Oral health consequences of smokeless tobacco use

Abstract

Smokeless tobacco (SLT) use has many oral effects including oral cancer, leukoplakia and erythroplakia, oral submucous fibrosis (if mixed with areca nut), loss of periodontal support (recession) and staining of teeth and composite restorations. This review was aimed to provide information to identify oral lesions that occur due to the use of smokeless tobacco so that effective interventions can be undertaken to reduce morbidity and mortality from the use of SLT.

Keywords: Chewing tobacco - leukoplakia - oral cancer - smokeless tobacco - submucous fibrosis.

Fig. 1

Oral squamous cell carcinoma in a patient addicted to gutka. Tumour arising from retromolar region has spread to the buccal sulcus. The figure demonstrates features of an exophytic growth with ulceration and necrosis.

Fig. 2

Verrucous carcinoma in oral cavity of a patient in a tobacco chewer. This is an advanced tumour with a typical verrucoid appearance.

Fig. 3

Lower labial sulcus of a patient showing tobacco pouch keratosis in places where the quid has been retained for long periods.

Fig. 4

Oral homogeneous leukoplakia affecting the commisure in a tobacco chewer.

Fig. 5

Erythroleukoplakia with candidal infection. This is mixed red and white lesion and has a worse prognosis than homogeneous leukoplakia.

Fig. 6

Proliferative verrucous leukoplakia. Thick white plaques are noted affecting several sites, gingiva, alveolar mucosa, the sulcus and spreading to lower lip.

Fig. 7

Oral submucous fibrosis, (A) left buccal mucosa, (B) right buccal mucosa, (C) palate. The buccal mucosae show loss of elasticity and fibrous banding. The palatal arch shows fibrosis.

Fig. 8

Tooth staining. These extrinsic stains are due to long term betel quid with tobacco use.