1. Indian Journal of Dental Sciences.
June 2012 Issue:2, Vol.:4
www.ijds.in Review Article
All rights are reserved
Indian Journal
of Dental Sciences
E ISSN NO. 2231-2293
P ISSN NO. 0976-4003
1
Dipika Garg
A Cigarette A Day, Keeps The Doctor In Pay 2
Sidharth Narula
3
Varun Jindal
Abstract 1
Smoking is one of the most common forms of recreational drug use. Tobacco smoking is today by St. Louis (MO) U.S.A.
2
Professor,
far the most popular form of smoking and is practiced by over one billion people in the majority of all Darshan Dental College, Udaipur.
human societies. The history of smoking can be dated to as early as 5000 BC, and has been 3
Sr. Lect
recorded in many different cultures across the world. Only relatively recently, and primarily in Bhojia Dental College, Baddi
industrialized Western countries, has smoking come to be viewed in a decidedly negative light. Address For Correspondence:
Today medical studies have proven that smoking tobacco is among the leading causes of many Dr. Dipika Garg MDS,
diseases such as lung cancer, heart attacks, COPD, erectile dysfunction and can also lead to birth St. Louis (MO) U.S.A.
defects. The inherent health hazards of smoking have caused many countries to institute high Email : drdipikagarg@gmail.com
taxes on tobacco products and anti-smoking campaigns are launched every year in an attempt to
Submission : 17th December 2011
curb tobacco smoking. Smoking cessation, referred to as "quitting", is the action leading towards
abstinence of tobacco smoking. There are a number of methods such as nicotine replacement Accepted : 14th May 2012
therapy, antidepressants, hypnosis, self-help, and support groups.
Quick Response Code
Key Words
Smoking, Drug, Tobacco, Cancers
Introduction knowledge that cigarette smoking is the
The main tobacco killers in both sexes are single major cause of cancer and
cancers, especially lung cancer, heart cardiovascular disease in the United
disease and chronic bronchitis. However, States, contributing to hundreds of social pressures and psychological needs
in developing countries with higher level thousands of premature deaths each year, including environmental influence
of traditional tobacco use, such as yet one-fourth to one-third of American ,school and peer influence, personal
chewing or smoking with the lit end of the adults continue to smoke. factors and knowledge, attitude and
chutta inside the mouth, tobacco use is Before examining the negative health beliefs about smoking.
associated with high level of oral cancer. effects of tobacco use, we would remind The tobacco market is dependent on a
For example, the highest reported rate of the reader that a popular emphasis on mass market. As smokers die or quit, they
mouth cancer in the world is among negative aspects is a rather new are keen to recruit new young smokers to
women in Bangalore. In India indeed it is phenomenon. Since the Middle Ages maintain their profits, particularly in
estimated that tobacco use causes around tobacco leaves have been used as new markets such as developing
one in five of all cancers in women. (1) medicinal herbs in ointments, poultices, countries. They tailor a product to appeal
This article aims to explore the reasons mouth rinses and smoke. Oral ulcers, to specific target groups by altering its
and consider why more attention needs to caries and "toothache" were all treated price, availability and image through
be paid to issues around smoking both in with this wonder drug. A product is still packaging, advertisement and promotion
terms of research and action. It will not readily available today, called "Dental using images and messages being
revisit the pathology associated with Snuff" which was advertised more than a glamorous, sophisticated, romantic,
smoking. century ago as a cure for toothache, healthy, sporty, fun, relaxing, liberated,
gingivitis, facial neuralgia, caries, and rebellious and, last but not least,
History scurvy. Given this positive image slimming. Young teenagers who smoke
Tobacco has been variously hailed as a throughout most of its history it's are more appreciative of cigarette
gift from the gods, a miraculous cure-all universal popularity is not surprising. It is advertisements than non smokers and the
for life's physical ills, a solace to the surprising, rather, that some persons have most heavily advertised brands are more
lonely soldier or sailor, a filthy habit, a always been moved to speak out against often bought by teenagers than adult
