at their convenience. In our experience, students also expressed a desire to see the oral pathology content paired with the behavioral educational component of tobacco cessation counseling. For example, in a patient for whom a lesion such as those described is found, how exactly would a learner provide education about the oral consequences of tobacco use, advise the patient about quitting, or assess their willingness to quit? Therefore, a component we included in this module is the 5As steps of tobacco dependence treatment (Ask, Advise, Assess, Assist, and Arrange) and a short explanation of how each step of this brief intervention could be applied with a patient. In this manner, a learner who completes this teaching module would not only be able to better understand and recognize some of the oral consequences of tobacco use in their patients, but they could then apply that knowledge to provide an evidence-based approach to educate and counsel patients regarding their oral findings and tobacco cessation and /or refer them to an appropriate resource for further evaluation and treatment. A lecture is limited in that it is teacher-driven, limits student engagement, and promotes a passive learning situation. Fostering active learning can be challenging but useful to enhance the breadth and depth of student comprehension and retention of the concepts being taught. Therefore, we encourage instructors to consider incorporating active learning strategies with this presentation. Suggestions for utilizing active learning strategies with this presentation include:
- Brief role play activity of patient/clinician communication (Implementing the 5 As; Patient Interviewing to obtain a tobacco history).
- Gaming ( Jeopardy-style; In-class audience response system or “clickers”).
- Strategic questioning /discussion throughout the lecture (purposefully inserting questions and answers within the PowerPoint; “Think Pair Share”: This classroom assessment technique (Angelo and Cross, 1993) allows the instructor to pose a specific question or general topic to the learners. After considering a response on their own, students pair up with a peer and share their insights. After collaboration, each (or selected) pairs then share responses with the entire class.
- Lecture based assignments and quizzes (Pre-class reading assignment followed by an online quiz; Post-class additional reading assignments based on lecture content.).
This information is made available under the Creative Commons license.
Publications, Presentations, and/or Citations for this Publication
- Aligne CA, Moss ME, Auinger P et al. Association of pediatric dental caries with passive smoking JAMA, 2003; 289: 1258–1264. http://dx.doi.org/10.1001/jama.289.10.1258
- American Academy http://www.perio.org/
- American Association of Oral and Maxillofacial Surgeons http://www.aaoms.org/oral_cancer.php
- Andersson G, Axéll T, Larsson A. Clinical classification of Swedish snuff dippers' lesions supported by histology. J Oral Pathol Med. 1991 Jul;20(6):253-7. http://dx.doi.org/10.1111/j.1600-0714.1991.tb00923.x
- Arbes SJ, Jr., Agustsdottir H, Slade GD. Environmental tobacco smoke and periodontal disease in the United States. Am J Public Health. 2001; 91(2): 253-7. http://dx.doi.org/10.2105/AJPH.91.2.253
- Ayo-Yusuf OA, Reddy PS, van Wyk PJ, van den Borne BW. Household smoking as a risk indicator for caries in adolescents' permanent teeth. J Adolesc Health. 2007 Sep;41(3):309-11. Epub 2007 Jul 12. http://dx.doi.org/10.1016/j.jadohealth.2007.04.012
- Bergström J. Tobacco smoking and supragingival dental calculus. J Clin Periodontol. 1999 Aug;26(8):541-7. http://dx.doi.org/10.1034/j.1600-051X.1999.260808.x
- Bergstrom J. Tobacco smoking and chronic destructive periodontal disease. Odontol. 2004; 92(1): 1-8. http://dx.doi.org/10.1007/s10266-004-0043-4
- Centers for Disease Control and Prevention (CDC). The health consequences of smoking: a report of the Surgeon General. [Atlanta, Ga.]: Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Washington, D.C. 2004.
- Centers for Disease Control and Prevention (CDC), “Vital Signs: Current Cigarette Smoking Among Adults Aged ≥ 18 Years—United States, 2005-2010,” Morbidity and Mortality Weekly Report (MMWR) 60, September 9, 2011. http://dx.doi.org/10.1016/j.ypdi.2011.01.006
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6035a5.htm. Accessed May 10, 2012.
- Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost, and economic costs—United States, 1997–2001. MMWR 2005;54:625–628.
- Cheng, C. Smokeless Tobacco Lesions. Medscape Reference. 2012. http://emedicine.medscape.com/article/1077117-overview. Accessed May 15, 2012.
- Fiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. Rockville, MD: Department of Health and Human Services, U.S. Public Health Service, 2008.
