1. PARTHA PRATIM
DAS
INTERN
BURDWAN DENTAL COLLEGE
AND HOSPITAL

4. TOBACCO CULTIVATION

5. INFLUENCE OF TOBACCO
USE ON DENTAL CARIES
DEVELOPMENT
UNDER THE GUIDANCE OF
DR. SANJIB MITRA
ASSOCIATE PROFESSOR
DEPARTMENT OF ORAL AND MAXILLOFACIAL
PATHOLOGY
BURDWAN DENTAL COLLEGE AND HOSPITAL

6. HISTORY OF TOBACCO
•Tobacco cultivation has a history of about 8000 years.
• Portuguese traders introduced tobacco in India during
1600.
• The entry of European colonial powers into India
spurred the import of tobacco into India.
(History of Tobacco by Dr. Sanjib Mitra)

7. TOBACCO PLAYS AN IMPORTANT
ROLE IN INDIAN ECONOMY
 Tobacco plays a significant role in the Indian
economy as it contributes substantially in terms of
excise revenue, export revenue and employment.
 India is the world’s second largest producer of
tobacco and also the second largest consumer of
unmanufactured tobacco. It is a major exporter of
unmanufactured tobacco.
(History of Tobacco by Dr. Sanjib Mitra)

9. TYPES OF TOBACCO USED
IN INDIA
Smoking
Chewing
Cigarettes
Bidi
Gudhaku
Chutta
Chewing tobacco
30%
Zarda
Dhumti
Bidi
54%
Khaini
Hookah
Cigarette
16%
Gutkha
Paan (with
tobacco)
Chillum
Gul
Cigars
(History of Tobacco by Dr. Sanjib Mitra)
Mawa
,Mishri

13. DENTAL CARIES
Defined as an irreversible microbial
disease of the calcified tissues of the teeth
characterized by demineralization of the
inorganic portion and destruction of the
organic substance of the tooth which often
leads to cavitations.
CURRENT TRENDS IN
CARIES PREVALENCE
Though various studies reveal
decrease of caries incidence in the
developed countries but the
prevalence of caries has been
reported to be increasing in
certain less developed countries.
(Shafer’s Textbook of Oral Pathology)

14. STAGES OF TOOTH DECAY
(Shafer’s Textbook of Oral Pathology)

15. Quantitative and qualitative measure that accurately reflects the extent
of dental caries in a population….
D- DECAYED
D- DECAYED
M- MISSING
F- FILLED
Can be DMF(T) or DMF(S) and DEF(T) or DEF(S)
E- INDICATED FOR
EXTRACTION
F- FILLED (considered
in case of pediatric
patients

16. ETIOLOGY OF DENTAL CARIES
Miller’s Chemicoparasitic Theory or
Acidogenic Theory
Caries is caused by acids produced by micro organisms in the mouth
THE ROLE OF CARBOHYDRATES
THE ROLE OF MICROORGANISMS
 THE ROLE OF ACIDS
 THE ROLE OF DENTAL PLAQUE
The Proteolysis Chelation
Theory(Schatz et al,1955)
The Sucrose Chelation
Theory(Egglers-Lura, 1967)
(Shafer’s Textbook of Oral Pathology)

17. CURRENT CONCEPTS IN
CARIES ETIOLOGY
(Shafer’s Textbook of Oral Pathology)

18. L
O
C
A
L
I
Z
A
T
I
O
N
Type of Caries
Microorganisms
Human Disease
Pit & Fissure
S. mutans
S. sanguis
Lactobacillus sp.
Actinomyces sp.
Very significant
Uncertain
Very significant
By chance
Smooth surface
S. mutans
S. salivarius
Very significant
By chance
Root surface
A.
B.
S.
S.
viscosus
naeslundii
mutans
sanguis
Very significant
Very significant
Significant
By chance
Deep dentinal
caries
Lactobacilli sp.
A. naeslundii
Other filamentous
rods
Very significant
Very significant
Very significant
O
F
M
I
C
R
O-
F
L
O
R
A
R
E
L
A
T
E
D
TO
CARIE
S
(Shafer’s Textbook of Oral Pathology)

