Nicotine - Oral Health

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Are alternative nicotine products safer than smoking? Can switching to alternative products improve oral health?


ENDS NVP ANDS E-Cigarettes

2024: E-cigarettes and heated tobacco products impact on dental color parameters

  • Conclusion: "Exclusive use of ECs and HTPs is associated with better dental color measurements than current smoking, suggesting that tar-free nicotine delivery technologies are unlikely to have negative effects on dental appearance."

2023: The risk profile of electronic nicotine delivery systems, compared to traditional cigarettes, on oral disease: a review

  • Relevant studies indicated that patients using ENDS have better preservation of alveolar bone height compared with traditional smokers.
  • Overall, ENDS appear to be more implant-friendly than conventional tobacco cigarettes
  • Many of the carcinogens present in tobacco are not present in the aerosol generated by ENDS, which makes ENDS appear to be less damaging to the oral mucosa.

2023: The impact of electronic and conventional cigarettes on periodontal health—a systematic review and meta-analysis

  • "The current findings suggest that e-cigarette use might be considered a healthier alternative to cigarette smoking concerning periodontal health. Even so, harmful effects of electronic nicotine delivery system (ENDS) usage on periodontal health were seen as well. However, a definitive decision on this research question remains elusive due to the absence of randomized controlled trials."

2023: Is vaping harmful to oral health?

  • "In summary, the oral health evidence supports the general public health messages and guidance on e-cigarettes. E-cigarette use is far less harmful than tobacco cigarettes, although not risk free – we will likely see oral health consequences of long-term vaping (but less than from tobacco smoking). E-cigarettes are not recommended for non-users, especially young people. For existing smokers, e-cigarettes can be an effective quit aid and dental professionals should support patients who choose to use this method of cessation."

2022: Electronic cigarettes: an update on products, regulation, public health approaches and oral health

  • Regulatory approaches vary considerably around the world but in the UK and Europe, e-cigarettes are regulated as consumer or medicinal product, and their use is permitted. In the UK, e-cigarettes have increasingly been supported by public health institutions for smoking cessation as part of a Tobacco Harm Reduction strategy.
  • The potential harms (including to oral health) from e-cigarette use are likely to be much less than from tobacco cigarettes.

2022: Vaping and oral health – an update for the dental team

  • In summary, e-cigarettes have good evidence to support them as an effective smoking cessation aid for tobacco smokers. Smokers can expect to see substantial improvements in their oral health if they fully switch to an e-cigarette. Longer-term use is a balanced judgement between smoking relapse prevention against the small risk of any detrimental effects from the e-cigarettes themselves.

2022: Electronic Cigarette Use Promotes a Unique Periodontal Microbiome

  • Our results demonstrate that the e-cig user’s subgingival microbiome is a unique amalgamation of microbiota, containing similarities to those of both conventional smokers and nonsmokers. Due to many shared features with the conventional smoker’s microbiome and considering the widespread promotion of e-cigarettes as a “healthier” alternative to or replacement for conventional cigarettes, our results show that e-cigarette use may promote a healthier SGP [subgingival plaque] microbiome with respect to that of smokers but not compared to that found with never smoking in the first place.

2022: Expert reaction to study looking at smoking, vaping and oral health

  • “They also reported an association between e-cigarette use and self-reported bleeding gums after brushing or flossing. The study authors themselves urge caution on over-interpreting this finding (see discussion section) – this may not be a direct effect of e-cigarette use and may be a result of users reducing or quitting regular cigarette smoking which is known to lead to increased bleeding. It’s an interesting finding that needs exploring in further research.
  • “The study did not find any association between e-cigarette use and any other oral health outcomes investigated (such as gum disease or tooth loss). As proposed in this paper, further follow up studies looking at the longer-term outcomes of e-cigarettes will be useful to explore this further.”

2021: Electronic Cigarettes and Oral Health

  • However, for smokers with existing oral diseases, the major benefits of quitting tobacco smoking are likely to outweigh any negative impacts from e-cigarette use, particularly over the short term. Hence, if a smoker is keen to use an e-cigarette as part of a quit attempt, we consider (according to currently available evidence) that they should not be discouraged from doing so based on oral health concerns.

