Tobacco smoking and surgical healing

[Anonymous]

It is believed that the crew of Columbus had introduced tobacco from the ‘American India’ to the rest of the world, and tobacco was attributed as a medicinal plant. It was often used to avert hunger during long hours of work. But in reality, tobacco causes various ill effects including pre-malignant lesions and cancers. This article aims at reviewing the literature pertaining to the effect of tobacco smoking upon the outcome of various surgical procedures performed in the oral cavity.
Tobacco affects postoperative wound healing following surgical and nonsurgical tooth extractions, routine maxillofacial surgeries, implants, and periodontal therapies. In an experimental study, bone regeneration after distraction osteogenesis was found to be negatively affected by smoking. Thus, tobacco, a peripheral vasoconstrictor, along with its products like nicotine increases platelet adhesiveness, raises the risk of microvascular occlusion, and causes tissue ischemia. Smoking tobacco is also associated with catecholamines release resulting in vasoconstriction and decreased tissue perfusion. Smoking is believed to suppress the innate and host immune responses, affecting the function of neutrophils – the prime line of defense against infection. Thus, the association between smoking and delayed healing of oral tissues following surgeries is evident. Dental surgeons should stress on the ill effects of tobacco upon the routine postoperative healing to smoker patients and should aid them to become tobacco-free.

        

[drsushant]

Smokers may be more vulnerable to diseases, in addition to developing diseases from smoking.

A new study explains that smoking forces the body to fight against helpful bacteria that serve to eliminate some harmful germs. The information appears in the journal Infection and Immunity.

The reason for this is based on the fact that the mouth of a nonsmoker contains an ecosystem of healthy bacteria. This type of ecosystem doesn’t exist for nonsmokers, opening the possibility of being susceptible to some dangerous bacteria.

A research team at Ohio State University, led by Assistant Professor of Periodontology Purnima Kumar, is investigating the impact of bacteria on oral disease. Based on the research, dentists may have to be more of a factor in treating smokers.

The team studied the way the ecosystem of the mouth was affected after removing various bacteria. To compile the data, 15 nonsmokers and 15 smokers were studied. The researchers were looking for two specific things: (1) which bacteria were present after analyzing the DNA signatures in dental plaque and (2) whether or not the person’s body viewed the bacteria a threat.

Smokers also have a higher amount of cytokines, which means the body is preparing to fight infection. The result is red, swollen gums or gingivitis, which can develop into periodontitis.

The mouth of the smoker is not just trying to combat harmful bacteria. Their bodies were treating the helpful bacteria as harmful as well. The research team hasn’t fully grasped why this happens, but the assumption is that smoking is confusing the relationship between the human host and the bacterial community.

        

[Drsumitra]

The Kerala Government has imposed a blanket ban on the manufacturing and sale of gutka/pan masala in the state. Kerala has thus become the second State in the country after Madhya Pradesh to ban gutka products.

Chief Minister Oommen Chandy said the State Government had enforced the ban on gutka/pan masala under the provisions of Food Safety and Standards Regulation Act, 2011.

The increasing incidence of gutka-induced diseases like oral cancer prompted the Government to take such a decision. The Union Ministry of Health & Family Welfare had, in April this year, informed the state government that States had the jurisdiction to ban gutka/pan masala under the Food Safety and Standards Regulation Act, 2011.

The health department initiated steps immediately in this regard following this and the notification banning gutka/pan masala in Kerala was issued by Commissioner of Food Safety, Kerala on May 22.

The ban prohibits the manufacture, storage, distribution and sale of products that contain tobacco and nicotine, in whatsoever name it is available in the market. The ban on gutka/pan masala follows a string of proactive initiatives taken by the Kerala Government for tobacco control.