19. INFLUENCE OF TOBACCO USE
Smoking and its relation to dental caries is a subject of
many opinions. From early reports and a common belief
was that smoking actually helps to reduce dental caries.
Schmidt, in 1951, supported this belief when he reported
that increase in tobacco smoking was against caries..
The concentration of thiocyanate, a constituent of
tobacco smoke and normal saliva with possible cariesinhibiting effect, was found to be higher in smoker’s saliva.
(Influence of tobacco use in dental caries development
Sajith Vellappally1, Zdeněk Fiala1, Jindra Šmejkalová1, Vimal Jacob1, Pilathadka Shriharsha2)

20. Thiocyanate molecule

21. TOBACCO AGGRAVATING DENTAL
CARIES
 The decreased buffering effect and possible
lower pH of smoker’s Saliva.
 The higher number of Lactobacilli and
Streptococcus mutans .
 In 1952, Ludwick and Massler reported that
those who smoked more than 15 cigarettes a day
had significantly higher number of
decayed, missing, and filled teeth.
• In 1990, Zitterbart confirmed association
between smoking and the prevalence of dental
caries in adult males. Smokers had significantly
higher DMFT (Decayed, Missing, and Filled Teeth)
score, untreated decayed surfaces, and missing
surfaces.
(Influence of tobacco use in dental caries development
Sajith Vellappally1, Zdeněk Fiala1, Jindra Šmejkalová1, Vimal Jacob1, Pilathadka Shriharsha2)

22. Association between
smoking and dental caries is
well documented
in older age groups.
Among middle-age (15) or
young adults (25) results
are inconsistent.
Non-smokers reported
more frequent healthy oral
health behavior than did
daily smokers
(Influence of tobacco use in dental caries development
Sajith Vellappally1, Zdeněk Fiala1, Jindra Šmejkalová1, Vimal Jacob1, Pilathadka
Shriharsha2)

24. ENVIRONMENTAL TOBACCO SMOKE OR PASSIVE
SMOKE AND PEDIATRIC DENTAL CARIES
 UK National Diet and Nutrition Survey (1995) suggested
maternal smoking as a significant risk factor for
predicting caries in preschool children
 Work of Aligne and colleagues (2003) has provided
strongest evidence yet of an increased risk of dental
caries in the deciduous dentition of children who are 4
to 11 years of age and have been exposed to passive
smoking or environmental tobacco smoke (ETS)
 A recent study done in 2004 also confirmed that
children residing in regularly smoking homes had
significantly higher prevalence of caries compared to Non
regular/nonsmoking homes .
Association of Pediatric Dental Caries With Passive Smoking FREE
C. Andrew Aligne, MD, MPH; Mark E. Moss, DDS, PhD; Peggy Auinger, MS; Michael
Weitzman, MD

25. Nicotine has been shown to promote the growth of cariogenic Streptococcus
mutans bacteria in vitro thus, mother who smoke may be more likely than nonsmokers to transmit these germs to children .
 ETS smoke has immunosuppressive properties and is a known risk factor for
infections of the cranial organs (e.g. otitis media); thus it is not surprising that it
might be risk factor for caries development as well..
 In addition ETS is associated with decreased serum vitamin C
levels in children and decreased levels of vitamin C are associated
with growth of cariogenic bacteria.
Association of Pediatric Dental Caries With Passive Smoking FREE
C. Andrew Aligne, MD, MPH; Mark E. Moss, DDS, PhD; Peggy
Auinger, MS; Michael Weitzman, MD

26. cotinine
COTININE A METABOLITE OF NICOTINE
FOUND IN SERUM OF PAEDIATRIC
PATIENTS EXPOSED TO PASSIVE SMOKE
Children from 4-11 years with serum cotinine levels more than 0.2ng/ml
were detected with an increased prevalence of dental caries

