“Effects of snuff dipping and cigarette smoking on oral health among male patients at a tertiary care hospital Peshawar

“Effects of snuff dipping and cigarette smoking on oral health among male patients at a tertiary care hospital Peshawar.”
INTRODUCTION:
Tobacco is the most toxic agent in our civilization ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISBN” : “9789533070940”, “author” : { “dropping-particle” : “”, “family” : “Aoshima”, “given” : “Hitoshi”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “0” }, “title” : “World ‘ s largest Science , Technology ; Medicine Open Access book publisher :”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=5149fee6-7c1e-49cb-b35d-15b427ba1f37” } , “mendeley” : { “formattedCitation” : “(1)”, “plainTextFormattedCitation” : “(1)”, “previouslyFormattedCitation” : “(1)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(1). The plant of tobacco is considered to be originated on the earth planet between North and South America. Cultivation of tobacco plant has been started 5000 years ago ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1080/08858198709527882”, “ISSN” : “0885-8195”, “author” : { “dropping-particle” : “”, “family” : “Mashberg”, “given” : “Arthur”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of Cancer Education”, “id” : “ITEM-1”, “issue” : “3”, “issued” : { “date-parts” : “1987” }, “page” : “193-193”, “title” : “Smokeless Tobacco”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=a24aa656-47d0-40f9-9a09-6f741cb5ae2b” } , “mendeley” : { “formattedCitation” : “(2)”, “plainTextFormattedCitation” : “(2)”, “previouslyFormattedCitation” : “(2)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(2). Tobacco is the most prominent cause of death now a day in the world the use of which can be controlled, which kills half of the users. The use of tobacco continuously increasing in the developing countries because of gradual increase of population with rapidly increase for the efforts of tobacco industry marketing ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “https://dx.doi.org/2324”, “ISBN” : “1022-386X”, “ISSN” : “1681-7168”, “PMID” : “27225147”, “abstract” : “OBJECTIVE: To assess the frequency of adverse addictive habits, specially alcohol and tobacco usage, among police personnel of Bhopal City, Central India and its association with the frequency of oral mucosal lesions and periodontal diseases., STUDY DESIGN: Across-sectional analytical study., PLACE AND DURATION OF STUDY: Bhopal City, Capital of Madhya Pradesh State, Central India, from February to April 2013., METHODOLOGY: All the police personnel posted at various police stations were interviewed and clinically examined. Police personnel who did not cooperate or were not willing, were excluded from the study. Chi-square test was used to analyze categorical variables., RESULTS: Atotal of 781 subjects were interviewed for the various forms of adverse habits, followed by clinical assessment of oral mucosal lesions and periodontal status using WHO 1997 criteria. The mean age of study subjects was 40.58 +/-9.84 years. Usage of tobacco was found among 55% and only 1.3% of subjects consumed alcohol. The prevalence of oral mucosal lesions and periodontal diseases was significantly higher among tobacco users., CONCLUSION: There was high usage of tobacco among police personnel in Bhopal City, India with a detrimental effect on oral health.”, “author” : { “dropping-particle” : “”, “family” : “Singh”, “given” : “Aishwarya”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Bhambal”, “given” : “Ajay”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Saxena”, “given” : “Sudhanshu”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Tiwari”, “given” : “Vidhatri”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Tiwari”, “given” : “Utkarsh”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of the College of Physicians and Surgeons–Pakistan : JCPSP”, “id” : “ITEM-1”, “issue” : “5”, “issued” : { “date-parts” : “2016” }, “page” : “403-407”, “title” : “Frequency of Addictive Habits and its Association with Oral Diseases Among a Cross Section of Indian Police Personnel Connotation.”, “type” : “article-journal”, “volume” : “26” }, “uris” : “http://www.mendeley.com/documents/?uuid=d0ff2000-653e-4eaf-99ed-5d569b11ff86” } , “mendeley” : { “formattedCitation” : “(3)”, “plainTextFormattedCitation” : “(3)”, “previouslyFormattedCitation” : “(3)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(3).
Tobacco use is the major cause of most non communicable diseases like cardiovascular diseases, stroke, low birth weight, cancers and oral diseases ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.5005/jp-journals-10015-1291”, “ISBN” : “0803356218”, “ISSN” : “09766006”, “abstract” : “Objectives: Cigarette smoking is recognized as the most important environmental risk factor in periodontitis and also an important risk factor for oral cancer. The aim of this study was to determine the prevalence of cigarette smoking and awareness of oral health problems of tobacco use among university students in Port Harcourt, Nigeria. Materials and methods: The study population consisted of 360 young adults: 188 (52.2%) males and 172 (47.8%) females. Participants answered questions regarding demography, smoking behavior, attitude and on oral effect of smoking. Data were analyzed using IBM SPSS (New York, USA) statistics version 20.0 and test of significance done using Chi-square. Results: The overall prevalence of smoking was 78 (21.7%): 52 (27.7%) in males and 26 (15.1%) in females. Males significantly smoked more than females (p = 0.002). Fifty-one (65.4%) of the current smokers commenced smoking in secondary school, 39 (50%) had smoked for 6 to 10 years, 54 (69.2%) consumed one to five sticks of cigarettes per day and among those who quitted smoking, 39 (52%) stopped smoking for health reasons. While 262 (72.8%) were ignorant that smoking was harmful to oral health, 223 (61.9%) and 278 (77.2%) respectively could not identify smoking as a risk factor for oral cancers and gum disease. Conclusion: Though majority of the students were aware of the negative impact of smoking on general health, most of them were ignorant of the effect on oral health. Therefore, shared risk approach should be employed to inform, guide and educate the public on the effects of tobacco and in the campaign against its use. u00a9 2014, Jaypee Brothers Medical Publishers (P) Ltd. All rights reserved.”, “author” : { “dropping-particle” : “”, “family” : “Omoigberai Bashiru”, “given” : “Braimoh”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Ayamma Udo”, “given” : “Umanah”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “World Journal of Dentistry”, “id” : “ITEM-1”, “issue” : “December”, “issued” : { “date-parts” : “2014” }, “page” : “209-212”, “title” : “Cigarette smoking and Awareness of Oral Health Problems of Tobacco use among Students at the University of Port Harcourt, South-South Nigeria”, “type” : “article-journal”, “volume” : “5” }, “uris” : “http://www.mendeley.com/documents/?uuid=09dcb186-cb65-4e96-a2a1-95d34a0a62b9” } , “mendeley” : { “formattedCitation” : “(4)”, “plainTextFormattedCitation” : “(4)”, “previouslyFormattedCitation” : “(4)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(4),ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISBN” : “0123456789”, “ISSN” : “1024-2708”, “PMID” : “12904615”, “abstract” : “OBJECTIVE: To review the effects of tobacco use on oral health, with particular emphasis on the effects of periodontal diseases, dental implant failures, and risk of development of oral cancers and precancers. DATA SOURCES: Medline literature search (1977-2002). STUDY SELECTION: Key words for the literature search were ‘tobacco smoking’, ‘periodontal disease’, ‘dental implant’, and ‘oral cancers and precancers’. DATA EXTRACTION: Evidence-based literature review. DATA SYNTHESIS: The prevalence and severity of periodontal diseases in their various forms are higher among smokers than among non-smokers. The success of dental implant treatments is significantly influenced by addiction to tobacco smoking. The failure rate of implant osseointegration is considerably higher among smokers, and maintenance of oral hygiene around the implants and risk of peri-implantitis are adversely affected by smoking. The risks of developing oral cancers and precancers are greater in smokers. Betel nut chewing and smokeless tobacco produce similar risk to cancer incidence as tobacco smoking. Cessation of tobacco use has a beneficial effect on halting the progression of periodontal diseases and on the outcome of periodontal therapy. CONCLUSIONS: Medical and dental teams should be aware of oral problems associated with tobacco use. Counselling on smoking cessation and smoking prevention programmes should be an integral component of medical and dental teaching and practice.”, “author” : { “dropping-particle” : “”, “family” : “Sham”, “given” : “a S K”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Cheung”, “given” : “L K”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Jin”, “given” : “L J”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Corbet”, “given” : “E F”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Hong Kong medical journal”, “id” : “ITEM-1”, “issue” : “4”, “issued” : { “date-parts” : “2003” }, “page” : “271-277”, “title” : “The Effects of Tobacco Use on Oral Health.”, “type” : “article-journal”, “volume” : “9” }, “uris” : “http://www.mendeley.com/documents/?uuid=7fb0e575-a672-4782-b84e-e181ad135ba3” } , “mendeley” : { “formattedCitation” : “(5)”, “plainTextFormattedCitation” : “(5)”, “previouslyFormattedCitation” : “(5)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(5),ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Use”, “given” : “Tobacco”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “November”, “issued” : { “date-parts” : “1999” }, “page” : “38-40”, “title” : “on the Prevalence and Severity”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=2cde9f4b-afb8-4d6b-986b-e3780524f619” } , “mendeley” : { “formattedCitation” : “(6)”, “plainTextFormattedCitation” : “(6)”, “previouslyFormattedCitation” : “(6)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(6). Tobacco is considered the major and very important risk factor for lots of oral conditions for example oral mucosal lesions, failure of dental implants and wound healing, periodontal diseases, gingival inflammation, acute necrotizing ulcerative gingivitis, and apthus ulcers. Most of the evidence suggests that the frequent usage tobacco increases the risk of oral diseases and its cessation reduces the risk ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISBN” : “9789533070940”, “author” : { “dropping-particle” : “”, “family” : “Aoshima”, “given” : “Hitoshi”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “0” }, “title” : “World ‘ s largest Science , Technology & Medicine Open Access book publisher :”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=5149fee6-7c1e-49cb-b35d-15b427ba1f37” } , “mendeley” : { “formattedCitation” : “(1)”, “plainTextFormattedCitation” : “(1)”, “previouslyFormattedCitation” : “(1)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(1). Tobacco is use in many forms including the products of smoking and smokeless tobacco ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISBN” : “0123456789”, “ISSN” : “1024-2708”, “PMID” : “12904615”, “abstract” : “OBJECTIVE: To review the effects of tobacco use on oral health, with particular emphasis on the effects of periodontal diseases, dental implant failures, and risk of development of oral cancers and precancers. DATA SOURCES: Medline literature search (1977-2002). STUDY SELECTION: Key words for the literature search were ‘tobacco smoking’, ‘periodontal disease’, ‘dental implant’, and ‘oral cancers and precancers’. DATA EXTRACTION: Evidence-based literature review. DATA SYNTHESIS: The prevalence and severity of periodontal diseases in their various forms are higher among smokers than among non-smokers. The success of dental implant treatments is significantly influenced by addiction to tobacco smoking. The failure rate of implant osseointegration is considerably higher among smokers, and maintenance of oral hygiene around the implants and risk of peri-implantitis are adversely affected by smoking. The risks of developing oral cancers and precancers are greater in smokers. Betel nut chewing and smokeless tobacco produce similar risk to cancer incidence as tobacco smoking. Cessation of tobacco use has a beneficial effect on halting the progression of periodontal diseases and on the outcome of periodontal therapy. CONCLUSIONS: Medical and dental teams should be aware of oral problems associated with tobacco use. Counselling on smoking cessation and smoking prevention programmes should be an integral component of medical and dental teaching and practice.”, “author” : { “dropping-particle” : “”, “family” : “Sham”, “given” : “a S K”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Cheung”, “given” : “L K”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Jin”, “given” : “L J”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Corbet”, “given” : “E F”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Hong Kong medical journal”, “id” : “ITEM-1”, “issue” : “4”, “issued” : { “date-parts” : “2003” }, “page” : “271-277”, “title” : “The Effects of Tobacco Use on Oral Health.”, “type” : “article-journal”, “volume” : “9” }, “uris” : “http://www.mendeley.com/documents/?uuid=7fb0e575-a672-4782-b84e-e181ad135ba3” } , “mendeley” : { “formattedCitation” : “(5)”, “plainTextFormattedCitation” : “(5)”, “previouslyFormattedCitation” : “(5)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(5), ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISSN” : “1210-7778”, “PMID” : “17958204”, “abstract” : “This review article describes different forms of tobacco usage and its direct relationship with the prevalence of dental caries. Smoking along with co-existing factors like old age, bad oral hygiene habits, food habits, limited preventive dental visits and over all health standards, can be associated with high caries incidence. However, a direct etiological relationship is lacking. Environmental tobacco smoke (ETS) causes dental caries in children but no studies have been reported in adults. Existing findings are not sufficient and conclusive enough to confirm that ETS causes dental caries. Oral use of smokeless tobacco (ST), predominantly tobacco chewing, is presumably a positive contributing factor to higher incidence of dental caries. Unfortunately, published studies are not converging towards one single factor through which tobacco usage can have direct relationship to dental caries. Key”, “author” : { “dropping-particle” : “”, “family” : “Vellappally”, “given” : “Sajith”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Cent Eur J Public Health”, “id” : “ITEM-1”, “issue” : “3”, “issued” : { “date-parts” : “2007” }, “page” : “116-121”, “title” : “Influence of tobacco use in dental caries development”, “type” : “article-journal”, “volume” : “15” }, “uris” : “http://www.mendeley.com/documents/?uuid=88d0b019-80a7-413b-b7bc-5fe970560ec5” } , “mendeley” : { “formattedCitation” : “(7)”, “plainTextFormattedCitation” : “(7)”, “previouslyFormattedCitation” : “(7)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(7). These products induce many of the oral diseases ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISBN” : “0123456789”, “ISSN” : “1024-2708”, “PMID” : “12904615”, “abstract” : “OBJECTIVE: To review the effects of tobacco use on oral health, with particular emphasis on the effects of periodontal diseases, dental implant failures, and risk of development of oral cancers and precancers. DATA SOURCES: Medline literature search (1977-2002). STUDY SELECTION: Key words for the literature search were ‘tobacco smoking’, ‘periodontal disease’, ‘dental implant’, and ‘oral cancers and precancers’. DATA EXTRACTION: Evidence-based literature review. DATA SYNTHESIS: The prevalence and severity of periodontal diseases in their various forms are higher among smokers than among non-smokers. The success of dental implant treatments is significantly influenced by addiction to tobacco smoking. The failure rate of implant osseointegration is considerably higher among smokers, and maintenance of oral hygiene around the implants and risk of peri-implantitis are adversely affected by smoking. The risks of developing oral cancers and precancers are greater in smokers. Betel nut chewing and smokeless tobacco produce similar risk to cancer incidence as tobacco smoking. Cessation of tobacco use has a beneficial effect on halting the progression of periodontal diseases and on the outcome of periodontal therapy. CONCLUSIONS: Medical and dental teams should be aware of oral problems associated with tobacco use. Counselling on smoking cessation and smoking prevention programmes should be an integral component of medical and dental teaching and practice.”, “author” : { “dropping-particle” : “”, “family” : “Sham”, “given” : “a S K”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Cheung”, “given” : “L K”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Jin”, “given” : “L J”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Corbet”, “given” : “E F”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Hong Kong medical journal”, “id” : “ITEM-1”, “issue” : “4”, “issued” : { “date-parts” : “2003” }, “page” : “271-277”, “title” : “The Effects of Tobacco Use on Oral Health.”, “type” : “article-journal”, “volume” : “9” }, “uris” : “http://www.mendeley.com/documents/?uuid=7fb0e575-a672-4782-b84e-e181ad135ba3” } , “mendeley” : { “formattedCitation” : “(5)”, “plainTextFormattedCitation” : “(5)”, “previouslyFormattedCitation” : “(5)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(5).