corrupting addiction, and the greatest it, even to the extent of proclaiming its smokers. How smoking is portrayed in
disease-producing product known to use a capital offense in some European the media more generally also affects the
man. This diversity of opinion has and Asian countries as early as the way in which young people view the
continued unchanged for centuries and sixteenth century. habit. Glamorous models, female
has appeared until very recently to be personalities, teenage pop idols and film
little affected by research results from How smoking spreads stars featuring in magazines, TV soaps,
more than 900,000 papers thus far The initiation of smoking among plays and films depict smoking as being
published on the topic. It is common adolescence is heavily influenced by part and parcel of their success. However,
©Indian Journal of Dental Sciences. (June 2012 Issue:2, Vol.:4) All rights are reserved. 128

2. adolescent smokers are more likely to be Smoking is directly responsible for 80 in reducing nicotine reinforcement in
under achievers in schools with low percent of lung cancer deaths in women clinically used doses. The NRTs are
academic goals. Using smoking to in the U.S. each year.(4) Smoking is effective in relieving tobacco withdrawal
bolster self confidence stems from the directly responsible for more than 90 and making abstinence easier in smokers
wide spread belief that smoking can help percent of chronic obstructive pulmonary trying to quit. NRTs approximately
calm nerves, control moods and alleviate disease (COPD), or emphysema and double the success rate of quitting
stress- all important concerns during chronic bronchitis deaths each year.(4) smoking relative to placebo. NRTs can be
adolescence. Postmenopausal women who smoke classified as short-acting (gum, lozenge,
have lower bone density than women inhaler, and spray) and longer-acting
Particularly about women who never smoked. Women who smoke (patch) products. Short-acting NRT
Smoking kills over half a million women have an increased risk for hip fracture products are especially effective in acute
each year and is the most important compared to never smokers. Cigarette management of tobacco withdrawal and
preventable cause of female premature smoking also causes skin wrinkling that craving. An important consideration for
death in several advanced countries. could make smokers appear less NRT treatment is titration of the dose
Women take up cigarette smoking as a attractive and prematurely old.(5) based on the smoker's nicotine intake,
widespread habit later than men, mainly determined roughly by the number of
due to socio- cultural factors, such as it Smokeless Tobacco cigarettes smoked per day (CPD). (7,8)
not being socially acceptable for women Like cigarettes, smokeless tobacco
to be seen smoking in public, religious products contain a variety of toxins Sustained-Release Bupropion
attitudes and women being generally less associated with cancer. At least 28 Bupropion, an atypical antidepressant, is
affluent than men. Smoking affects cancer-causing chemicals have been approved for treatment of smoking
women's health in ways which specific to identified in smokeless tobacco products. cessation. In preclinical studies,
them. Research has shown women who Smokeless tobacco is known to cause bupropion reduced nicotine's rewarding
smoke (i) have a 10 times higher risks of cancers of the mouth, lip, tongue, and effects and attenuated nicotine
heart disease and an increased risks of pancreas. Users also may be at risk for withdrawal symptoms. Its mechanism of
stoke if they also use oral contraceptives cancer of the voice box, esophagus, colon action is thought to be mediated by its
(ii) have a two fold associated higher and bladder, because they swallow some ability to block the reuptake of
risks of cervical cancer and (iii) of the toxins in the juice created by using norepinephrine and DA in the
experience detrimental affects on their smokeless tobacco.Smokeless tobacco mesolimbic system and nucleus
reproductive health, including can irritate your gum tissue, causing accumbens, a key area for nicotine
dysmenorrhoea, reducing fertility and an periodontal (gum) disease. Sugar is often reinforcement. Additionally, bupropion
early menopause. Women who smoke added to enhance the flavor of smokeless antagonizes brain nicotinic receptors and
during pregnancy also increase by a tobacco, increasing the risk for tooth blocks the reinforcing effects of nicotine.