27. SMOKELESS TOBACCO AND DENTAL
CARIES
Controlling for cigarette smoking, a
dose-response relationship was also shown
between caries and the number of years
of snuff use..
 The types of sweeteners and sugars
commonly found in ST are
fructose, glucose, sucrose, maltose, and
isomaltose.
 Individuals who chew tobacco appear to
have more dental caries than non-users.
(Influence of tobacco use in dental caries development
Sajith Vellappally1, Zdeněk Fiala1, Jindra Šmejkalová1, Vimal
Jacob1, Pilathadka Shriharsha2)

28. A wad of tobacco is kept in the oral cavity for 30
minutes on average,there isin vitro evidence of
stimulated growth of Streptococcus mutans and
Streptococcus sanguis in the presence of smokeless
tobacco extracts.
 It has been also found that extracts from chewing
tobacco with high sugar content increased in vitro
growth of Lactobacillus casei , a bacterium implicated in
root surface caries.
(Influence of tobacco use in dental caries development
Sajith Vellappally1, Zdeněk Fiala1, Jindra Šmejkalová1, Vimal
Jacob1, Pilathadka Shriharsha2)

29. Summary of major biological effects of
tobacco related to dental caries
Forms of tobacco use
Biological effects
Tobacco smoking
•Concentration of thiocynate found to be higher in smoker’s saliva may have possible
caries inhibiting effect .
• Decreased buffering effect and possible lower pH of saliva in smokers may indicate
increased susceptibility to caries.
• Higher number of lactobacilli and Streptococcus mutans in smokers may indicate caries
susceptibility
Environmental tobacco
smoke (ETS)
• Biological plausibility of causal role of ETS in caries formation in children .
• Immunosuppressive properties of ETS might be a risk factor for dental caries
development .
• ETS may decrease serum vitamin C level, which may be associated with growth of
cariogenic bacteria in children .
• ETS may reduce the protective properties of saliva that can operate against caries
Smokeless tobacco
• High levels of fermentable sugar and sweeteners in ST can stimulate growth of
cariogenic bacteria (55, 56, 59).
• Extracts from chewing tobacco with high sugar content increased in vitro growth of
Lactobacillus casei (59, 61).
• Extracts of ST may serve as a growth substrate for Streptococcus mutans, Streptococcus
salivarius and Streptococcus
sanguis (64).
(Influence of tobacco use in dental caries development
Sajith Vellappally1, Zdeněk Fiala1, Jindra Šmejkalová1, Vimal Jacob1, Pilathadka Shriharsha2)

30. THE BASIC UNDERLYING
MECHANISM BEHIND

31. ANTIGEN I/ II BINDING OF
CARIOGENIC STREPTOCOCCI

32. INSPITE OF SIGNIFICANTLY HIGHER
LEVELS OF IG A & J CHAINS SMOKELESS
TOBACCO HAS IMPAIRED IMMUNE
RESPONSES

33. Nicotine is a major component of tobacco
smoke, and signals via nicotinic
acetylcholine receptors (nAChR)
nicotine suppresses the cytodifferentiation
and mineralization of HDPCs- human dental
pulp cells , possibly via nAChR.
Thus inducing caries which
is a demineralising process
of the calcified tissues of
the teeth

35. OUR ROLE TO CURB THE MENACE OF
TOBACCO USE
Education
Legislation
Regulation
Enforcement
Taxation
Economic Alternatives
Support for cessation
Community Mobilization
Reduction in demand and
supply
Tobacco cessation

36. The 5 A’s
2 A’s and an R
ASK
ASK
ADVISE
ADVISE
ASSESS
ASSIST
ARRANGE
REFER

37. AS THEY SAY “ WHEN THERE IS A
WILL, THERE IS A WAY”

38. The smiling teeth reflects a healthy heart
& mind

39. THANK YOU
RESPECTED JUDGES
FRIENDS
DR. SANJIB MITRA
Associate Professor
Department of Oral and Maxillofacial Pathology
Burdwan Dental College and Hospital
PROFESSOR DR. TAMAL PATRA
Principal
Burdwan Dental College and Hospital
INDIAN DENTAL ASSOCIATION WEST BENGAL STATE BRANCH