Smokeless tobacco is mainly used either as snuff or as chewing tobacco. Snuff may be dry or may be moist, the later is taken orally ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.21767/2471-8041.100043”, “author” : { “dropping-particle” : “”, “family” : “Eltohami”, “given” : “Yousif I”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Alim”, “given” : “Nour E”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Abuaffan”, “given” : “Amal H”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2017” }, “page” : “1-3”, “title” : “iMedPub Journals Snuff Dipping Sudanese Tombak Keratosis – A Case Report”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=0d15127f-79c2-4cc3-9859-4b57955bc68e” } , “mendeley” : { “formattedCitation” : “(8)”, “plainTextFormattedCitation” : “(8)”, “previouslyFormattedCitation” : “(8)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(8). Snuff is actually a mixture of tobacco after crushing, ash, powdered lime and is places between cheeks and gums at the vestibule in the form of a ball ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Article”, “given” : “Original”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Jpmi”, “id” : “ITEM-1”, “issue” : “01”, “issued” : { “date-parts” : “2009” }, “page” : “28-34”, “title” : “Original Article Oral Cavity Cancers in North West Pakistan : a Hospital Based Study”, “type” : “article-journal”, “volume” : “23” }, “uris” : “http://www.mendeley.com/documents/?uuid=e2f32d53-788f-4117-95bf-03717e9d83b0” } , “mendeley” : { “formattedCitation” : “(9)”, “plainTextFormattedCitation” : “(9)”, “previouslyFormattedCitation” : “(9)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(9). Some users place it under the tongue ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1080/08858198709527882”, “ISSN” : “0885-8195”, “author” : { “dropping-particle” : “”, “family” : “Mashberg”, “given” : “Arthur”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of Cancer Education”, “id” : “ITEM-1”, “issue” : “3”, “issued” : { “date-parts” : “1987” }, “page” : “193-193”, “title” : “Smokeless Tobacco”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=a24aa656-47d0-40f9-9a09-6f741cb5ae2b” } , “mendeley” : { “formattedCitation” : “(2)”, “plainTextFormattedCitation” : “(2)”, “previouslyFormattedCitation” : “(2)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(2). The snuff is more accepted socially and one can use it without someone noticing him without detection ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Scientific Advisory Committee on Tobacco Products Regulation”, “given” : “”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “14”, “issued” : { “date-parts” : “2000” }, “page” : “9”, “title” : “Recommendation on Smokeless Tobacco Products”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=4dc9b0e3-8340-4304-a39c-4bcb5efc7e9b” } , “mendeley” : { “formattedCitation” : “(10)”, “plainTextFormattedCitation” : “(10)”, “previouslyFormattedCitation” : “(10)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(10). Snuff dipping is common in Pakistan, Afghanistan, Iran, South Africa and central Asia ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1080/08858198709527882”, “ISSN” : “0885-8195”, “author” : { “dropping-particle” : “”, “family” : “Mashberg”, “given” : “Arthur”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of Cancer Education”, “id” : “ITEM-1”, “issue” : “3”, “issued” : { “date-parts” : “1987” }, “page” : “193-193”, “title” : “Smokeless Tobacco”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=a24aa656-47d0-40f9-9a09-6f741cb5ae2b” } , “mendeley” : { “formattedCitation” : “(2)”, “plainTextFormattedCitation” : “(2)”, “previouslyFormattedCitation” : “(2)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(2). Smokeless tobacco use is twice high compared to smoking. It is mostly associated with pre cancers lesions which can lead to morbidity and mortality if it is not diagnosed earlier ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.21767/2471-8041.100043”, “author” : { “dropping-particle” : “”, “family” : “Eltohami”, “given” : “Yousif I”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Alim”, “given” : “Nour E”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Abuaffan”, “given” : “Amal H”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2017” }, “page” : “1-3”, “title” : “iMedPub Journals Snuff Dipping Sudanese Tombak Keratosis – A Case Report”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=0d15127f-79c2-4cc3-9859-4b57955bc68e” } , “mendeley” : { “formattedCitation” : “(8)”, “plainTextFormattedCitation” : “(8)”, “previouslyFormattedCitation” : “(8)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(8). National cancer institute identified 28 cancer causing chemicals ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1158/1055-9965”, “abstract” : “Backgroundu2014This longitudinal study sought to identify groups of breast cancer survivors exhibiting distinct trajectories of depressive symptoms up to 24 months following diagnosis, and to describe characteristics associated with these trajectories. Methodsu2014653 women completed baseline questionnaires within 8 months of breast cancer diagnosis on patient characteristics, symptoms, and psychosocial variables. Depressive symptoms were assessed at baseline and 6, 12, and 18 months after baseline. Chart reviews provided cancer and treatment-related data. Finite mixture modeling identified trajectories of depressive symptoms measured with the Beck Depression Inventory (BDI). Resultsu2014Six distinct trajectories were identified. Just over half of the sample had consistently very low (3.8%) or low (47.3%) BDI scores well below the traditional BDI cut-point of 10 thought to be indicative of clinically significant depression; 29.2% had consistently borderline scores; 11.3% had initially high scores that declined over time, but remained above the cut-point; 7.2% showed increased BDI over time; and a small but unique group (1.1%) reported chronically high scores above 25. Women in groups with lower depressive symptom levels were older, had less rigorous chemotherapy, fewer physical symptoms (fatigue and pain), and lower levels of illness intrusiveness. Conclusionsu2014Approximately 20% of women had levels of depressive symptoms indicative of clinical depression that were maintained two years post-diagnosis. Factors related to trajectory membership such as illness intrusiveness, social support, fatigue, pain, and vasomotor symptoms suggest”, “author” : { “dropping-particle” : “”, “family” : “Avis”, “given” : “Nancy E.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Levine”, “given” : “Beverly J.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Case”, “given” : “Douglas J.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Naftalis”, “given” : “Elizabeth Z.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Zee Van”, “given” : “Kimberly J.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Cancer Epidemiol Biomarkers Prev.”, “id” : “ITEM-1”, “issue” : “11”, “issued” : { “date-parts” : “2015” }, “page” : “1789u20131795”, “title” : “Trajectories of Depressive Symptoms Following Breast Cancer Diagnosis”, “type” : “article-journal”, “volume” : “24” }, “uris” : “http://www.mendeley.com/documents/?uuid=5cf17487-b547-4f98-ba9b-c23586ab15d2” } , “mendeley” : { “formattedCitation” : “(11)”, “plainTextFormattedCitation” : “(11)”, “previouslyFormattedCitation” : “(11)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(11). Other conditions including gingival recession, dental caries, tooth attritions and other risk factor for cardiovascular diseases, diabetes, diseases related to reproductive system and overall mortality ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Scientific Advisory Committee on Tobacco Products Regulation”, “given” : “”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “14”, “issued” : { “date-parts” : “2000” }, “page” : “9”, “title” : “Recommendation on Smokeless Tobacco Products”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=4dc9b0e3-8340-4304-a39c-4bcb5efc7e9b” } , “mendeley” : { “formattedCitation” : “(10)”, “plainTextFormattedCitation” : “(10)”, “previouslyFormattedCitation” : “(10)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(10).
Smoking includes cigars, bidi smoking pipe and cigarettes ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1922/IDJ”, “ISBN” : “0020-6539 (Print)\r0020-6539”, “ISSN” : “0020-6539”, “PMID” : “21302741”, “abstract” : “To evaluate the potential of two whitening toothpastes on stain removal, using two different spectrophotometeric devices.”, “author” : { “dropping-particle” : “”, “family” : “Kawashima”, “given” : “Nobuyuki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Wadachi”, “given” : “Reiko”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Suda”, “given” : “Hideaki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “International Dental Journal”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2009” }, “page” : “5-11”, “title” : “Root canal medicaments”, “type” : “article-journal”, “volume” : “59” }, “uris” : “http://www.mendeley.com/documents/?uuid=f5c59163-c89a-4b75-b684-aeb08b1ae7d7” } , “mendeley” : { “formattedCitation” : “(12)”, “plainTextFormattedCitation” : “(12)”, “previouslyFormattedCitation” : “(12)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(12). Since many years smoking is considered to link with cancers, poor pregnancy outcomes, low birth weight and miscarriages, and lung diseases. For the 2 decades evidences suggested that smoking is linked with periodontal diseases. Cigarette smoking induces some irreversible process which does not progress after cessation ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISBN” : “0022-0337 (Print)\r0022-0337 (Linking)”, “ISSN” : “0022-0337”, “PMID” : “11336116”, “abstract” : “This article reviews the effects of smoked and smokeless tobacco on periodontal status, including the impact of smoking on periodontal therapy and potential mechanisms for the adverse effects of tobacco on the periodontium. Approximately half of periodontitis cases have been attributed to either current or former smoking. Both cigar and cigarette smokers have significantly greater loss of bone height than nonsmokers, and there is a trend for pipe smokers to have more bone loss than nonsmokers. Unlike smokers, who experience widespread periodontal destruction, the most prevalent effects of smokeless tobacco are localized to the site of placement, in the form of gingival recession and white mucosal lesions. Smoking has an adverse effect on all forms of periodontal therapy, and up to 90 percent of refractory periodontitis patients are smokers. The pathogenesis of smoking-related periodontal destruction has been attributed to alterations in the microflora and/or host response. Some data indicates that smoking may increase levels of certain periodontal pathogens, but there is more evidence that smoking has a negative effect on host response, such as neutrophil function and antibody production. An encouraging finding is that periodontal disease progression slows in patients who quit smoking and that these individuals have a similar response to periodontal therapy as nonsmokers. The facts presented in this paper will assist dental health professionals in treatment-planning decisions and provide them with important information to share with patients who use tobacco products.”, “author” : { “dropping-particle” : “”, “family” : “Johnson”, “given” : “G K”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Slach”, “given” : “N A”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of dental education”, “id” : “ITEM-1”, “issue” : “4”, “issued” : { “date-parts” : “2001” }, “page” : “313-321”, “title” : “Impact of tobacco use on periodontal status.”, “type” : “article-journal”, “volume” : “65” }, “uris” : “http://www.mendeley.com/documents/?uuid=0390a920-d80c-47a1-9d16-a8cffe1e6cff” } , “mendeley” : { “formattedCitation” : “(13)”, “plainTextFormattedCitation” : “(13)”, “previouslyFormattedCitation” : “(13)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(13). Smoking is related to tooth loss as well ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISSN” : “0002-8177 (Print)”, “PMID” : “2913100”, “author” : { “dropping-particle” : “”, “family” : “McCann”, “given” : “D”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of the American Dental Association (1939)”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2015” }, “page” : “18-25”, “title” : “Tobacco use and oral health.”, “type” : “article-journal”, “volume” : “211” }, “uris” : “http://www.mendeley.com/documents/?uuid=a1b6e5e3-76db-4a55-b8b8-f0ac78ebef33” } , “mendeley” : { “formattedCitation” : “(14)”, “plainTextFormattedCitation” : “(14)”, “previouslyFormattedCitation” : “(14)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(14), ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1922/IDJ”, “ISBN” : “0020-6539 (Print)\r0020-6539”, “ISSN” : “0020-6539”, “PMID” : “21302741”, “abstract” : “To evaluate the potential of two whitening toothpastes on stain removal, using two different spectrophotometeric devices.”, “author” : { “dropping-particle” : “”, “family” : “Kawashima”, “given” : “Nobuyuki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Wadachi”, “given” : “Reiko”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Suda”, “given” : “Hideaki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “International Dental Journal”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2009” }, “page” : “5-11”, “title” : “Root canal medicaments”, “type” : “article-journal”, “volume” : “59” }, “uris” : “http://www.mendeley.com/documents/?uuid=f5c59163-c89a-4b75-b684-aeb08b1ae7d7” } , “mendeley” : { “formattedCitation” : “(12)”, “plainTextFormattedCitation” : “(12)”, “previouslyFormattedCitation” : “(12)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(12). Smoking us also considered a risk factor for peri-implant mucositis, greater marginal bone loss, post operative infections and implant failure ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISSN” : “0002-8177 (Print)”, “PMID” : “2913100”, “author” : { “dropping-particle” : “”, “family” : “McCann”, “given” : “D”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of the American Dental Association (1939)”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2015” }, “page” : “18-25”, “title” : “Tobacco use and oral health.”, “type” : “article-journal”, “volume” : “211” }, “uris” : “http://www.mendeley.com/documents/?uuid=a1b6e5e3-76db-4a55-b8b8-f0ac78ebef33” } , “mendeley” : { “formattedCitation” : “(14)”, “plainTextFormattedCitation” : “(14)”, “previouslyFormattedCitation” : “(14)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(14). There are almost 7000 chemicals in the smoke of tobacco, 69 of which are considered responsible for cancers. Smokers are at 25 times greater risk to develop lung cancer than non smokers and lung cancer is the main risk to cause morbidity among UK population almost 35,895 deaths in the year of 2014, contributed more than 22% of all of the deaths associated with cancers. Tobacco is also known to cause bowel cancer which is the 4th highly diagnosed cancer among all of the cancers and the 3rd most prominent cause of number of deaths among all deaths associated with cancers ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Health”, “given” : “Oral”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “0” }, “title” : “Health Consequences of Tobacco Use and the Impact on”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=81ab14e5-a252-46e3-9dbc-cc64f9109481” } , “mendeley” : { “formattedCitation” : “(15)”, “plainTextFormattedCitation” : “(15)”, “previouslyFormattedCitation” : “(15)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(15).