 

        

[drsushant]

Researchers at Weill Cornell Medical College have developed and successfully tested in mice an innovative vaccine to treat nicotine addiction.
In the journal Science Translational Medicine, the scientists describe how a single dose of their novel vaccine protects mice, over their lifetime, against nicotine addiction. The vaccine is designed to use the animal’s liver as a factory to continuously produce antibodies that gobble up nicotine the moment it enters the bloodstream, preventing the chemical from reaching the brain and even the heart.
"As far as we can see, the best way to treat chronic nicotine addiction from smoking is to have these Pacman-like antibodies on patrol, clearing the blood as needed before nicotine can have any biological effect," says the study’s lead investigator, Dr. Ronald G. Crystal, chairman and professor of Genetic Medicine at Weill Cornell Medical College.
"Our vaccine allows the body to make its own monoclonal antibodies against nicotine, and in that way, develop a workable immunity," Dr. Crystal says.
Previously tested nicotine vaccines have failed in clinical trials because they all directly deliver nicotine antibodies, which only last a few weeks and require repeated, expensive injections, Dr. Crystal says. Plus, this kind of impractical, passive vaccine has had inconsistent results, perhaps because the dose needed may be different for each person, especially if they start smoking again, he adds.
"While we have only tested mice to date, we are very hopeful that this kind of vaccine strategy can finally help the millions of smokers who have tried to stop, exhausting all the methods on the market today, but find their nicotine addiction to be strong enough to overcome these current approaches," he says. Studies show that between 70 and 80 percent of smokers who try to quit light up again within six months, Dr. Crystal adds.
About 20 percent of adult Americans smoke, and while it is the 4,000 chemicals within the burning cigarette that causes the health problems associated with smoking — diseases that lead to one out of every five deaths in the U.S. — it is the nicotine within the tobacco that keeps the smoker hooked.
A New Kind of Vaccine
There are, in general, two kinds of vaccines. One is an active vaccine, like those used to protect humans against polio, the mumps, and so on. This kind of vaccine presents a bit of the foreign substance (a piece of virus, for example) to the immune system, which "sees" it and activates a lifetime immune response against the intruder. Since nicotine is a small molecule, it is not recognized by the immune system and cannot be built into an active vaccine.
The second type of vaccine is a passive vaccine, which delivers readymade antibodies to elicit an immune response. For example, the delivery of monoclonal (identically produced) antibodies that bind on to growth factor proteins on breast cancer cells shut down their activity.
The Weill Cornell research team developed a new, third kind — a genetic vaccine — that they initially tested in mice to treat certain eye diseases and tumor types. The team’s new nicotine vaccine is based on this model.
The researchers took the genetic sequence of an engineered nicotine antibody, created by co-author Dr. Jim D. Janda, of The Scripps Research Institute, and put it into an adeno-associated virus (AAV), a virus engineered to not be harmful. They also included information that directed the vaccine to go to hepatocytes, which are liver cells. The antibody’s genetic sequence then inserts itself into the nucleus of hepatocytes, and these cells start to churn out a steady stream of the antibodies, along with all the other molecules they make.
In mice studies, the vaccine produced high levels of the antibody continuously, which the researchers measured in the blood. They also discovered that little of the nicotine they administered to these mice reached the brain. Researchers tested activity of the experimental mice, treated with both a vaccine and nicotine, and saw that it was not altered; infrared beams in the animals’ cages showed they were just as active as before the vaccine was delivered. In contrast, mice that received nicotine and not treated with the vaccine basically "chilled out" — they relaxed and their blood pressure and heart activity were lowered — signs that the nicotine had reached the brain and cardiovascular system.
The researchers are preparing to test the novel nicotine vaccine in rats and then in primates — steps needed before it can be tested ultimately in humans.
Dr. Crystal says that, if successful, such a vaccine would best be used in smokers who are committed to quitting. "They will know if they start smoking again, they will receive no pleasure from it due to the nicotine vaccine, and that can help them kick the habit," he says.
He adds that it might be possible, given the complete safety of the vaccine, to use it to preempt nicotine addiction in individuals who have never smoked, in the same way that vaccines are used now to prevent a number of disease-producing infections. "Just as parents decide to give their children an HPV vaccine, they might decide to use a nicotine vaccine. But that is only theoretically an option at this point," Dr. Crystal says. "We would of course have to weight benefit versus risk, and it would take years of studies to establish such a threshold."
"Smoking affects a huge number of people worldwide, and there are many people who would like to quit, but need effective help," he says. "This novel vaccine may offer a much-needed solution."
The study was funded by the National Institutes of Health, the National Foundation for Cancer Research, and the Malcolm Hewitt Wiener Foundation.
The Cornell Center for Technology Enterprise and Commercialization, on behalf of Cornell University, has filed patent applications on the work described in this study.
Other study co-authors are Dr. Martin J. Hicks, Dr. Jonathan B. Rosenberg, Dr. Bishnu P. De, Dr. Odelya Pagovich, Dr. Jian-ping Qiu, Dr. Stephen M. Kaminsky, Dr. Neil R. Hackett, and Dr. Stefan Worgall from Weill Cornell Medical College, and Dr. Colin N. Young and Dr. Robin L. Davisson from Cornell University.