quarter their risks of mis-carriage and by decay. Smokeless tobacco also typically (9)
a third the risks of the infants prenatal contains sand and grit, which can wear
death, they are twice as likely to have down your teeth. (6) Varenicline (CHANTIX)
premature labour and 3 times more likely Varenicline is a partial agonist for the
to have a low birth weight baby. In Treating The Addiction á4â2 subtype of nAChRs, which are
developing countries where the health of Nicotine, the main addictive chemical in associated with the addictive effects of
mother and baby is already jeopardized tobacco smoke, is essential in continued nicotine. Varenicline is also a full agonist
through poverty and malnutrition, the and compulsive tobacco use. Seven at the á7 nAChR. In smokers, varenicline
effects of smoking are likely to have even medications are currently US Food and attenuates the subjective rewarding
greater impact on birth weight and Drug Administration (FDA) approved responses and heart rate increases
prenatal mortality. Smoking is more for smoking cessation: five nicotine induced by intravenous nicotine.
common among these in low income, r e p l a c e m e n t t h e r a p i e s ( N RTs ) , Varenicline also improves tobacco
who have low status jobs or are bupropion, and varenicline. In addition, withdrawal symptoms, mood, and
unemployed, are single parents or clonidine and nortriptyline are effective cognitive performance in abstinent
divorced, have low level of academic for smoking cessation but are not FDA smokers. All these effects may contribute
achievement and are from under approved for this indication. to varenicline's efficacy for smoking
privileged ethnic groups.(2) As one starts cessation. (9)
to smoke regularly, his/ her body gets Nicotine Replacement Therapy
used to regular nicotine doses and In the US market, five NRT products are Nortriptyline
becomes physiologically dependant. currently available: nicotine patch, Nortriptyline, a tricyclic antidepressant,
There are no consistent patterns or trends nicotine chewing gum, nicotine lozenge, has been found to be effective for
among women. Prevalence rates vary nicotine nasal spray, and nicotine vapor smoking cessation. The underlying
from as much as 58% in Nepal and over a inhaler. Nicotine gum, patch, and lozenge mechanism of nortriptyline's efficacy for
third in European countries, such as are available as over-the-counter (OTC) smoking cessation might be through
Denmark and Poland, to barely products, whereas nasal spray and vapor norepinephrine reuptake inhibition in
detectable levels in many African inhaler are available by prescription only. central synapses or through nAChR
countries, such as the Ivory Coast and Although initially thought to be a antagonism. In clinical trials for smoking
Guinea. (3) "substitution" treatment, similar to cessation, the dose of nortriptyline was
methadone treatment for opioid 75 to 100 mg/d, and the length of
In the U.S.A. addiction, the NRTs have limited efficacy treatment was 8 to 12 weeks. Compared
©Indian Journal of Dental Sciences. (June 2012 Issue:2, Vol.:4) All rights are reserved. 129

3. with placebo, nortriptyline Conclusion 4. Centers for Disease Control and
approximately doubles the rates of Mark Twain once said "Quitting smoking Prevention. National Center for
smoking abstinence. (9) is easy. I have done it a thousand times". Health Statistics. National Vital
Smoking cessation programs are useful Statistics Reports. Births: Final Data
Clonidine in helping smokers to quit, but smoking is for 2005. December 5, 2007; 56(10).
Clonidine, an antihypertensive agent, a very difficult addiction to break and the 5. Smokeless tobacco as a nicotine
reduces central sympathetic activity by need for novel and effective approaches delivery device: harm or harm
stimulating the á2-adrenergic receptors. to smoking cessation interventions is reduction?Benowitz NL. Clin
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Source of Support : Nill, Conflict of Interest : None declared
©Indian Journal of Dental Sciences. (June 2012 Issue:2, Vol.:4) All rights are reserved. 130