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DENTAL CARIES:
Old opinions suggested the inverse relation of smoking with dental caries so they might see low caries in smokers. Only few researchers suggested increase risk of caries with elevation of cigarette smoking. Smokers also have poor oral hygiene because they show fewer tendencies towards brushing. In natural tobacco 20% sugar level is present which can lead to caries. Although direct relation is not found between smoking and caries ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISSN” : “1210-7778”, “PMID” : “17958204”, “abstract” : “This review article describes different forms of tobacco usage and its direct relationship with the prevalence of dental caries. Smoking along with co-existing factors like old age, bad oral hygiene habits, food habits, limited preventive dental visits and over all health standards, can be associated with high caries incidence. However, a direct etiological relationship is lacking. Environmental tobacco smoke (ETS) causes dental caries in children but no studies have been reported in adults. Existing findings are not sufficient and conclusive enough to confirm that ETS causes dental caries. Oral use of smokeless tobacco (ST), predominantly tobacco chewing, is presumably a positive contributing factor to higher incidence of dental caries. Unfortunately, published studies are not converging towards one single factor through which tobacco usage can have direct relationship to dental caries. Key”, “author” : { “dropping-particle” : “”, “family” : “Vellappally”, “given” : “Sajith”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Cent Eur J Public Health”, “id” : “ITEM-1”, “issue” : “3”, “issued” : { “date-parts” : “2007” }, “page” : “116-121”, “title” : “Influence of tobacco use in dental caries development”, “type” : “article-journal”, “volume” : “15” }, “uris” : “http://www.mendeley.com/documents/?uuid=88d0b019-80a7-413b-b7bc-5fe970560ec5” } , “mendeley” : { “formattedCitation” : “(7)”, “plainTextFormattedCitation” : “(7)”, “previouslyFormattedCitation” : “(7)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(7). Incidence of caries increases with cigarette smoking. From in vitro studies it is reported that a biofilm is formed with nicotine ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISSN” : “0002-8177 (Print)”, “PMID” : “2913100”, “author” : { “dropping-particle” : “”, “family” : “McCann”, “given” : “D”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of the American Dental Association (1939)”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2015” }, “page” : “18-25”, “title” : “Tobacco use and oral health.”, “type” : “article-journal”, “volume” : “211” }, “uris” : “http://www.mendeley.com/documents/?uuid=a1b6e5e3-76db-4a55-b8b8-f0ac78ebef33” } , “mendeley” : { “formattedCitation” : “(14)”, “plainTextFormattedCitation” : “(14)”, “previouslyFormattedCitation” : “(14)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(14). Some reports suggested that the buffering capacity of the saliva may be change which can alter the tendency towards caries ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1922/IDJ”, “ISBN” : “0020-6539 (Print)\r0020-6539”, “ISSN” : “0020-6539”, “PMID” : “21302741”, “abstract” : “To evaluate the potential of two whitening toothpastes on stain removal, using two different spectrophotometeric devices.”, “author” : { “dropping-particle” : “”, “family” : “Kawashima”, “given” : “Nobuyuki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Wadachi”, “given” : “Reiko”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Suda”, “given” : “Hideaki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “International Dental Journal”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2009” }, “page” : “5-11”, “title” : “Root canal medicaments”, “type” : “article-journal”, “volume” : “59” }, “uris” : “http://www.mendeley.com/documents/?uuid=f5c59163-c89a-4b75-b684-aeb08b1ae7d7” } , “mendeley” : { “formattedCitation” : “(12)”, “plainTextFormattedCitation” : “(12)”, “previouslyFormattedCitation” : “(12)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(12). Another suggestion is that smokers may also have poor oral and food habits which can also affect the caries incidence. From a recent study it is confirmed that the rate of caries among Italian service men, who smoke are greater than light smokers and non smokers ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISBN” : “978-91-628-8533-5”, “abstract” : “Background and aims: This thesis describes oral health and the use of tobacco with the emphasis on dental caries and Swedish snuff (snus). There appears to be a general opinion in Sweden that snus protects against caries, but there are no scientific studies that support these speculations. More research is therefore needed and the aims of the present investigations were accordingly: 1) to describe the use of tobacco and changes over time (1983-2003) in randomly selected individuals between 15 and 70 years of age, in relation to socioeconomic conditions and dental care habits, 2) to study the relationship between various intraoral caries-associated variables and the effect of smoking and of using snus on dental caries, 3) to study caries-related factors and the pH fall in dental plaque in a group of Swedish snus users and 4) to investigate pH changes in plaque in vivo when using different snus products, both with and without nicotine, and to analyse their carbohydrate content. Methods: Three previous epidemiological cross-sectional studies carried out in 1983, 1993 and 2003 were the platform for Studies I & II (n=2015 and 1591 respectively). The participants were between 15 and 70 years of age. Study III was a clinical study with middle-aged adults (26-62 years old), who had been using snus for u226510 years (n=102) and a control group (n=101) consisting of non-tobacco users. Study IV, in which plaque pH was measured in situ, comprised 10 snus users.”, “author” : { “dropping-particle” : “”, “family” : “Hellqvist”, “given” : “Lena”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “International Journal of Dental Hygiene Acta Odontologica Scandinavica and Swedish Dental Journal”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2012” }, “title” : “Smoking, Snuffing and Oral Health with Special Reference to Dental Caries Abstract Smoking, Snuffing and Oral Health with Special Reference to Dental Caries”, “type” : “book” }, “uris” : “http://www.mendeley.com/documents/?uuid=b61c1fcc-25b0-4938-8d12-ce60edd1e327” } , “mendeley” : { “formattedCitation” : “(16)”, “plainTextFormattedCitation” : “(16)”, “previouslyFormattedCitation” : “(16)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(16).

