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Surgeon General updates tobacco, oral health links

January 17, 2014

By Craig Palmer, ADA News staff

Washington—The U.S. Surgeon General’s 50th anniversary review of tobacco science since Dr. Luther Terry’s landmark report on smoking and health updates evidence on the implications for oral health from tobacco use and the "expanding use of multiple products or the replacement of conventional combustible cigarettes with other nicotine delivery systems."

The 998-page report significantly expands the list of illnesses "causally associated" with active smoking to include orofacial clefts in infants, the acting Surgeon General, Boris D. Lushniak, M.D., said in a preface. "The evidence is sufficient to infer a causal relationship between maternal smoking in early pregnancy and orofacial clefts," the report said.

The Association congratulated acting Surgeon General Lushniak "for issuing a report that further examines the relationship between tobacco use and an array of health problems, including oral cancer, gum disease and dental caries."

The dental disease chapter in the 2014 report offers these conclusions and implications based on recent research reported in the scientific literature:

  • The evidence is suggestive but not sufficient to infer a causal relationship between active cigarette smoking and dental caries.
  • The evidence is suggestive but not sufficient to infer a causal relationship between exposure to tobacco smoke and dental caries in children.
  • In developed nations, smoking is strongly associated with sociodemographic characteristics and a wide range of health behaviors that also are strongly associated with elevated risk for caries. Given the public health importance of dental caries, further research on smoking is needed with careful attention to confounding.
  • The evidence is suggestive but not sufficient to infer a causal relationship between cigarette smoking and failure of dental implants.
  • The existing evidence suggests that smoking may compromise the prognosis for osseointegrated dental implants. Thus, an intervention to discontinue tobacco use should be part of the treatment plan for persons who are considering a dental implant.

The report also examines evidence on the health consequences of nicotine exposure.

"The possibility of increasing chronic nicotine exposure in the population from various nicotine-containing products for the long-term merits further research," the report said. "Cancer, cardiovascular and neurocognitive outcomes are of concern. The evidence is already sufficient to provide appropriately cautious messages to pregnant women and women of reproductive age as well as adolescents about the use of nicotine-containing products such as smokeless tobacco and electronic cigarettes, and newer forms of nicotine-containing products, as alternatives to smoking."

The Surgeon General’s tobacco science update concludes with "calls for dramatic action" to reduce tobacco use. "The current rate of progress in tobacco control is not fast enough," the report concludes. "More needs to be done."

The commissioner of the U.S. Food and Drug Administration, which regulates tobacco products under the Family Smoking Prevention and Control Act, said the FDA "will continue to propose and implement tobacco products regulations to protect the nation’s health."