2020: Expert sounds alarm on oral cancer

  • A dental expert urged smokers to switch to electronic cigarettes (e-cigs) and heated tobacco products (HTPs) as a “harm reduction measure,” saying smoking is the leading cause of oral cancer. “We warn our patients who are smokers that smoking is the leading cause of oral cancer and strongly advise them to quit smoking. For those who cannot or do not want to quit smoking by themselves or with currently approved methods, we convince them to switch to non-combustible alternatives,” said Fernando Fernandez, president of the Philippine College of Oral and Maxillofacial Surgeons (Pcoms) during the Scientific Conversations on Tobacco Harm Reduction held recently at the Shangri-La at the Fort in Taguig City.

2020: Consensus statement from several health organizations, including the Dental Health Foundation of Ireland

  • “As the vapour from e-cigarettes does not contain tobacco combustion products such as tar, which have been proven to be responsible for most of the adverse health effects of smoking, the HSE, which implements the tobacco control policy developed by the Department of Health, holds that e-cigarettes are not risk-free but are a potentially safer alternative for individuals who may find it difficult to stop using tobacco.”

2019: Influence of Electronic Cigarettes on Selected Antibacterial Properties of Saliva

  • Lowering the level of IgA in saliva may lead to a weakening of the specific immune response and cause earlier development of more severe periodontitis. In our research, it was observed that the tobacco smokers’ level of salivary IgA was statistically significantly lower in comparison to the values in both the control group and the group of e-cigarette users. IgA content in the saliva of e-cigarette users was not statistically significant lower compared to the control group. This indicates that electronic cigarettes compared to traditional cigarettes have less effect on IgA concentration in saliva.

2019: A lower impact of an acute exposure to electronic cigarette aerosols than to cigarette smoke in human organotypic buccal and small airway cultures was demonstrated using systems toxicology assessment

  • Overall, the study demonstrated that exposure to undiluted test mix or base EC aerosols under the testing conditions (an acute 28-min exposure), even at a deposited nicotine concentration that is 200 times greater than that found in the saliva of EC users, had no impact on morphology of buccal and small airway cultures. In contrast, following the same puff number, the already diluted 3R4F CS resulted in overt tissue damage.
  • The study was funded by Philip Morris International. The MarkTen® EC devices were manufactured and provided by Altria Client Services LLC. All authors are paid employees of Philip Morris International R&D, or Altria Client Services LLC.

2019: A Comparison of Flavorless Electronic Cigarette-Generated Aerosol and Conventional Cigarette Smoke on the Planktonic Growth of Common Oral Commensal Streptococci

  • A potential implication of these results is that flavorless E-liquids and their generated aerosol induce less tooth decay and periodontal disease than traditional cigarette smoke.
  • A case for improving oral health (and overall health) could be made by federal health regulatory agencies for promoting the use of electronic nicotine delivery systems over the use of traditional cigarettes as a means of harm reduction.

2019: Effect of nicotine on human gingival, periodontal ligament and oral epithelial cells. A systematic review of the literature

  • According to findings from in vitro studies, nicotine, at levels found in tobacco smokers, nicotine replacement therapy users and e-cigarette users, is unlikely to be cytotoxic to human gingival and periodontal cells, though saliva levels in smokeless tobacco users may be high enough to achieve cytotoxicity. There was limited and contradictory evidence for nicotine effects on cell attachment, proliferation and inflammatory mediator production.

2019: Impact of cigarette smoking and vaping on the outcome of full-mouth ultrasonic scaling among patients with gingival inflammation: a prospective study

  • There are no studies that have assessed the oral soft tissue response to full-mouth ultrasonic scaling (FMUS) among cigarette-smokers (CS) (group 1), individuals vaping electronic-cigarettes (E-cigs) (group 2), and never-smokers (NS) (group 3). The aim was to assess the impact of cigarette smoking and vaping on periodontal tissues following FMUS.
  • Following FMUS, gingival inflammation is worse in CS compared with individuals vaping E-cigs and NS.