Caries has also a high risk among snuff dippers. Root caries are common among snuff dippers. Snuff dipping increases collagenase activity which enhances bacterial accumulation on cementum causes root caries. Another mechanism supposed is that loss of keratinized gingiva and abrasion of teeth causes PDL problems which exposes root surface and thus cause root surface caries ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Vikneshan”, “given” : “M”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “V”, “family” : “Ankola”, “given” : “Anil”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hiremath”, “given” : “Anand”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hebbal”, “given” : “Mamata”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Suganya”, “given” : “M”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “2”, “issued” : { “date-parts” : “2014” }, “page” : “64-69”, “title” : “Cavity- an Overview”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=5acd45bf-bb0f-485e-9087-854f99559f39” } , “mendeley” : { “formattedCitation” : “(17)”, “plainTextFormattedCitation” : “(17)”, “previouslyFormattedCitation” : “(17)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(17).

PERIODONTITIS:
Smoking is the prominent risk factor for periodontitis and other periodontal diseases. The relation of PDL diseases and cigarette smoking is measured from attachment loss. Responses of smokers to periodontal therapy are also low. The number of cigarettes which are smoked in a day matters a lot in increasing the risk for periodontal diseases. The risk is doubled for lower users’ category and 6 times increases for smokers who smokes more than 30 cigarettes per day. Percentage of progression for periodontal diseases is 16% in both cigar and cigarette smokers. Smokeless tobacco users are suffered from gingival recession at the placement site. Periodontal diseases are the consequences of many factors like tobacco use, bacteria, genetic factor, immunological status, diabetes and age ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISSN” : “0022-0337”, “PMID” : “11336115”, “abstract” : “Tobacco use is a risk factor for oral cancer, oral mucosal lesions, periodontal disease and impaired healing after periodontal treatment, gingival recession, and coronal and root caries. Available evidence suggests that the risks of oral diseases increase with greater use of tobacco and that quitting smoking can result in decreased risk. The magnitude of the effect of tobacco on the occurrence of oral diseases is high, with users having many times the risk of non-users. There is a clear benefit to quitting tobacco use. The risks of oral cancer and periodontal disease decline as time from cessation increases, and some oral mucosal lesions may resolve with cessation of smokeless tobacco use. Smoking accounts for half of periodontal disease and three-fourths of oral cancers in the United States. Because tobacco accounts for such a high proportion of these diseases, comprehensive tobacco control policies are required to make progress in reducing the burden of tobacco-related oral diseases. Effective treatments to prevent tobacco use and increase cessation are available and need greater implementation. Dental practices may provide a uniquely effective setting for tobacco prevention and cessation.”, “author” : { “dropping-particle” : “”, “family” : “Winn”, “given” : “Deborah M.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “J Dent Educ”, “id” : “ITEM-1”, “issue” : “4”, “issued” : { “date-parts” : “2001” }, “page” : “306-312”, “title” : “Tobacco Use and Oral Disease”, “type” : “article-journal”, “volume” : “65” }, “uris” : “http://www.mendeley.com/documents/?uuid=09da100d-7dd1-45b1-bb6d-63cce6b01870” } , “mendeley” : { “formattedCitation” : “(18)”, “plainTextFormattedCitation” : “(18)”, “previouslyFormattedCitation” : “(18)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(18). The odds in smokers for attachment loss are increases, ranging from 2.05 in light smokers and 4.75 in heavy smokers ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISBN” : “0022-0337 (Print)\r0022-0337 (Linking)”, “ISSN” : “0022-0337”, “PMID” : “11336116”, “abstract” : “This article reviews the effects of smoked and smokeless tobacco on periodontal status, including the impact of smoking on periodontal therapy and potential mechanisms for the adverse effects of tobacco on the periodontium. Approximately half of periodontitis cases have been attributed to either current or former smoking. Both cigar and cigarette smokers have significantly greater loss of bone height than nonsmokers, and there is a trend for pipe smokers to have more bone loss than nonsmokers. Unlike smokers, who experience widespread periodontal destruction, the most prevalent effects of smokeless tobacco are localized to the site of placement, in the form of gingival recession and white mucosal lesions. Smoking has an adverse effect on all forms of periodontal therapy, and up to 90 percent of refractory periodontitis patients are smokers. The pathogenesis of smoking-related periodontal destruction has been attributed to alterations in the microflora and/or host response. Some data indicates that smoking may increase levels of certain periodontal pathogens, but there is more evidence that smoking has a negative effect on host response, such as neutrophil function and antibody production. An encouraging finding is that periodontal disease progression slows in patients who quit smoking and that these individuals have a similar response to periodontal therapy as nonsmokers. The facts presented in this paper will assist dental health professionals in treatment-planning decisions and provide them with important information to share with patients who use tobacco products.”, “author” : { “dropping-particle” : “”, “family” : “Johnson”, “given” : “G K”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Slach”, “given” : “N A”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of dental education”, “id” : “ITEM-1”, “issue” : “4”, “issued” : { “date-parts” : “2001” }, “page” : “313-321”, “title” : “Impact of tobacco use on periodontal status.”, “type” : “article-journal”, “volume” : “65” }, “uris” : “http://www.mendeley.com/documents/?uuid=0390a920-d80c-47a1-9d16-a8cffe1e6cff” } , “mendeley” : { “formattedCitation” : “(13)”, “plainTextFormattedCitation” : “(13)”, “previouslyFormattedCitation” : “(13)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(13).

GINGIVAL RECESSION:
Major effect of snuff on periodontium is the inter-dental attachment loss. Localized gingival recession is the primary and very prominent outcome of snuff dipping at the site of snuff placing. Adult populations who use snuff for long term suffer from periodontal pathologies. Generally gingival recession results in 25-30% of smokeless tobacco users ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Vikneshan”, “given” : “M”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “V”, “family” : “Ankola”, “given” : “Anil”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hiremath”, “given” : “Anand”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hebbal”, “given” : “Mamata”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Suganya”, “given” : “M”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “2”, “issued” : { “date-parts” : “2014” }, “page” : “64-69”, “title” : “Cavity- an Overview”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=5acd45bf-bb0f-485e-9087-854f99559f39” } , “mendeley” : { “formattedCitation” : “(17)”, “plainTextFormattedCitation” : “(17)”, “previouslyFormattedCitation” : “(17)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(17). Gingival recession rate increases 0.33mm/year of smokeless tobacco users 4. Gingival recession occur due to periodontal ligaments breakdown from exacerbated inflammatory responses due to smokeless tobacco. Mechanical trauma from smokeless tobacco use is also contributing to gingival recession ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Vikneshan”, “given” : “M”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “V”, “family” : “Ankola”, “given” : “Anil”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hiremath”, “given” : “Anand”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hebbal”, “given” : “Mamata”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Suganya”, “given” : “M”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “2”, “issued” : { “date-parts” : “2014” }, “page” : “64-69”, “title” : “Cavity- an Overview”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=5acd45bf-bb0f-485e-9087-854f99559f39” } , “mendeley” : { “formattedCitation” : “(17)”, “plainTextFormattedCitation” : “(17)”, “previouslyFormattedCitation” : “(17)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(17). Gingival recession is an irreversible process and can be prevented only not to use the tobacco products ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISSN” : “0002-8177 (Print)”, “PMID” : “2913100”, “author” : { “dropping-particle” : “”, “family” : “McCann”, “given” : “D”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of the American Dental Association (1939)”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2015” }, “page” : “18-25”, “title” : “Tobacco use and oral health.”, “type” : “article-journal”, “volume” : “211” }, “uris” : “http://www.mendeley.com/documents/?uuid=a1b6e5e3-76db-4a55-b8b8-f0ac78ebef33” } , “mendeley” : { “formattedCitation” : “(14)”, “plainTextFormattedCitation” : “(14)”, “previouslyFormattedCitation” : “(14)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(14). Gingival recession has high prevalence in smokers as well ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “ADHA”, “given” : “”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “American Dental Hygienists Association”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2010” }, “page” : “10-11”, “title” : “Want Some Life Saving Advice ?”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=6aecaf1f-354a-4afb-b87b-94ed7a0d8b8e” } , “mendeley” : { “formattedCitation” : “(19)”, “plainTextFormattedCitation” : “(19)”, “previouslyFormattedCitation” : “(19)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(19).