- Fiore MC, Baker TB. Clinical practice. Treating smokers in the health care setting. N Engl J Med. 2011 Sep 29;365(13):1222-31. http://dx.doi.org/10.1056/NEJMcp1101512
- Foulds J, Schmelzer AC, Steinberg MB. Treating tobacco dependence as a chronic illness and a key modifiable predictor of disease. Int J Clin Pract. 2010 Jan;64(2):142-6. Epub 2009 Nov 16. http://dx.doi.org/10.1111/j.1742-1241.2009.02243.x
- Fure S. Ten-year cross-sectional and incidence study of coronal and root caries and some related factors in elderly Swedish individuals. Gerodontology. 2004 Sep;21(3):130-40. http://dx.doi.org/10.1111/j.1741-2358.2004.00025.x
- Greer RO Jr. Oral manifestations of smokeless tobacco use. Otolaryngol Clin North Am. 2011 Feb;44(1):31-56. http://dx.doi.org/10.1016/j.otc.2010.09.002
- Grossi SH, Zamgon JJ, Ho AW, et al. Assessment of risk for periodontal disease. I. Risk indicators for attachment loss. J Periodontol. 1994;65: 260-267. http://dx.doi.org/10.1902/jop.19220.127.116.110
- Haffajee AD, Socransky SS. Relationship of cigarette smoking to the subgingival microbiota. J Clin Periodontol. 2001; 28(5): 377-88. http://dx.doi.org/10.1034/j.1600-051x.2001.028005377.x
- Haneberg B, Tonjum T, Rodahl K, Gedde-Dahl TW. Factors preceding the onset of meningococcal disease, with special emphasis on passive smoking, symptoms of ill health. NIPH Ann. 1983; 6(2): 169-73.
- Hanioka T, Ojima M, Tanaka K, Yamamoto M. Does secondhand smoke affect the development of dental caries in children? A systematic review. Int J Environ Res Public Health. 2011 May;8(5):1503-19. Epub 2011 May 12. http://dx.doi.org/10.3390/ijerph8051503
- Hecht SS. Tobacco carcinogens, their biomarkers and tobacco-induced cancer. Nat Rev Cancer. 2003 Oct;3(10):733-44. Erratum in: Nat Rev Cancer. 2004 Jan;4(1):84. http://dx.doi.org/10.1038/nrc1190
- Johnson GK, Slach NA. Impact of tobacco use on periodontal status.J Dent Educ. 2001 Apr;65(4):313-21.
- Jontell M, Holmstrupp P. Red and White Lesions of the Oral Mucosa. In: Burket's Oral Medicine.Eds: Burket LW, Greenberg MS, Glick M, Ship JA. BC Decker Publishers, Hamilton, Ontario. 2008, pg. 85.
- Kadunce DP, Burr R, Gress R, Kanner R, Lyon JL, Zone JJ. Cigarette smoking: risk factor for premature facial wrinkling. Ann Intern Med. 1991 May 15;114(10):840-4. http://dx.doi.org/10.7326/0003-4819-114-10-840,,
- Lindhe J, Lang NP, and Karring, T Clinical Periodontology and Implant Dentistry. 2008, 5th Edition. Wiley-Blackwell Publishing. 2008. pp 591, 597.
- Neville B. Damm D, White DK. Color Atlas of Clinical Oral Pathology. BC Decker Publishing, Hamilton Ontario, CA. 2003.
- Neville B, Damm D, Allen CA, Bouquot J. Oral and Maxillofacial Pathology, 2nd ed. WB Saunders Co., Philadelphia, PA.2002. pp13-14; 324-325; 337-345;345-46;350-51;356-67
- Nield-Gehrig JS, Willmann DE. Smoking and Periodontal Disease . In: Nield-Gehrig et al. Foundations of Periodontics for the Dental Hygienist 3rd ed. Philadelphia PA Lippincott 2011:195-207
- Nishida N, Yamamoto Y, Tanaka M, et al. Association between involuntary smoking and salivary markers related to periodontitis: a 2-year longitudinal study. J Periodontol. 2008; 79(12): 2233-40. http://dx.doi.org/10.1902/jop.2008.080149
- Nishida N, Yamamoto Y, Tanaka M, et al. Association between passive smoking and salivary markers related to periodontitis. J Clin Periodontol. 2006; 33(10): 717-23. http://dx.doi.org/10.1111/j.1600-051X.2006.00982.x
- Numabe Y, Ogawa T, Kamoi H, et al. Phagocytic function of salivary PMN after smoking or secondary smoking. Ann Periodontol. 1998; 3(1): 102-7. http://dx.doi.org/10.1902/annals.1918.104.22.168
- Reardon JZ. Environmental tobacco smoke: respiratory and other health effects. Clin Chest Med. 2007; 28(3): 559-73, vi. http://dx.doi.org/10.1016/j.ccm.2007.06.006
- Romito LM, Saxton MK, Coan LL, Christen AG. Retail promotions and perceptions of R.J. Reynolds' novel dissolvable tobacco in a US test market. Harm Reduct J. 2011 May 15;8(1):10. http://dx.doi.org/10.1186/1477-7517-8-10
- Scully C. Cancers of the Oral Mucosa. Medscape Reference. 2012. http://emedicine.medscape.com/article/1075729-overview. Accessed May 15, 2012.