 

        

[Drsumitra]

if you’ve recently been diagnosed as needing a root canal treatment, it may be comforting to know that you’re not alone. Like you, it’s estimated that about half of the adult population in the U.S. will need a root canal treatment by the age of 50.
The good news is if you don’t smoke you can avoid increasing your chances of needing a root canal. If you do smoke, you may be surprised to learn about the recent dental health findings at Boston University’s Goldman School of Dental Medicine. Studies there revealed that your gender, how much you smoke and how long you’ve been smoking can significantly multiply your need for root canal treatment.
Are Men More Vulnerable?
Poets, musicians and humorists have long opined the differences between men and women. How the sexes are dissimilar will always be hotly debated, but one thing is certain: Men and women are distinctly different when it comes to dental health.
A survey revealed that men of all ages are more likely than women to develop cavities, periodontal disease and oral cancer; smoking puts men at twice the risk over women. Smoking also doubles the need for root canals in men.
"Our study has shown that men have almost twice the risk of having root canal treatments if they smoke cigarettes, compared to men who never smoke," said Elizabeth Krall Kaye, author of the Boston University study and professor in the department of health policy and health services.
So does that mean women are in the clear? Not really, says Kaye. Historically, women haven’t smoked as long or as much per day as men but Kaye believes that the risk associated with smoking and root canals still applies.
Why smoking makes men and women more susceptible to dental problems that require root canal treatment is still somewhat of a mystery. Kaye and her associates think the answers lie in what smoking does to your overall health: It affects your ability to ward off infection, increases inflammation and damages your circulation system.
Why Time Matters
If you recently picked up the habit of smoking, you may be at lower risk for root canals — but don’t let that fool you into thinking you’re safe. The likelihood that a "newbie" smoker will need a root canal is still 20 percent greater than a non-smoker. Smoking for 4-12 years doubles the risk. But the most vulnerable are long-time smokers or anyone who has smoked for 12 or more years; the chances of needing a root canal then jumps to a whopping 120 percent more than non-smokers!
Fortunately, you can greatly reduce your need for root canals by quitting cigarette smoking and staying smoke-free. In fact, if you stay smoke-free for at least nine years, your chances of needing a root canal treatment can drop as low as a non-smoker’s.
Rely on Your Dentist
It’s important to remember that your dentist is the one person who can help you maintain good oral health even if you smoke. So don’t shy away from your dentist if you’re a smoker; dentists want to help you, not judge you. With regular dental visits and dental cleanings, your dentist can monitor your dental health and help alleviate some of the consequences of smoking.
Even better, if you need help quitting, your dentist is a great person to turn to for advice. He or she may be able to provide smoking cessation products such as nicotine patches or can help refer you to effective smoking cessation programs or clinics. If you don’t have a dentist, let us help find you one.