2019: Clinical periodontal status and gingival crevicular fluid cytokine profile among cigarette-smokers, electronic-cigarette users and never-smokers

  • Periodontal status is poorer and GCF levels of proinflammatory cytokines are higher in cigarette-smokers compared with electronic-cigarette smokers and never-smokers. However, the probability of increased periodontal inflammation and GCF proinflammatory cytokine levels in electronic-cigarette users than never-smokers cannot be annulled.

2018: Comparative study of the effects of cigarette smoke and electronic cigarettes on human gingival fibroblast proliferation, migration and apoptosis

  • The damage to gingival fibroblasts was greater with conventional cigarette smoke condensate than with nicotine-rich e-vapor condensate.

2018: Assessment of enamel discoloration in vitro following exposure to cigarette smoke and emissions from novel vapor and tobacco heating products

  • For the first time, diverse NGPs [next generation tobacco and nicotine products] across the risk continuum were assessed in vitro for their impact on enamel staining. CS exposure significantly increased the level of bovine enamel sample discoloration, whereas THP1.0 [tobacco heated product] or NVP [nicotine vapor product] exposure resulted in values comparable to the controls.
  • This study was funded by British American Tobacco (BAT) R&D, Southampton. Experimental work was performed at BAT R&D and Intertek CRS, UK. All authors are employees of BAT, Intertek CRS or Borgwaldt KC GmbH.

2018: Effects of tobacco smoke and electronic cigarette vapor exposure on the oral and gut microbiota in humans: a pilot study

  • In summary, we found that tobacco smoking significantly alters the bacterial profiles in feces, buccal, and saliva samples. Compared to controls, exposure to ECs had no effect on the oral or gut communities. Changes in the gut microbiota of tobacco smokers were associated with increased relative abundance of Prevotella and decreased relative abundance of Bacteroides. From a microbial ecology perspective, this study supports the perception that ECs represent a safer alternative to tobacco smoking.

2017: Comparison of Periodontal Parameters and Self-Perceived Oral Symptoms Among Cigarette Smokers, Individuals Vaping Electronic Cigarettes, and Never-Smokers

  • To the authors’ knowledge, there are no studies that have compared periodontal parameters and self-perceived oral symptoms (OSs) among cigarette smokers (CSs) (group 1), individuals exclusively vaping electronic cigarettes (group 2), and never-smokers (NSs) (group 3).
  • Periodontal inflammation and self-perceived OSs were poorer among CSs than among vaping individuals and NSs.

2017: Consensus statement from Scottish Consultants in Dental Health and other UK health organizations

  • There is now agreement based on the current evidence that vaping e-cigarettes is definitely less harmful than smoking tobacco. Although most e-cigarettes contain nicotine, which is addictive, vaping carries less risk than smoking tobacco. Thus, it would be a good thing if smokers used them instead of tobacco.

2016: Electronic Cigarette: Role in the Primary Prevention of Oral Cavity Cancer

  • Cigarette smoke has been identified as the main cause of oral cavity carcinoma. ...in our in vivo study, the oral cavity cells of e-cigarette smokers showed CMN and TMN values similar to those of healthy controls, indicating the safety of e-cigarettes. The use of electronic cigarettes seems to be safe for oral cells and should be suggested as an aid to smoking cessation.

2015: Oral Health Foundation: (Formerly known as the British Dental Health Foundation)

  • "Smoking is the cause of many serious oral health problems, including worsening gum disease, which is one of the most common causes of caries in UK adults. It is also responsible for the majority or mouth cancers and is the direct cause of thousands of deaths every year. Every year almost seven thousand people in the UK are diagnosed with mouth cancer, and it leads to more deaths than testicular and cervical cancer combined."
  • "We need to spread the message that e-cigarettes, while not risk free, are much less harmful than smoking, as currently nearly half the population are not aware of this… The British Dental Health Foundation believe that there is a long way to go to before we get to a smoke-free lifestyle but any way which smoking numbers can be cut, and therefore lives saved, is positive and one which we will support.”

HnB THP HTP Heated Tobacco Products

2024: E-cigarettes and heated tobacco products impact on dental color parameters

  • Conclusion: "Exclusive use of ECs and HTPs is associated with better dental color measurements than current smoking, suggesting that tar-free nicotine delivery technologies are unlikely to have negative effects on dental appearance."