- Shenkin JD, Broffitt B, Levy SM, Warren JJ. The association between environmental tobacco smoke and primary tooth caries. J Public Health Dent. 2004 Summer;64(3):184-6. http://dx.doi.org/10.1111/j.1752-7325.2004.tb02750.x
- Shizukuishi S. Smoking and periodontal disease. Clin Calcium 2007;17(2):226-32.
- Silverman S. Nicotine Stomatitis Differential Diagnoses. Medscape Reference. 2012. http://emedicine.medscape.com/article/1076183-overview. Accessed May 12, 2012.
- Sreedevi M, Ramesh A, Dwarakanath C. Periodontal status in smokers and nonsmokers: a clinical, microbiological, and histopathological study. Int J Dent. 2012;2012:571590. Epub 2012 Feb 14.
- Steele T. Premalignant Lesions of the Oral Cavity. Medscape Reference. 2012. http://emedicine.medscape.com/article/1491418-overview#a1. Accessed May 15, 2012. http://dx.doi.org/10.1155/2012/571590
- Stepanov I, Biener L, Knezevich A, Nyman AL, Bliss R, Jensen J, Hecht SS, Hatsukami DK. Monitoring tobacco-specific N-nitrosamines and nicotine in novel Marlboro and Camel smokeless tobacco products: findings from Round 1 of the New Product Watch. Nicotine Tob Res. 2012 Mar;14(3):274-81. Epub 2011 Oct 29 http://dx.doi.org/10.1093/ntr/ntr209
- Stepanov I, Jensen J, Hatsukami D, Hecht SS. New and traditional smokeless tobacco: comparison of toxicant and carcinogen levels. Nicotine Tob Res. 2008 Dec;10(12):1773-82. http://dx.doi.org/10.1080/14622200802443544
- Stewart SL, Cardinez CJ, Richardson LC, Norman L, Kaufmann R, Pechacek TF, Thompson TD, Weir HK, Sabatino SA; Centers for Disease Control and Prevention (CDC).Surveillance for cancers associated with tobacco use--United States, 1999-2004. MMWR Surveill Summ. 2008 Sep 5;57(8):1-33.
- Tanaka K, Hanioka T, Miyake Y, Ojima M, Aoyama H. Association of smoking in household and dental caries in Japan. J Public Health Dent. 2006 Fall;66(4):279-81. http://dx.doi.org/10.1111/j.1752-7325.2006.tb04083.x
- Tanaka K, Miyake Y, Arakawa M, Sasaki S, Ohya Y. Household smoking and dental caries in schoolchildren: the Ryukyus Child Health Study. BMC Public Health. 2010 Jun 14;10:335. http://dx.doi.org/10.1186/1471-2458-10-335
- Tanaka K, Miyake Y, Sasaki S, et al. Active and passive smoking and tooth loss in Japanese women: baseline data from the osaka maternal and child health study. Ann Epidemiol. 2005; 15(5): 358-64. http://dx.doi.org/10.1016/j.annepidem.2004.12.005
- Umeda M, Chen C, Bakker I, et al. Risk indicators for harboring periodontal pathogens. J Periodontol. 1998; 69(10): 1111-8. http://dx.doi.org/10.1902/jop.1922.214.171.1241
- U.S. Food and Drug Administration. Available at: http://www.fda.gov/newsevents/publichealthfocus/ucm172906.htm
- Warnakulasuriya S, Johnson NW, van der Waal I. Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med. Nov 2007;36(10):575-80. http://dx.doi.org/10.1111/j.1600-0714.2007.00582.x
- Warnakulasuriya S, Dietrich T, Bornstein MM, Casals Peidró E, Preshaw PM, Walter C,
Wennström JL, Bergström J. Oral health risks of tobacco use and effects of cessation. Int Dent J. 2010 Feb;60(1):7-30.
- Williams SA, Kwan SY, Parsons S.. Parental smoking practices and caries experience in pre-school children. Caries Res. 2000 Mar-Apr;34(2):117-22. http://dx.doi.org/10.1159/000016578
- Zambon JJ, Grossi SG, Machtei EE, et al. Cigarette smoking increases the risk for subgingival infection with periodontal pathogens. J Periodontol. 1996; 67(10 Suppl): 1050-4. http://dx.doi.org/10.1902/jop.1996.67.10s.1050