Mainers are inundated with messages that increasing their access to dentists will improve their oral health. Unfortunately, the message that is absent is that the true cause of dental disease is personal behavior, which is rarely addressed in the media or by policymakers.
Near the top of the list of personal behaviors that have a profoundly negative impact on oral health is the use of tobacco. Tobacco causes destructive and costly damage to the tissues of the mouth that goes far beyond unsightly staining. This damage is hard to prevent or repair, even with the best access to the best of dental services.
A report recently highlighted the use in Maine of hospital emergency rooms for dental pain, mostly by adults on MaineCare and the uninsured. More than 40 percent of adults on MaineCare use tobacco. This means a large number of adults on MaineCare are at risk of the diseases caused by tobacco, but they lack the dental coverage to maintain their oral health.
It should come as no surprise that tobacco is destructive to the mouth, since tobacco and its byproducts damage all cells and tissues with which they come in contact. The damage done to tissues in the mouth is complex and multifaceted. It includes reduced healing capacity, damaged blood vessels and blood flow, and an impaired immune system to fight disease in the mouth.
Studies have shown a direct correlation between the number of cigarettes a person smokes in a day and the severity of gum disease. Other studies have shown a direct correlation between the amount of smoking and the loss of healthy bone tissue. It is bone that anchors your teeth in your mouth.
Once tobacco has caused gum disease, the body’s natural response is to repair those tissues. However, in a smoker, the ability to respond to the damage is significantly impaired, resulting in speedier disease progression. In addition, treatment for gum disease is not as effective in smokers as it is in nonsmokers.
There have been some studies showing increased amounts of tooth decay in smokers compared to nonsmokers. There are even studies that show that children who are exposed to secondhand smoke in their homes are at increased risk for tooth decay. One explanation is that the bad bacteria that causes tooth decay flourishes when exposed to tobacco smoke.
Of course the most disconcerting effect of tobacco on tissues in the mouth is oral cancer. Studies show that oral cancer rates are almost 20 times higher in smokers than in nonsmokers, and that 75 percent of oral cancers are found among people who both smoke and consume alcohol regularly.
The use of chewing tobacco, which is becoming more widespread particularly among teens, has very detrimental effects on oral health. Chewing tobacco is linked to cancers of the tongue, lip, mouth and several others. It also is associated with gum disease. Chewing tobaccos are often flavored with sugar, increasing the risk of tooth decay. Chewing tobacco is not a safe alternative to smoking.
And when it comes to tobacco use, the apple doesn’t fall far from the tree. Children of smokers are much more likely to become smokers themselves. Tobacco use results in a terrible cycle of oral and dental disease that disproportionately effects low-income populations. This is a cycle that can be halted simply by quitting the tobacco habit.
If the citizens of Maine are truly interested in improving their oral health, the first and simplest thing they can do is stop smoking. Instead of focusing on training more dental providers as a solution to a preventable disease, we should instead focus on the simple things we do that harm us and start to break the cycle of disease.
Pediatric pediatric dentist Jonathan Shenkin practices in Augusta and serves on the faculty of Health Policy and Health Services Research at the Boston University School of Dental Medicine.