Prevalence of tobacco use has declined in some high-income countries but continues to increase in low- and middle-income countries, especially among young people and women. Undoubtedly, the increasing number of smokers and smokeless tobacco users among young people in different areas of the world will considerably affect the general and oral health of future generations. The prevalence of tobacco use in most countries is the highest amongst people of low educational background and among the poor and marginalized people.
Risks to oral health and intervention
Tobacco use is a major preventable cause of premature death and of several general diseases. In addition, cigarette, pipe, cigar and bidi smoking, betel quid chewing (pan), guhtka use and other traditional forms of tobacco have several effects in the mouth. Tobacco is a risk factor for oral cancer, oral cancer recurrence, adult periodontal diseases and congenital defects such as cleft lip and palate in children. Tobacco suppresses the immune system’s response to oral infection, compromises healing following oral surgical and accidental wounding, promotes periodontal degeneration in diabetics and adversely affects the cardiovascular system. Moreover, tobacco greatly increases the risk when used in combination with alcohol or areca nut. Most oral consequences of tobacco use impair quality of life be they as simple as halitosis, as complex as oral birth defects, as common as periodontal disease or as troublesome as complications during wound healing.
The WHO Oral Health Programme aims to control tobacco-related oral diseases and adverse conditions through several strategies. Within WHO, the Programme forms part of the WHO tobacco-free initiatives, with fully integrated oral health-related programmes. Externally, the Programme encourages the adoption and use of WHO tobacco-cessation and control policies by international and national oral health organizations. Primary partners are WHO Collaborating Centres in Oral Health and NGOs who are in official relations with WHO, i.e. the International Association for Dental Research (IADR) and the FDI World Dental Federation. A number of projects have been initiated in Canada, European Union countries, Japan, New Zealand and the United States, and more programmes are being considered in India and China.
There are several ethical, moral, and practical reasons why oral health professionals should strengthen their contributions to tobacco-cessation programmes, for example:
- They are especially concerned about the adverse effects in the oropharyngeal area of the body that are caused by tobacco practices.
- They meet, on a regular basis, children, youth and their caregivers, thus providing opportunities to influence individuals to entirely avoid, postpone initiation or quit using tobacco before they become strongly dependent.
- They often have more time with patients than many other clinicians, providing opportunities to integrate education and intervention.
- They often treat women of childbearing age, thus are able to inform such patients about the potential harm to their babies from tobacco use.
- They are as effective as other clinicians in helping tobacco users quit and results are improved when more than one discipline assists individuals during the quitting process.
- They can build their patient’s interest in discontinuing tobacco use by showing actual tobacco effects in the mouth.
The tobacco-related goal of the WHO Oral Health Programme is to ensure that oral health teams and oral health organizations are directly, appropriately and routinely involved in influencing patients and the public at large to avoid and discontinue the use of all forms of tobacco.
The aim of cancer control is a reduction in both the incidence of the disease and associated morbidity and mortality. This requires not only knowledge of the natural history of the disease but also an understanding of the underpinning social, economic and cultural factors. Screening and early detection can save lifes. Several developed and developing countries are in the process of implementing cancer prevention programmes, including oral cancer prevention. It is essential to educate people to recognize the early signs and symptoms of oral cancer. Particularly in developing countries, primary health care workers trained in the detection of oral cancer will become a considerable force for prevention through early detection and health promotion to raise awareness in the community. An effective referral system must be identified to ensure vital actions are taken.
The WHO Oral Health Programme supports the inclusion of oral cancer prevention as part of national cancer control programmes, based on careful planning, monitoring and evaluation, and partnership-building.