2022: Effects of conventional and heated tobacco product smoking on discoloration of artificial denture teeth

  • Conventional cigarette and heated tobacco product smoke can change the color of denture teeth. Heated tobacco product smoke causes less discoloration of denture teeth.

2020: Expert sounds alarm on oral cancer

  • A dental expert urged smokers to switch to electronic cigarettes (e-cigs) and heated tobacco products (HTPs) as a “harm reduction measure,” saying smoking is the leading cause of oral cancer. “We warn our patients who are smokers that smoking is the leading cause of oral cancer and strongly advise them to quit smoking. For those who cannot or do not want to quit smoking by themselves or with currently approved methods, we convince them to switch to non-combustible alternatives,” said Fernando Fernandez, president of the Philippine College of Oral and Maxillofacial Surgeons (Pcoms) during the Scientific Conversations on Tobacco Harm Reduction held recently at the Shangri-La at the Fort in Taguig City.

2019: Effects of cigarette smoke and tobacco heating aerosol on color stability of dental enamel, dentin, and composite resin restorations

  • The findings of the current study indicate that CS causes discoloration of dental hard tissues and color mismatch of esthetic composite resin restorations. THS 2.2 induces much less discoloration in dental hard tissues and dental composite restorations in comparison with CS. These results are consistent with available evidence that THS 2.2 generates an aerosol with a different chemical composition from CS and with no combustion-related solid particles typically found in CS tar.
  • This study was funded in part by Philip Morris International. Drs Filippo Zanetti, Julia Hoeng, and Manuel C. Peitsch are employees at Philip Morris International R&D.

2018: Assessment of enamel discoloration in vitro following exposure to cigarette smoke and emissions from novel vapor and tobacco heating products

  • For the first time, diverse NGPs [next generation tobacco and nicotine products] across the risk continuum were assessed in vitro for their impact on enamel staining. CS exposure significantly increased the level of bovine enamel sample discoloration, whereas THP1.0 [tobacco heated product] or NVP [nicotine vapor product] exposure resulted in values comparable to the controls.
  • This study was funded by British American Tobacco (BAT) R&D, Southampton. Experimental work was performed at BAT R&D and Intertek CRS, UK. All authors are employees of BAT, Intertek CRS or Borgwaldt KC GmbH.

Nicotine

2021: Potential Suppressive Effect of Nicotine on the Inflammatory Response in Oral Epithelial Cells: An In Vitro Study

  • HSC-2 cell viability was not impaired by nicotine at the concentrations usually observed in smokers; increased expressions of IL-8 and ICAM-1 induced by P. gingivalis LPS or TNF-α were diminished by nicotine treatment. Additionally, an inhibitory effect on β-defensin production was also demonstrated. Apart from being the usually alleged harmful substance, nicotine probably exerted a suppressive effect on inflammatory factors production in HSC-2 cells.
  • Acknowledgement: This research was supported by the grant from Ministry of Science and Technology of China under a contract from the International Science & Technology Cooperation Program Foundation Nr.1019 and the National Natural Science Foundation of China (Grant No. 81500859).
  • Citation: An, N., Holl, J., Wang, X., Rausch, M. A., Andrukhov, O., & Rausch-Fan, X. (2021). Potential Suppressive Effect of Nicotine on the Inflammatory Response in Oral Epithelial Cells: An In Vitro Study. International Journal of Environmental Research and Public Health, 18(2), 483. https://doi.org/10.3390/ijerph18020483

Nicotine - Aphthous Ulcers and Behçet’s Disease

2015 Use of pure nicotine for the treatment of aphthous ulcers

  • The theory that nicotine is known as the protective factor is also supported by three case reports, in which aphthous ulcers were prevented or healed while the patients used nicotine replacement materials.
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387635/?report=printablePrintable Version
  • Citation: Motamedi MR, Golestannejad Z. Use of pure nicotine for the treatment of aphthous ulcers. Dent Res J (Isfahan). 2015 Mar-Apr;12(2):197-8. PMID: 25878688; PMCID: PMC4387635.