 

        

[drmithila]

A ban on gutkha, the popular chewing tobacco held responsible for the high incidence of oral cancer in India, is spreading across the populous country. Numerous courts are now supporting the movement.
Tobacco has been chewed in India for centuries and in the past decade, gutkha has emerged as the chewing tobacco of choice.
Ready-packaged in small sachets, gutkha is a commercially produced mixture of crushed areca nut, tobacco, lime, paraffin and other “secret” ingredients. Some brands also contain lead, arsenic, chromium, nickel and cadmium.
Because of its sweet or chocolate-like flavor and dirt-cheap prices – as low as 2 euro cents per sachet – gutkha has become increasingly popular among children who chew and even eat it.
More chew than smoke
In fact, five million Indian children are already addicted to gutkha, with another 5,000 joining their ranks everyday, according to an Indian Health Ministry report. Many try it for the first time as early as age five.
Gutkha is cheap, as little as two euro cents
Overall, more tobacco is chewed than smoked in India. Last year, the Global Adult Tobacco Survey (GATS) reported that 26 percent of adult Indians were tobacco chewers while 14 percents were smokers. One-third of Indian men and one-fifth of women users were addicted to chewing tobacco, most of them to gutkha, according to survey.
To make its shelf-life longer, some producers add magnesium carbonate, which is used in fire extinguishers and is also a known carcinogen.
Among more than 3,000 chemical components found in the tobacco products, including gutkha, at least 28 were proved to be carcinogenic, according to oncologist Sharadwat Mukherjee.
A cause of cancer and other diseases
“Every year, more than 80,000 cases of oral cancer are reported in India and rising use of gutkha is the key reason behind the spurt of the disease,” Mukherjee told DW. “More than 90 percent of oral cancer cases are directly associated with the use of tobacco and India has the highest prevalence of oral cancer globally – even 12 to 13-year-old children are getting pre-cancerous growths in their mouth after two or three years of chewing it.”
Five million Indian children are already addicted to gutkha
Mukherjee added that gutkha was also triggering a host of other cardiovascular, gastrointestinal and even psychological diseases.
When the chewing tobacco was introduced to the market in the 1990s, its producers said it was a palate cleanser or mouth freshener. The product was also identified as a foodstuff.
In August 2011, India’s Food Safety and Standard Authority issued a regulation banning nicotine or tobacco in foodstuffs, including gutkha.
Several medical experts and non-government organizations have mounted a country-wide campaign lobbying for a blanket ban on the manufacture and sale of gutkha across the country.
Calls for nation-wide ban
In April 2011 Madhya Pradesh became the first Indian state to ban gutkha. With the states of Andhra Pradesh and Odisha joining the ban earlier this month, the manufacture and sale of the chewing tobacco has now been prohibited in 17 of India’s 28 states and three of the seven union territories (UTs), including New Delhi.
Anti-gutkha activist dentist Debjit Ray told DW that although the tobacco product was banned in Bihar, Jharkhand and Odisha, it was still being sold secretly in all three states. He said the product was smuggled from the adjacent West Bengal state, where it was still legal.
“A ban in only part of the country is of no help at all; all states and UTs where gutkha is not yet banned should cooperate and ban it immediately,” said Ray, who is based in Kolkata, the capital of West Bengal. “Gutkha chewers spit just everywhere and spread many infectious diseases. Gutkha stains make public places look awfully ugly.”
Gutkha is mix of tobacco and a handful of unhealthy substances
Anti-gutkha activists in West Bengal have long demanded a ban on the chewing tobacco but the state government has yet to act. Earlier this month, they took their demand to the High Court in Kolkata, which last week criticized the West Bengal government for not banning the product.
Money talks
The state, according to the court, is more eager in generating revenue from the sale of gutkha than in ending the health risks it causes thousands of people.
“We hope the court will order the government to immediately ban gutkha in the state at the hearing next month,” said Ray.
Although gutkha sachets display a warning that the product causes cancer, most people ignore the health risks, according to the dentist. “Unless gutkha is banned and actually made unavailable in the market across the whole country,” he said, “you cannot stop people from chewing it.”

        

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