[Sacamuelas]

Spent last Friday in a continuing education seminar on Oral/pharyngeal carcinoma. The speaker was the dean of oral pathology at Louisiana State University medical center.

Just wanted to point out some of the interesting findings this Professor has arrived at concerning dip/snuff/chew. I know some of you have been in the process of quitting.

Oral cancer is extremely rare in smokeless tobacco users that do not smoke/drink alcohol on a regular basis.

In one study by Smith and Mincer(Univ. of TN dept. of pathology) which followed 15,500 patients for a full 20 years of follow-up, only 2 (TWO) cases of oral cancer were diagnosed. This actually relates to a lower than average oral cancer rate when compared with the general population. It "could" be said that this study proves that smokeless tobacco could even prevent oral cancer.

No longer do the words that I learned, " Its not a matter of if you will get cancer, but WHEN you will get cancer if you continue to dip", stand true. It appears that some of the hype may not be correct.

One of the most dramatic and particularly well-designed studies that actually does show a direct correlation with cancer and smokeless tobacco was done by a NIH scientist by the name of Debra Winn. She studied female users that ALL had 50+ years of tobacco use. She found that there was a marked increase of oral CA (13-48x more likely). However, even she derived during her research that it took on average at least 40 years of smokeless tobacco for CA to develop. That is why she designed her study to focus on the population that it did. Again, to achieve her remarkable cancer causing stats her study focused only on individuals 50+ yrs of use, which makes it difficult if not impossible to correlate the results with the general population.

This new information drastically differs from what most of us have been told and taught. From the CE, I have noted a few key points that ought to be recognized by practitioners.

1. On average it takes 40 years of use to cause cancer solely due to smokeless tobacco

2. The cancer found is almost exclusively low grade (less aggressive form).

3. Smokeless tobacco is a very mild carcinogen, if at all.

4. Oral cancer involves many cofactors of etiology, smokeless tobacco is just one of the players (a minor one at that). The major ones are alcohol and smoking.

5. Patients do however get oral lesions if they use. On average, 53 % of patients will get an oral lesion of some type (usually a superficial inflammatory reaction that causes thickening of the mucosal epithelium). Most common appearance is a white (leukoplakia) lesion right where the patient places the snuff in his mouth.

6. Its use will cause gingival recession and periodontal problems in the chronic placement areas associate with dip.

7. It has been shown to be associated with a LOWER caries (cavity) rate than in non-users in the same population class.

8. The lesions that are to be considered high risk are almost all red/white mixed or red in apperance. These require biopsy without delay.

Some things I advise my patients of if they are users....

1. I don't dip, and don't plan to start even though it is not as "cancerous" as we initially thought
2. If you use, you should still quit for overall oral health.
3. It can still cause you trouble with your teeth/gums/breath
4. Extreme long-term usage could still cause cancer
5. Do NOT start smoking just to help you stop dipping. Smoking is statistically much worse for you.
6. Most of the lesions associated with dipping appear cancerous but do not histologically progress to carcinoma. Biopsy of particularly “mean� ones is still necessary though.


I thought it was interesting info for some of you. Especially with how commonly we face this in practice.