2011 Occurrence of recurrent aphthous stomatitis only on lining mucosa and its relationship to smoking – A possible hypothesis

  • In addition, nicotine or its metabolites can result in decrease of pro-inflammatory cytokines like tumor necrosis factor-α, interleukins 1 and 6, and increase of anti-inflammatory cytokine interleukin-10. Consequently, there is reduced susceptibility to RAS due to immunosuppression and/or reduction in inflammatory response.
  • PDF Version
  • Subramanyam, R. V. (2011). Occurrence of recurrent aphthous stomatitis only on lining mucosa and its relationship to smoking – A possible hypothesis. Medical Hypotheses, 77(2), 185–187. doi:10.1016/j.mehy.2011.04.006

2010 Nicotine-patch therapy on mucocutaneous lesions of Behçet’s disease: a case series

  • In this report, we describe five ex-smoker BD patients with active mucocutaneous lesions, not responsive to standard pharmacological treatments and treated with transdermal nicotine patches. Four out of five patients quickly responded to nicotine-patch therapy and experienced a complete regression of all mucocutaneous lesions within 6 months of observation.
  • PDF Version
  • Citation: Giovanni Ciancio, Matteo Colina, Renato La Corte, Andrea Lo Monaco, Francesco De Leonardis, Francesco Trotta, Marcello Govoni, Nicotine-patch therapy on mucocutaneous lesions of Behçet’s disease: a case series, Rheumatology, Volume 49, Issue 3, March 2010, Pages 501–504, doi: 10.1093/rheumatology/kep401
  • Keywords: Behçet’s disease, Cigarette smoking, Nicotine therapy, Mucocutaneous lesions

2002 Minor recurrent aphthous stomatitis and smoking: an epidemiological study measuring plasma cotinine

  • NOTE: Safer Nicotine Wiki does NOT endorse smoking for any potential therapeutic benefits. Smoking has too many severe consequences. Studies showing that less people who smoke end up with a specific ailment are included to show the potential benefits of the nicotine.
  • This study shows that a group of RAS patients is significantly less likely to contain smokers than a matched control population, and among smokers the level of cigarette use was significantly lower in RAS patients than the control population. The perceived negative association between RAS and smoking was supported by this epidemiological study.
  • PDF Version
  • Citation: Atkin PA, Xu X, Thornhill MH. Minor recurrent aphthous stomatitis and smoking: an epidemiological study measuring plasma cotinine. Oral Dis. 2002 May;8(3):173-6. doi: 10.1034/j.1601-0825.2002.01826.x. PMID: 12108762.

2000 Nicotine Patches for Aphthous Ulcers Due to Behçet's Syndrome

  • We describe a woman with Behçet's syndrome characterized by recurrent oral and genital aphthous ulcers, severe eye involvement, and the onset of arthritis at the age of 29 years. At the age of 35 several large and extremely painful buccal aphthous ulcers developed. Therapy with a nicotine patch led to a regression of all aphthous ulcers within a few days. A month later, after the patient had stopped using the nicotine patches, four aphthous ulcers developed within a week. These ulcers rapidly regressed once she resumed using the nicotine patches.
  • PDF Version (Note: Need to scroll down to the correct section)
  • Citation: Philippe Scheid, M.D., Abraham Bohadana, M.D., Yves Martinet, M.D., Ph.D., Université Henri Poincaré, 54500 Nancy-Vandoeuvre, France, December 14, 2000, N Engl J Med 2000; 343:1816-1817, DOI: 10.1056/NEJM200012143432418

1991 Recurrent aphthous ulcers and nicotine

  • The aim of this study was to investigate the effect of nicotine, in the form of Nicorette tablets, on aphthous ulcers in non-smoking patients. This preliminary trial shows that nicotine may have a beneficial effect on aphthous ulcers.
  • PDF Version
  • Citation: Bittoun, R. (1991), Recurrent aphthous ulcers and nicotine. Medical Journal of Australia, 154: 471-472. https://doi.org/10.5694/j.1326-5377.1991.tb121180.x