HALITOSIS:
Sulphur compounds which are volatile and present as a component in the smoke of tobacco is the cause of halitosis. Other causes for halitosis are hypo salivation and periodontal diseases ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.5835/jecm.omu.34.01.002”, “author” : { “dropping-particle” : “”, “family” : “Yavuz Y.”, “given” : “”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of Experimental and Clinical Medicine (Turkey)”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2013” }, “page” : “3-7”, “title” : “Journal of Experimental and Clinical Medicine (Turkey): Editorial.”, “type” : “article-journal”, “volume” : “34” }, “uris” : “http://www.mendeley.com/documents/?uuid=b9ff79cc-172a-4ab9-a488-87497cea37f7” } , “mendeley” : { “formattedCitation” : “(20)”, “plainTextFormattedCitation” : “(20)”, “previouslyFormattedCitation” : “(20)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(20). In the breath the concentration of volatile sulphur depends on the time at which last cigarette was smoked and its concentration can be detected with helimeter ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1922/IDJ”, “ISBN” : “0020-6539 (Print)\r0020-6539”, “ISSN” : “0020-6539”, “PMID” : “21302741”, “abstract” : “To evaluate the potential of two whitening toothpastes on stain removal, using two different spectrophotometeric devices.”, “author” : { “dropping-particle” : “”, “family” : “Kawashima”, “given” : “Nobuyuki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Wadachi”, “given” : “Reiko”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Suda”, “given” : “Hideaki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “International Dental Journal”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2009” }, “page” : “5-11”, “title” : “Root canal medicaments”, “type” : “article-journal”, “volume” : “59” }, “uris” : “http://www.mendeley.com/documents/?uuid=f5c59163-c89a-4b75-b684-aeb08b1ae7d7” } , “mendeley” : { “formattedCitation” : “(12)”, “plainTextFormattedCitation” : “(12)”, “previouslyFormattedCitation” : “(12)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(12). Cigarette smoking is the main cause for bad breath and xerostomia, these conditions leads to lower the ability of smell and taste ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Condition”, “given” : “Tobacco-associated”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Facts”, “given” : “Health”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Benefits”, “given” : “Cessation”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2013” }, “page” : “6-7”, “title” : “Oral Health Effects of Tobacco and Benefits of Quitting When counseling your patients on tobacco use , share these facts and cessation benefits to encourage them to quit .”, “type” : “article-journal”, “volume” : “6” }, “uris” : “http://www.mendeley.com/documents/?uuid=03e6bbbe-32e1-4241-9b01-06eb4333e024” } , “mendeley” : { “formattedCitation” : “(21)”, “plainTextFormattedCitation” : “(21)”, “previouslyFormattedCitation” : “(21)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(21). Recent studies have also shown an inverse relation of smoking and volatile sulphur concentration in 20 years old male population ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1922/IDJ”, “ISBN” : “0020-6539 (Print)\r0020-6539”, “ISSN” : “0020-6539”, “PMID” : “21302741”, “abstract” : “To evaluate the potential of two whitening toothpastes on stain removal, using two different spectrophotometeric devices.”, “author” : { “dropping-particle” : “”, “family” : “Kawashima”, “given” : “Nobuyuki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Wadachi”, “given” : “Reiko”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Suda”, “given” : “Hideaki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “International Dental Journal”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2009” }, “page” : “5-11”, “title” : “Root canal medicaments”, “type” : “article-journal”, “volume” : “59” }, “uris” : “http://www.mendeley.com/documents/?uuid=f5c59163-c89a-4b75-b684-aeb08b1ae7d7” } , “mendeley” : { “formattedCitation” : “(12)”, “plainTextFormattedCitation” : “(12)”, “previouslyFormattedCitation” : “(12)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(12).

LEUKOPLAKIA:
Leukoplakia is the formation of white patches and lesions on cheeks, gums, and tongue and is most common in smokeless tobacco users like snuff dippers. These patches are commonly seen at the site of placement/ dipping ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1158/1055-9965”, “abstract” : “Backgroundu2014This longitudinal study sought to identify groups of breast cancer survivors exhibiting distinct trajectories of depressive symptoms up to 24 months following diagnosis, and to describe characteristics associated with these trajectories. Methodsu2014653 women completed baseline questionnaires within 8 months of breast cancer diagnosis on patient characteristics, symptoms, and psychosocial variables. Depressive symptoms were assessed at baseline and 6, 12, and 18 months after baseline. Chart reviews provided cancer and treatment-related data. Finite mixture modeling identified trajectories of depressive symptoms measured with the Beck Depression Inventory (BDI). Resultsu2014Six distinct trajectories were identified. Just over half of the sample had consistently very low (3.8%) or low (47.3%) BDI scores well below the traditional BDI cut-point of 10 thought to be indicative of clinically significant depression; 29.2% had consistently borderline scores; 11.3% had initially high scores that declined over time, but remained above the cut-point; 7.2% showed increased BDI over time; and a small but unique group (1.1%) reported chronically high scores above 25. Women in groups with lower depressive symptom levels were older, had less rigorous chemotherapy, fewer physical symptoms (fatigue and pain), and lower levels of illness intrusiveness. Conclusionsu2014Approximately 20% of women had levels of depressive symptoms indicative of clinical depression that were maintained two years post-diagnosis. Factors related to trajectory membership such as illness intrusiveness, social support, fatigue, pain, and vasomotor symptoms suggest”, “author” : { “dropping-particle” : “”, “family” : “Avis”, “given” : “Nancy E.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Levine”, “given” : “Beverly J.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Case”, “given” : “Douglas J.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Naftalis”, “given” : “Elizabeth Z.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Zee Van”, “given” : “Kimberly J.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Cancer Epidemiol Biomarkers Prev.”, “id” : “ITEM-1”, “issue” : “11”, “issued” : { “date-parts” : “2015” }, “page” : “1789u20131795”, “title” : “Trajectories of Depressive Symptoms Following Breast Cancer Diagnosis”, “type” : “article-journal”, “volume” : “24” }, “uris” : “http://www.mendeley.com/documents/?uuid=5cf17487-b547-4f98-ba9b-c23586ab15d2” } , “mendeley” : { “formattedCitation” : “(11)”, “plainTextFormattedCitation” : “(11)”, “previouslyFormattedCitation” : “(11)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(11). Some of them can lead to oral cancer. These lesions can be diagnosed on the basis of size of lesion, histopathological condition, and persistency which last longer than 2-4 weeks. Smokers with leukoplakia and other pre cancer lesions have 5% cancer transformation rate. Cessation of smoking decreases the cases of leukoplakia as 36% ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISBN” : “0123456789”, “ISSN” : “1024-2708”, “PMID” : “12904615”, “abstract” : “OBJECTIVE: To review the effects of tobacco use on oral health, with particular emphasis on the effects of periodontal diseases, dental implant failures, and risk of development of oral cancers and precancers. DATA SOURCES: Medline literature search (1977-2002). STUDY SELECTION: Key words for the literature search were ‘tobacco smoking’, ‘periodontal disease’, ‘dental implant’, and ‘oral cancers and precancers’. DATA EXTRACTION: Evidence-based literature review. DATA SYNTHESIS: The prevalence and severity of periodontal diseases in their various forms are higher among smokers than among non-smokers. The success of dental implant treatments is significantly influenced by addiction to tobacco smoking. The failure rate of implant osseointegration is considerably higher among smokers, and maintenance of oral hygiene around the implants and risk of peri-implantitis are adversely affected by smoking. The risks of developing oral cancers and precancers are greater in smokers. Betel nut chewing and smokeless tobacco produce similar risk to cancer incidence as tobacco smoking. Cessation of tobacco use has a beneficial effect on halting the progression of periodontal diseases and on the outcome of periodontal therapy. CONCLUSIONS: Medical and dental teams should be aware of oral problems associated with tobacco use. Counselling on smoking cessation and smoking prevention programmes should be an integral component of medical and dental teaching and practice.”, “author” : { “dropping-particle” : “”, “family” : “Sham”, “given” : “a S K”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Cheung”, “given” : “L K”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Jin”, “given” : “L J”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Corbet”, “given” : “E F”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Hong Kong medical journal”, “id” : “ITEM-1”, “issue” : “4”, “issued” : { “date-parts” : “2003” }, “page” : “271-277”, “title” : “The Effects of Tobacco Use on Oral Health.”, “type” : “article-journal”, “volume” : “9” }, “uris” : “http://www.mendeley.com/documents/?uuid=7fb0e575-a672-4782-b84e-e181ad135ba3” } , “mendeley” : { “formattedCitation” : “(5)”, “plainTextFormattedCitation” : “(5)”, “previouslyFormattedCitation” : “(5)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(5).