Nicotine Gum

2012 Randomized controlled trial to evaluate tooth stain reduction with nicotine replacement gum during a smoking cessation program

  • The results of this study confirm that chewing the tested nicotine replacement gum as recommended in a ‘real world’ active smoking cessation program produces a statistically significant change in the parameter of whitening as measured by change from baseline versus the negative control (Microtab) following 6 weeks in a smoking cessation programme. The Vita® Shade Guide (the secondary outcome measure) supported the trend of stain improvement. These results support the efficacy of the tested nicotine replacement gum in stain reduction, in arresting the progression of tooth stain and in shade lightening.
  • Acknowledgement: The study was fully funded by McNeil AB who is the manufacturer of the test and control products. It was designed by McNeil AB in consultation with HW and DOM. The study was run, participants recruited, smoking cessation intervention administered and data collected by the team of research staff at the Oral Health Services Research Centre at University College Cork under the leadership of HW with consultant input from DOM. RK carried out the clinical examinations but was blinded to intervention allocation. The data were analysed by McNeil AB with input from HW and DOM. The study was externally monitored by MDS Pharma Services, UK and conducted to ICH GCP standards. The data were interpreted by HW, DOM and RK. The manuscript was drafted by HW with editorial comment from the other authors. HW decided to submit the manuscript for publication.
  • Citation: Whelton H, Kingston R, O'Mullane D, Nilsson F. Randomized controlled trial to evaluate tooth stain reduction with nicotine replacement gum during a smoking cessation program. BMC Oral Health. 2012 Jun 13;12:13. doi: 10.1186/1472-6831-12-13. PMID: 22695211; PMCID: PMC3444372.

Nicotine - Orofacial Dyskinesia

2012: Nicotine Reduces Antipsychotic-Induced Orofacial Dyskinesia in Rats

  • In summary, our data show that nicotine treatment decreases haloperidol-induced VCMs [vacuous chewing movements] in an established rat model of tardive dyskinesia. The demonstration that nicotine removal leads to a return of VCMs, whereas nicotine re-exposure reduced haloperidol-induced VCMs, suggests a causal relationship. These data have clinical applications for the treatment of tardive dyskinesias associated with long-term antipsychotic treatment using nicotine.

Nicotine Patch

2020 Effectiveness of nicotine patch for the control of pain, oedema, and trismus following third molar surgery: a randomized clinical trial

  • The positive findings in the present study in surgeries performed under local anaesthesia are in agreement with data from systematic reviews that have reported the effectiveness of nicotine in the control of postoperative pain following surgery under general anaesthesia.
  • This study establishes a new prevention and treatment modality regarding pain, oedema, and trismus in a versatile, convenient, safe, and effective form, thereby minimizing gastrointestinal and cardiovascular disorders caused by the use of anti-inflammatory drugs in third molar surgeries.
  • PDF Version
  • Citation: Landim FS, Laureano Filho JR, Nascimento J, do Egito Vasconcelos BC. Effectiveness of nicotine patch for the control of pain, oedema, and trismus following third molar surgery: a randomized clinical trial. Int J Oral Maxillofac Surg. 2020 Nov;49(11):1508-1517. doi: 10.1016/j.ijom.2019.08.013. Epub 2020 May 4. PMID: 32381373.
  • Acknowledgements: Funding - CAPES, Ministry of Education, Brazil

2000 Nicotine Patches for Aphthous Ulcers Due to Behçet's Syndrome

  • We describe a woman with Behçet's syndrome characterized by recurrent oral and genital aphthous ulcers, severe eye involvement, and the onset of arthritis at the age of 29 years. At the age of 35 several large and extremely painful buccal aphthous ulcers developed. Therapy with a nicotine patch led to a regression of all aphthous ulcers within a few days. A month later, after the patient had stopped using the nicotine patches, four aphthous ulcers developed within a week. These ulcers rapidly regressed once she resumed using the nicotine patches.
  • PDF Version (Note: Need to scroll down to the correct section)
  • Citation: Philippe Scheid, M.D., Abraham Bohadana, M.D., Yves Martinet, M.D., Ph.D., Université Henri Poincaré, 54500 Nancy-Vandoeuvre, France, December 14, 2000, N Engl J Med 2000; 343:1816-1817, DOI: 10.1056/NEJM200012143432418

Nicotine Pouches

2023: Nicotine pouches: a review for the dental team

  • Nicotine pouches are a new product that the dental professional should be aware of, particularly in smokers and ex-smokers. They are likely to have a relatively low-risk profile, similar to other forms of orally administered nicotine; however, the prolonged and regular use may give increased risk of local oral problems. Further research is required.

2022: The effect of a non-tobacco-based nicotine pouch on mucosal lesions caused by Swedish smokeless tobacco (snus)

  • The findings of this study demonstrate that the almost complete substitution of snus with a non-tobacco-based nicotine product resulted in the gradual resolution of pre-existing oral mucosal lesions in healthy snus users over a 6-week period. Furthermore, findings showed that the investigational non-tobacco-based nicotine products do not elicit an inflammatory response in vitro.

Snus

2020: No association between moist oral snuff (snus) use and oral cancer: pooled analysis of nine prospective observational studies

  • Swedish snus use does not appear to be implicated in the development of oral cancer in men.

Snus science database

  • Snusforumet’s snus science database includes a collection of studies and research on snus and snus policy from a variety of sources and perspectives. The documents are in Swedish, English, and Norwegian.

Tobacco Harm Reduction (Not specific to one product)

2021: Letter from one hundred specialists in nicotine science, policy, and practice

  • The urgent need to reduce deaths from smoked tobacco: parties should challenge WHO to modernise its approach to tobacco policy. Tobacco harm reduction presents significant public health opportunities.
  • Signatories include Oral Health expert: Arleen R. Reyes, DMD, ICD, ICCDE - Past President, Philippine Dental Association Chairman, Commission on Dental Education Asia -Pacific Dental Federation Philippines

Smoking, Tobacco Harm Reduction, and Oral Health Care Providers (Lack of Knowledge/Misinformation)

2022: Dental Student's Awareness and Perception toward Nicotine Replacement Therapy in Riyadh Region Saudi Arabia

  • About 74.4% of participants were aware of NRT nearly 50% of students think motivating about NRT is waste of time.

2022: Knowledge and Perception of e-Cigarettes among Dental Students in Riyadh Region Saudi Arabia

  • In the present study, results 80% of the participants had no clear opinion on the health effects of e-cigarette indicating lack of knowledge about use, potential merits, and demerits of e-cigarette.

2021: Nicotine-related misperceptions among faculty and students at a Midwestern dental school

  • The response rate for faculty was 55.1% and that for students was 37.5%. The majority of faculty and students “agreed” or “strongly agreed” that nicotine causes cancer, birth defects, cardiovascular disease, oral inflammation, and Chronic Obstructive Pulmonary Disease.
  • Dental school faculty and students linked the risks of smoking tobacco to nicotine. Based on the results of this study, we feel our institution's curriculum should consider including information specific to nicotine in addition to tobacco in general.

2017: Knowledge, attitude and practices of institution-based dentists toward nicotine replacement therapy

  • Having the advantage of working in an academic environment, the postgraduate students and members of faculty lack a detailed knowledge about NRT restricting them to practice it whenever required though they report a strong positive attitude toward this pharmacotherapy. Hence, there is a strong need for implementation of tobacco control policy in India, making repeated training on tobacco cessation counseling giving importance to NRT, not only to students but also to all the faculty members of all the dental institutions of this country where tobacco-related problems are highly prevalent.

Responses to Misinformation

2022: Vaping misrepresentations

  • Response to: Fairchild R, Setarehnejad A. Erosive potential of commonly available vapes: a cause for concern? Br Dent J 2021; 231: 487-491.
    • also: Bartlett D. Expert view: David Bartlett. Br Dent J 2021; 231: 700.
  • "The authors incorrectly claim that nicotine causes a 'high risk of oral and whole-body health complications'. They cite a WHO poster which presents the effects of whole tobacco smoke on health, not the effect of nicotine. Nicotine has been used in the form of NRT for over 30 years, including in pregnant women, and is regarded as extremely safe, even for long-term use"

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