ORAL CANCER:
In all of the malignant tumors of humans, oral cancer serves 5% and this is the majority of cases of head and neck region. Burgri Y et al has reported that prevalence of oral cancer is 4.1 per 100,000 in a year in male population while 4 per 100,000 in a year in female population. Mehrotra R and Singh M reported in their study that neoplasias of head and neck is the most common cancer in the India whereas oral cancer ranks on top 1st position in all of the neoplasias of the head and neck region. Oral cancer serves 3% of all of the cancers in United States ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Article”, “given” : “Original”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Jpmi”, “id” : “ITEM-1”, “issue” : “01”, “issued” : { “date-parts” : “2009” }, “page” : “28-34”, “title” : “Original Article Oral Cavity Cancers in North West Pakistan : a Hospital Based Study”, “type” : “article-journal”, “volume” : “23” }, “uris” : “http://www.mendeley.com/documents/?uuid=e2f32d53-788f-4117-95bf-03717e9d83b0” } , “mendeley” : { “formattedCitation” : “(9)”, “plainTextFormattedCitation” : “(9)”, “previouslyFormattedCitation” : “(9)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(9). Oral cancer serves the 3rd most common cancer among males and the 2nd common cancer among females in Pakistan. Both cigarette smoking and snuff dipping causes squamous cell carcinoma ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1002/(SICI)1097-0215(20000401)86:1<128::AID-IJC20>3.0.CO;2-M”, “ISBN” : “0020-7136”, “ISSN” : “00207136”, “PMID” : “10728606”, “abstract” : “Oral cancer is the second most common cancer in women and the third most common in men in Pakistan. Tobacco is smoked and chewed extensively in Pakistan. Paan is a quid of piper betel leaf that contains areca nut, lime, condiment, sweeteners, and sometimes tobacco, which is also used extensively. We did this study to clarify the independent association of paan and oral cancer. Between July 1996 and March 1998, we recruited biopsy-proven, primary cases of oral squamous-cell carcinoma, from 3 tertiary teaching centers in Karachi, Pakistan, and controls pair-matched for age, gender, hospital and time of occurrence, excluding persons with a past or present history of any malignancy. There were 79 cases and 149 controls. Approximately 68% of the cases were men, 49 years old on average, the youngest being 22 years old and the eldest 80. People with oral submucous fibrosis were 19.1 times more likely to develop oral cancer than those without it, after adjusting for other risk factors. People using paan without tobacco were 9.9 times, those using paan with tobacco 8.4 times, more likely to develop oral cancer as compared with non-users, after adjustment for other covariates. This study identifies an independent effect of paan without tobacco in the causation of oral cancer. Its findings may be of significance in South Asian communities where paan is used, and among health-care providers who treat persons from South Asia.”, “author” : { “dropping-particle” : “”, “family” : “Merchant”, “given” : “Anwar”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Husain”, “given” : “Syed S M”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hosain”, “given” : “Mervyn”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Fikree”, “given” : “Fariyal F.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Pitiphat”, “given” : “Waranuch”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Siddiqui”, “given” : “Amna Rehana”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hayder”, “given” : “Syed J.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Haider”, “given” : “Syed M.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Ikram”, “given” : “Mubashir”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Chuang”, “given” : “Sung Kiang”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Saeed”, “given” : “Shaikh A.”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “International Journal of Cancer”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2000” }, “page” : “128-131”, “title” : “Paan without tobacco: An independent risk factor for oral cancer”, “type” : “article-journal”, “volume” : “86” }, “uris” : “http://www.mendeley.com/documents/?uuid=b9f51a8c-af3f-42f6-9b6d-cf6fa64cf5ca” } , “mendeley” : { “formattedCitation” : “(22)”, “plainTextFormattedCitation” : “(22)”, “previouslyFormattedCitation” : “(22)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(22).

Tobacco smoking is a major risk factor for periodontitis, pre cancers, and oral cancers ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.5005/jp-journals-10015-1291”, “ISBN” : “0803356218”, “ISSN” : “09766006”, “abstract” : “Objectives: Cigarette smoking is recognized as the most important environmental risk factor in periodontitis and also an important risk factor for oral cancer. The aim of this study was to determine the prevalence of cigarette smoking and awareness of oral health problems of tobacco use among university students in Port Harcourt, Nigeria. Materials and methods: The study population consisted of 360 young adults: 188 (52.2%) males and 172 (47.8%) females. Participants answered questions regarding demography, smoking behavior, attitude and on oral effect of smoking. Data were analyzed using IBM SPSS (New York, USA) statistics version 20.0 and test of significance done using Chi-square. Results: The overall prevalence of smoking was 78 (21.7%): 52 (27.7%) in males and 26 (15.1%) in females. Males significantly smoked more than females (p = 0.002). Fifty-one (65.4%) of the current smokers commenced smoking in secondary school, 39 (50%) had smoked for 6 to 10 years, 54 (69.2%) consumed one to five sticks of cigarettes per day and among those who quitted smoking, 39 (52%) stopped smoking for health reasons. While 262 (72.8%) were ignorant that smoking was harmful to oral health, 223 (61.9%) and 278 (77.2%) respectively could not identify smoking as a risk factor for oral cancers and gum disease. Conclusion: Though majority of the students were aware of the negative impact of smoking on general health, most of them were ignorant of the effect on oral health. Therefore, shared risk approach should be employed to inform, guide and educate the public on the effects of tobacco and in the campaign against its use. u00a9 2014, Jaypee Brothers Medical Publishers (P) Ltd. All rights reserved.”, “author” : { “dropping-particle” : “”, “family” : “Omoigberai Bashiru”, “given” : “Braimoh”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Ayamma Udo”, “given” : “Umanah”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “World Journal of Dentistry”, “id” : “ITEM-1”, “issue” : “December”, “issued” : { “date-parts” : “2014” }, “page” : “209-212”, “title” : “Cigarette smoking and Awareness of Oral Health Problems of Tobacco use among Students at the University of Port Harcourt, South-South Nigeria”, “type” : “article-journal”, “volume” : “5” }, “uris” : “http://www.mendeley.com/documents/?uuid=09dcb186-cb65-4e96-a2a1-95d34a0a62b9” } , “mendeley” : { “formattedCitation” : “(4)”, “plainTextFormattedCitation” : “(4)”, “previouslyFormattedCitation” : “(4)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(4). Smoking leads in all of the causes of oral cancer. Smokers are at 5-10 times at higher risk to develop the oral cancer than non smokers. Cessation of smoking for 5 years decreases the risk up to half ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Condition”, “given” : “Tobacco-associated”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Facts”, “given” : “Health”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Benefits”, “given” : “Cessation”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2013” }, “page” : “6-7”, “title” : “Oral Health Effects of Tobacco and Benefits of Quitting When counseling your patients on tobacco use , share these facts and cessation benefits to encourage them to quit .”, “type” : “article-journal”, “volume” : “6” }, “uris” : “http://www.mendeley.com/documents/?uuid=03e6bbbe-32e1-4241-9b01-06eb4333e024” } , “mendeley” : { “formattedCitation” : “(21)”, “plainTextFormattedCitation” : “(21)”, “previouslyFormattedCitation” : “(21)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(21).

Smokeless tobacco contains 28 cancer causing chemicals ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Condition”, “given” : “Tobacco-associated”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Facts”, “given” : “Health”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Benefits”, “given” : “Cessation”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2013” }, “page” : “6-7”, “title” : “Oral Health Effects of Tobacco and Benefits of Quitting When counseling your patients on tobacco use , share these facts and cessation benefits to encourage them to quit .”, “type” : “article-journal”, “volume” : “6” }, “uris” : “http://www.mendeley.com/documents/?uuid=03e6bbbe-32e1-4241-9b01-06eb4333e024” } , “mendeley” : { “formattedCitation” : “(21)”, “plainTextFormattedCitation” : “(21)”, “previouslyFormattedCitation” : “(21)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(21). Tests have performed for smokeless tobacco on animals from which it comes to know that application of these products produces tumors. Carcinomas of smokeless tobacco users are mostly limited to the site where it is placed. Using moist snuff leads to the mutations, chromosomal aberration, and the sister chromatic exchange. Snuff dipping induces pre cancer lesions which may develop oral cancer.

Older Swedish studies found the relation of oral cancer with snuff dipping, although recent studies remain unsuccessful in showing any effect to develop cancer in the oral cavity as well as in the head and neck region. Although the Cohort study of Scandinavia and USA it is cleared that overall risk for smokers to develop oral cancer is higher than snuff dippers ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1016/j.lpm.2011.06.005”, “ISSN” : “0755-4982”, “PMID” : “21840161”, “abstract” : “The use of snus (smokeless tobacco) can be detrimental to health. Containing carcinogenic nitrosamines (Swedish snus do not contain nitrosamine). Snus delivers rapidly high doses of nicotine which can lead to dependence. It do not induce bronchial carcinoma differently smoked tobacco. Lesions usually develop in the area of the mouth where the snus is placed. Non-malignant oral lesions include leukoedema, hyperkeratotic lesions of the oral mucosa and localised periodontal disease. The most frequently occurring premalignant lesion is leukoplakia. Studies reveal conflicting evidence about the risk of oral and gastroesophageal cancer with regard to snus users. However, the use of snus has proved to be a risk factor in developing pancreatic cancer and increases the risk of fatal myocardial infarction and ischemic stroke. During pregnancy, snus is associated with an increased risk of pre-eclampsia and premature delivery. Nicotine substitution therapy and bupropion and varenicline reduce withdrawal symptoms and tobacco craving during snus cessation. However, they have not been shown to assist in long-term abstinence. Information concerning potential hazards of using snus products must be incorporated into health educational programmes in order to discourage its use. Snus is not a recommended product to help in stopping to smoke.”, “author” : { “dropping-particle” : “”, “family” : “Underner”, “given” : “Michel”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Perriot”, “given” : “Jean”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Peiffer”, “given” : “Gu00e9rard”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Presse Mu00e9dicale (Paris, France: 1983)”, “id” : “ITEM-1”, “issue” : “1”, “issued” : { “date-parts” : “2012” }, “page” : “3-9”, “title” : “Smokeless tobacco”, “type” : “article-journal”, “volume” : “41” }, “uris” : “http://www.mendeley.com/documents/?uuid=4bcc792b-ed28-4ec9-bae2-82d7597abcab” } , “mendeley” : { “formattedCitation” : “(23)”, “plainTextFormattedCitation” : “(23)”, “previouslyFormattedCitation” : “(23)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(23).

TOOTH ABRASION, MELANOSIS AND DENTAL STAINING:
Snuff dipping causes the teeth to stain and abrade it. Abrasion occurs due to the placement of snuff at a same and particular site in repetition or due to the chemical erosion. Melanosis and dental staining are rarely seen among snuff dippers. Staining of composite restorations is also seen among snuff dippers ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Vikneshan”, “given” : “M”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “V”, “family” : “Ankola”, “given” : “Anil”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hiremath”, “given” : “Anand”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hebbal”, “given” : “Mamata”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Suganya”, “given” : “M”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “2”, “issued” : { “date-parts” : “2014” }, “page” : “64-69”, “title” : “Cavity- an Overview”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=5acd45bf-bb0f-485e-9087-854f99559f39” } , “mendeley” : { “formattedCitation” : “(17)”, “plainTextFormattedCitation” : “(17)”, “previouslyFormattedCitation” : “(17)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(17).
Discoloration of teeth is also caused by smoking which stain the teeth black or brown, the restorations and the dentures, decreases the ability to taste and to smell and to produce black and hairy tongue also know as coated tongue ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Condition”, “given” : “Tobacco-associated”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Facts”, “given” : “Health”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Benefits”, “given” : “Cessation”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2013” }, “page” : “6-7”, “title” : “Oral Health Effects of Tobacco and Benefits of Quitting When counseling your patients on tobacco use , share these facts and cessation benefits to encourage them to quit .”, “type” : “article-journal”, “volume” : “6” }, “uris” : “http://www.mendeley.com/documents/?uuid=03e6bbbe-32e1-4241-9b01-06eb4333e024” } , “mendeley” : { “formattedCitation” : “(21)”, “plainTextFormattedCitation” : “(21)”, “previouslyFormattedCitation” : “(21)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(21), ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1922/IDJ”, “ISBN” : “0020-6539 (Print)\r0020-6539”, “ISSN” : “0020-6539”, “PMID” : “21302741”, “abstract” : “To evaluate the potential of two whitening toothpastes on stain removal, using two different spectrophotometeric devices.”, “author” : { “dropping-particle” : “”, “family” : “Kawashima”, “given” : “Nobuyuki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Wadachi”, “given” : “Reiko”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Suda”, “given” : “Hideaki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “International Dental Journal”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2009” }, “page” : “5-11”, “title” : “Root canal medicaments”, “type” : “article-journal”, “volume” : “59” }, “uris” : “http://www.mendeley.com/documents/?uuid=f5c59163-c89a-4b75-b684-aeb08b1ae7d7” } , “mendeley” : { “formattedCitation” : “(12)”, “plainTextFormattedCitation” : “(12)”, “previouslyFormattedCitation” : “(12)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(12). The oral mucosa and floor of the mouth as well as the soft palate suffer from smokers Melanosis which can be seen as irregular, diffuse and brownish pigmentation. Cigarette smoking stimulates melanocytes which then secretes melanin especially in dark people. In a recent Nigerian study it is concluded that the prevalence is higher in smokers than non smokers for smokers Melanosis and the number of sites affected totally depend on the duration and degree of smoking ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1922/IDJ”, “ISBN” : “0020-6539 (Print)\r0020-6539”, “ISSN” : “0020-6539”, “PMID” : “21302741”, “abstract” : “To evaluate the potential of two whitening toothpastes on stain removal, using two different spectrophotometeric devices.”, “author” : { “dropping-particle” : “”, “family” : “Kawashima”, “given” : “Nobuyuki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Wadachi”, “given” : “Reiko”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Suda”, “given” : “Hideaki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “International Dental Journal”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2009” }, “page” : “5-11”, “title” : “Root canal medicaments”, “type” : “article-journal”, “volume” : “59” }, “uris” : “http://www.mendeley.com/documents/?uuid=f5c59163-c89a-4b75-b684-aeb08b1ae7d7” } , “mendeley” : { “formattedCitation” : “(12)”, “plainTextFormattedCitation” : “(12)”, “previouslyFormattedCitation” : “(12)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(12). Cigarette smoking also causes Melanosis of gums ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Condition”, “given” : “Tobacco-associated”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Facts”, “given” : “Health”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Benefits”, “given” : “Cessation”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2013” }, “page” : “6-7”, “title” : “Oral Health Effects of Tobacco and Benefits of Quitting When counseling your patients on tobacco use , share these facts and cessation benefits to encourage them to quit .”, “type” : “article-journal”, “volume” : “6” }, “uris” : “http://www.mendeley.com/documents/?uuid=03e6bbbe-32e1-4241-9b01-06eb4333e024” } , “mendeley” : { “formattedCitation” : “(21)”, “plainTextFormattedCitation” : “(21)”, “previouslyFormattedCitation” : “(21)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(21). These effects decreases and disappears after the cessation of smoking ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1922/IDJ”, “ISBN” : “0020-6539 (Print)\r0020-6539”, “ISSN” : “0020-6539”, “PMID” : “21302741”, “abstract” : “To evaluate the potential of two whitening toothpastes on stain removal, using two different spectrophotometeric devices.”, “author” : { “dropping-particle” : “”, “family” : “Kawashima”, “given” : “Nobuyuki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Wadachi”, “given” : “Reiko”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Suda”, “given” : “Hideaki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “International Dental Journal”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2009” }, “page” : “5-11”, “title” : “Root canal medicaments”, “type” : “article-journal”, “volume” : “59” }, “uris” : “http://www.mendeley.com/documents/?uuid=f5c59163-c89a-4b75-b684-aeb08b1ae7d7” } , “mendeley” : { “formattedCitation” : “(12)”, “plainTextFormattedCitation” : “(12)”, “previouslyFormattedCitation” : “(12)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(12). After the cessation of cigarette smoking Melanosis disappears ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Condition”, “given” : “Tobacco-associated”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Facts”, “given” : “Health”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Benefits”, “given” : “Cessation”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2013” }, “page” : “6-7”, “title” : “Oral Health Effects of Tobacco and Benefits of Quitting When counseling your patients on tobacco use , share these facts and cessation benefits to encourage them to quit .”, “type” : “article-journal”, “volume” : “6” }, “uris” : “http://www.mendeley.com/documents/?uuid=03e6bbbe-32e1-4241-9b01-06eb4333e024” } , “mendeley” : { “formattedCitation” : “(21)”, “plainTextFormattedCitation” : “(21)”, “previouslyFormattedCitation” : “(21)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(21).

NICOTINE DEPENDENCE:
Different products of tobacco lead to nicotine dependence ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Health”, “given” : “Oral”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “0” }, “title” : “Health Consequences of Tobacco Use and the Impact on”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=81ab14e5-a252-46e3-9dbc-cc64f9109481” } , “mendeley” : { “formattedCitation” : “(15)”, “plainTextFormattedCitation” : “(15)”, “previouslyFormattedCitation” : “(15)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(15). Cessation of smoking is influenced by the number of cigarettes smoked in a day. It is reported that smokers who smoke heavily do not quit easily. The amount of nicotine in a cigarette dictates the cessation of smoking. In 2000 Colby et al reported that 20-68% of smokers who are adolescent can suffer with nicotine dependence, while quitting smoking can be predicted from the extent of nicotine dependence. The nicotine dependence is started from the very initial dose of nicotine. The evening time students of university can be easily addicted to smoke than the morning time students, while evening time students are easily be nicotine dependent ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISBN” : “9789521072499”, “abstract” : “ISBN 978-952-10-7249-9 ISBN 978-952-10-7250-5 Unigrafia Helsinki 2011 1 Abbreviations 4 Abstract 5 List of original publications 7”, “author” : { “dropping-particle” : “”, “family” : “Heikkinen”, “given” : “Anna Maria”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Meurman”, “given” : “Jukka H”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Koskenvuo”, “given” : “Markku”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Gustafsson”, “given” : “Anders”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Patja”, “given” : “Docent Kristiina”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Knuuttila”, “given” : “Matti”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “October”, “issued” : { “date-parts” : “2011” }, “title” : “Oral Health, Smoking and Adolescence”, “type” : “book” }, “uris” : “http://www.mendeley.com/documents/?uuid=5118658b-ef94-4425-b80b-494e275151a0” } , “mendeley” : { “formattedCitation” : “(24)”, “plainTextFormattedCitation” : “(24)”, “previouslyFormattedCitation” : “(24)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(24). Adolescent who smoke occasionally and not often also suffers from addiction of nicotine even at the very early stages of their smoking, and the most targeted age of users to have nicotine addiction is adolescence. The nicotine dependence of smokers can be treated with the nicotine replacement therapy ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISSN” : “1553-0205”, “PMID” : “16734993”, “abstract” : “PURPOSE: This pilot study assessed smoking-related behaviors, experiences, and beliefs among a sample of continuation high school students in California to inform dental hygienists about adolescent tobacco use and to assist with the development of effective tobacco cessation intervention strategies., METHODS: After gaining informed consent, we conducted a self-administered questionnaire among 117 adolescent volunteers in rural northern California. The questionnaire assessed demographic variables, lifetime tobacco use, current alcohol use and tobacco use status, early smoking experiences and sensations, factors that might motivate a quit attempt, depression index scores, and other psychosocial variables associated with adolescent smoking. Means and frequencies were generated to evaluate characteristics of tobacco use in this sample of adolescents. Variables of interest were stratified by regular and social smokers. Univariate association of smoking with alcohol use is described by an odds ratio with a 95% confidence interval. Wilcoxon rank sum tests were used to evaluate gender differences among mean depression index scores., RESULTS: Fifty percent of subjects were current smokers, 21% had tried smoking, 5% were former smokers, and 24% had never smoked. Current smokers were 8 times more likely to drink alcohol compared to nonsmokers (OR = 8.0; 95% CI 3.1 – 21.2). Among current smokers, 32% were classified as regular smokers and 18% as social smokers. Sixty-three percent of regular smokers and 42% of social smokers reported smoking within 30 minutes of waking, an indicator of nicotine dependence. Patterns of smoking were variable in rate and frequency ranging from 1 to 30 cigarettes per day. Current female smokers scored higher on the modified Beck Depression Inventory (0-3) than current male smokers (p < 0.001). Oral health issues related to tobacco use, such as gum disease and tooth staining, were identified as factors that might motivate a quit attempt. Frequently reported reasons for use (eg, tension and craving) and reasons for relapse (eg, desire remained high, withdrawal symptoms) were related to nicotine dependence. Fifty-three percent of all smokers had tried to stop smoking but were unsuccessful. Intrapersonal characteristics such as risk-taking, rebellion, and impulsive spending appeared to be related to smoking., CONCLUSION: In this sample of adolescents, smoking patterns were variable and many adolescents experienced symptoms of nicotine depeu2026”, “author” : { “dropping-particle” : “”, “family” : “Ellison”, “given” : “J”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Mansell”, “given” : “C”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Hoika”, “given” : “L”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “MacDougall”, “given” : “W”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Gansky”, “given” : “S”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Walsh”, “given” : “M”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of dental hygiene : JDH / American Dental Hygienists’ Association”, “id” : “ITEM-1”, “issue” : “2”, “issued” : { “date-parts” : “2006” }, “page” : “8”, “title” : “Characteristics of adolescent smoking in high school students in California.”, “type” : “article-journal”, “volume” : “80” }, “uris” : “http://www.mendeley.com/documents/?uuid=540d5ba2-7d2e-49c3-a4e2-a9710fe89bdc” } , “mendeley” : { “formattedCitation” : “(25)”, “plainTextFormattedCitation” : “(25)”, “previouslyFormattedCitation” : “(25)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(25).

All of the products of smokeless tobacco also have nicotine which leads to addiction ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1080/08858198709527882”, “ISSN” : “0885-8195”, “author” : { “dropping-particle” : “”, “family” : “Mashberg”, “given” : “Arthur”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of Cancer Education”, “id” : “ITEM-1”, “issue” : “3”, “issued” : { “date-parts” : “1987” }, “page” : “193-193”, “title” : “Smokeless Tobacco”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=a24aa656-47d0-40f9-9a09-6f741cb5ae2b” } , “mendeley” : { “formattedCitation” : “(2)”, “plainTextFormattedCitation” : “(2)”, “previouslyFormattedCitation” : “(2)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(2), ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Scientific Advisory Committee on Tobacco Products Regulation”, “given” : “”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “14”, “issued” : { “date-parts” : “2000” }, “page” : “9”, “title” : “Recommendation on Smokeless Tobacco Products”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=4dc9b0e3-8340-4304-a39c-4bcb5efc7e9b” } , “mendeley” : { “formattedCitation” : “(10)”, “plainTextFormattedCitation” : “(10)”, “previouslyFormattedCitation” : “(10)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(10). The amount of nicotine present in the 17 different brands to of moist snuff ranged between 0.47% dry wt to 3.43% which means 3.4 mg/g to 14.5 mg/g corresponding ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1080/08858198709527882”, “ISSN” : “0885-8195”, “author” : { “dropping-particle” : “”, “family” : “Mashberg”, “given” : “Arthur”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of Cancer Education”, “id” : “ITEM-1”, “issue” : “3”, “issued” : { “date-parts” : “1987” }, “page” : “193-193”, “title” : “Smokeless Tobacco”, “type” : “article-journal”, “volume” : “2” }, “uris” : “http://www.mendeley.com/documents/?uuid=a24aa656-47d0-40f9-9a09-6f741cb5ae2b” } , “mendeley” : { “formattedCitation” : “(2)”, “plainTextFormattedCitation” : “(2)”, “previouslyFormattedCitation” : “(2)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(2). Quitting to use smokeless tobacco products is also are also difficult as for smoking, however a person who smoke as well as use smokeless tobacco products are even more difficult to quit. Sellers and manufacturer of the tobacco products suggest smokeless tobacco products to users who are not allowed to smoke which leads a person t help in the adaptation of smokeless tobacco products along with smoking ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Scientific Advisory Committee on Tobacco Products Regulation”, “given” : “”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “14”, “issued” : { “date-parts” : “2000” }, “page” : “9”, “title” : “Recommendation on Smokeless Tobacco Products”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=4dc9b0e3-8340-4304-a39c-4bcb5efc7e9b” } , “mendeley” : { “formattedCitation” : “(10)”, “plainTextFormattedCitation” : “(10)”, “previouslyFormattedCitation” : “(10)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(10).

EFFECT OF CESSATION:
The percentage or number of smokers has decreased now a day than former smokers. Those people who quitted smoking cigarette before reaching at the age of 35 are having the same mortality rate as those who did not smoke ever. The nicotine replacement therapy increased the percentage of smoking cessation as 50%-70% which is easily available in the form of inhalator or nasal spray, gums, patches and mouth spray. Mobile apps are also available which helps to quit smoking ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Health”, “given” : “Oral”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “0” }, “title” : “Health Consequences of Tobacco Use and the Impact on”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=81ab14e5-a252-46e3-9dbc-cc64f9109481” } , “mendeley” : { “formattedCitation” : “(15)”, “plainTextFormattedCitation” : “(15)”, “previouslyFormattedCitation” : “(15)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(15).
Quitting smoking decreases the risk to develop oral cancers, pre cancer lesions, periodontal diseases, tooth loss, melanosis, and dental caries ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1922/IDJ”, “ISBN” : “0020-6539 (Print)\r0020-6539”, “ISSN” : “0020-6539”, “PMID” : “21302741”, “abstract” : “To evaluate the potential of two whitening toothpastes on stain removal, using two different spectrophotometeric devices.”, “author” : { “dropping-particle” : “”, “family” : “Kawashima”, “given” : “Nobuyuki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Wadachi”, “given” : “Reiko”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Suda”, “given” : “Hideaki”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “International Dental Journal”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2009” }, “page” : “5-11”, “title” : “Root canal medicaments”, “type” : “article-journal”, “volume” : “59” }, “uris” : “http://www.mendeley.com/documents/?uuid=f5c59163-c89a-4b75-b684-aeb08b1ae7d7” } , “mendeley” : { “formattedCitation” : “(12)”, “plainTextFormattedCitation” : “(12)”, “previouslyFormattedCitation” : “(12)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(12). Smoking induces irreversible process in the periodontium but after the cessation of smoking the process does not progress more ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISBN” : “0022-0337 (Print)\r0022-0337 (Linking)”, “ISSN” : “0022-0337”, “PMID” : “11336116”, “abstract” : “This article reviews the effects of smoked and smokeless tobacco on periodontal status, including the impact of smoking on periodontal therapy and potential mechanisms for the adverse effects of tobacco on the periodontium. Approximately half of periodontitis cases have been attributed to either current or former smoking. Both cigar and cigarette smokers have significantly greater loss of bone height than nonsmokers, and there is a trend for pipe smokers to have more bone loss than nonsmokers. Unlike smokers, who experience widespread periodontal destruction, the most prevalent effects of smokeless tobacco are localized to the site of placement, in the form of gingival recession and white mucosal lesions. Smoking has an adverse effect on all forms of periodontal therapy, and up to 90 percent of refractory periodontitis patients are smokers. The pathogenesis of smoking-related periodontal destruction has been attributed to alterations in the microflora and/or host response. Some data indicates that smoking may increase levels of certain periodontal pathogens, but there is more evidence that smoking has a negative effect on host response, such as neutrophil function and antibody production. An encouraging finding is that periodontal disease progression slows in patients who quit smoking and that these individuals have a similar response to periodontal therapy as nonsmokers. The facts presented in this paper will assist dental health professionals in treatment-planning decisions and provide them with important information to share with patients who use tobacco products.”, “author” : { “dropping-particle” : “”, “family” : “Johnson”, “given” : “G K”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Slach”, “given” : “N A”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of dental education”, “id” : “ITEM-1”, “issue” : “4”, “issued” : { “date-parts” : “2001” }, “page” : “313-321”, “title” : “Impact of tobacco use on periodontal status.”, “type” : “article-journal”, “volume” : “65” }, “uris” : “http://www.mendeley.com/documents/?uuid=0390a920-d80c-47a1-9d16-a8cffe1e6cff” } , “mendeley” : { “formattedCitation” : “(13)”, “plainTextFormattedCitation” : “(13)”, “previouslyFormattedCitation” : “(13)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(13).
A dentist advice to quit smoking is very fruitful for the overall health of the patient ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Use”, “given” : “Tobacco”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issue” : “November”, “issued” : { “date-parts” : “1999” }, “page” : “38-40”, “title” : “on the Prevalence and Severity”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=2cde9f4b-afb8-4d6b-986b-e3780524f619” } , “mendeley” : { “formattedCitation” : “(6)”, “plainTextFormattedCitation” : “(6)”, “previouslyFormattedCitation” : “(6)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(6). Dental related therapies are having poor prognosis if a patient continues to smoke. While for the achievement of oral health the cost will be increased for a better and intensive therapy. A patient who quit smoking at the very early stages will suffer less from financial burden ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “ISBN” : “0123456789”, “ISSN” : “1024-2708”, “PMID” : “12904615”, “abstract” : “OBJECTIVE: To review the effects of tobacco use on oral health, with particular emphasis on the effects of periodontal diseases, dental implant failures, and risk of development of oral cancers and precancers. DATA SOURCES: Medline literature search (1977-2002). STUDY SELECTION: Key words for the literature search were ‘tobacco smoking’, ‘periodontal disease’, ‘dental implant’, and ‘oral cancers and precancers’. DATA EXTRACTION: Evidence-based literature review. DATA SYNTHESIS: The prevalence and severity of periodontal diseases in their various forms are higher among smokers than among non-smokers. The success of dental implant treatments is significantly influenced by addiction to tobacco smoking. The failure rate of implant osseointegration is considerably higher among smokers, and maintenance of oral hygiene around the implants and risk of peri-implantitis are adversely affected by smoking. The risks of developing oral cancers and precancers are greater in smokers. Betel nut chewing and smokeless tobacco produce similar risk to cancer incidence as tobacco smoking. Cessation of tobacco use has a beneficial effect on halting the progression of periodontal diseases and on the outcome of periodontal therapy. CONCLUSIONS: Medical and dental teams should be aware of oral problems associated with tobacco use. Counselling on smoking cessation and smoking prevention programmes should be an integral component of medical and dental teaching and practice.”, “author” : { “dropping-particle” : “”, “family” : “Sham”, “given” : “a S K”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Cheung”, “given” : “L K”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Jin”, “given” : “L J”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Corbet”, “given” : “E F”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Hong Kong medical journal”, “id” : “ITEM-1”, “issue” : “4”, “issued” : { “date-parts” : “2003” }, “page” : “271-277”, “title” : “The Effects of Tobacco Use on Oral Health.”, “type” : “article-journal”, “volume” : “9” }, “uris” : “http://www.mendeley.com/documents/?uuid=7fb0e575-a672-4782-b84e-e181ad135ba3” } , “mendeley” : { “formattedCitation” : “(5)”, “plainTextFormattedCitation” : “(5)”, “previouslyFormattedCitation” : “(5)” }, “properties” : { }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }(5).

MATERIAL AND METHODS:
A cross sectional comparative was conducted to assess the use of two different forms of tobacco that is snuff and cigarette, and the oral health risks of the use of these products among male population visiting a tertiary care hospital LRH Peshawar from February to May 2018. Permission was taken from the undergraduate research committee of IPMS and then from the administration of LRH Peshawar. The sample size selected was 162 with the justification and calculations. Convenient sampling technique was used to achieve the exact sample size. Participants were first informed about the aims and objectives of the study. All of the volunteer males who used to smoke cigarette and/or were snuff dippers, were examined and took history and relevant data from them. Subjects who refused to participate in the study, diabetic patients, stomach patients, mentally retarded patients, and children were excluded from the study.
A proforma was used to collect data and record all of the related information like demographic data, type of tobacco used/consumed, the number of snuff dipped per day or the number of cigarette smoked per day, the time from which they started using tobacco products, brushing habits, and the related risks and effects of using tobacco products on the oral cavity. While taking history the questions and the given options were read to the subjects who were illiterate and who did not understand English language. The clinical examination of the oral cavity including the soft and hard tissues was conducted using sterilized examination instruments with special consideration given to infection control/cross infections. The examination of the oral cavity was conducted for the assessment of the snuff dipping and/or cigarette smoking like gingivitis, periodontitis, gingival recession, dental staining, melanosis, dental caries, pre cancer lesions, and oral cancer. Participants were examined while seated on the dental chair under the light of dental unit. The recorder were seated close to the participant so that she could easily heard and the examiner could easily see what has actually recorded was right or wrong. Oral examination was conducted by a single examiner wearing examination gloves and was correctly and uniformly examined starting from maxilla down to the mandibular region. The palpation of soft tissue with the help of gloved fingers, and the mouth mirror, dental probe and twizer were used for the inspection of oral cavity. The obtained data were putted and analyzed on SPSS version 22.

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