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Copy of Neoplasia-Tobacco Use

Pathology Neoplasia-Tobacco Use Presentation

Gabriela Salvadori

on 1 March 2013

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Transcript of Copy of Neoplasia-Tobacco Use

Tobacco Use By: Lizzie Glick, Melana Iseminger,
and Staci Funkhouser - Spit tobacco contains nicotine and can become addictive when used.

• Spit tobacco contains at least 28 cancer-causing chemicals such as benzopyrene and formaldehyde.
- Formaldehyde is a chemical used to preserve dead bodies and dead animals.
-Spit tobacco contains 3,000 other chemicals such as acetone (paint stripper), ammonia (toilet bowl cleaner), and cadmium (battery acid).2

**In the U.S., an estimated 3.3 percent of adults are current smokeless tobacco users; use is much higher among males than females (6.5% vs. 0.4%). Amongst specific populations, American Indian/Alaska natives have the highest use (7%) followed by white males (4.3%). Tobacco Use- Chew/Smokeless Tobacco -a new growth of cells
- occurs in response to a stimulus but does
not stop when the stimulus is removed
*The stimulus is usually unknown or encountered many years prior to growth Neoplasia **The most common form of snuff is moist snuff. Moist snuff is a fine-grain tobacco, kept moist in tins or plastic cans.

• Snuff may also come prepared in small teabag-like pouches called sachets. Tobacco Use- Chew/Smokeless Tobacoo - Benign-- do not have an effect on the host unless they impinge on a nerve or vital organ

- Malignant-- grow more rapidly and invade surrounding tissue; can be fatal if not detected.
-they can become fatal if they are allowed to metastasize (spread through the body). Neoplasm Groups Neoplastic growth occurs from neoplasm

- Occurs when a genetic mutation interferes with
the regulation of normal cell growth Tobacco Use- Chew/Smokeless Tobacco Tobacco Use- Cigarette - Tobacco found in cigarettes is a green leafy plant that is generally grown in warmer climates.

-The farmers use fertilizers to enrich the soil and use insecticides to kill the insects that eat the tobacco plant.

-After the plants are picked, machines break the plants down into smaller bits and pieces which are then ran through artificial flavoring and chemicals to keep them burning, otherwise the burning tobacco would go out pretty quickly. Tobacco Use- Chew/Smokeless Tobacco Tobacco Use- Cigarettes Continued... * An estimated 45.3 million people, or 19.3% of all adults in the United States smoke cigarettes.

* Cigarette smoking is more common among men than women with 21.5% of men smoking cigarettes and 17.3% of women. ** "Each year, smoking kills more people than AIDS, alcohol, drug abuse, car crashes, murders, suicides, and fires -- COMBINED!" -oralcancerfoundation.org • Other snuff is dry and powdery and can be snorted or used orally.

• Chewing tobacco is most often a shredded or leafy form of tobacco usually available
in pouches. -Gruen Von Behrens story The Gruen Story Continued:

One week later a 17 year-old boy would undergo 13 hours of surgery followed by a month of recovery in the hospital. Then came the radiation treatments. Within six weeks he'd lose 70 pounds, lose the skin on his face, his mouth would become a blistery white mess and his teeth would rot.

At 19 "doctors transplanted three inches of bone from his back to his face to give him a jaw. The transplant lasted two days. Then his body rejected it.” Tobacco Use: Hookah -Most hookah smokers are between the ages of 18 and 25

Water Pip smoking delivers the addictive drug addictive drug nicotine and is at least as toxic as cigarette smoke Tobacco Use- Hookah - Most people who smoke the hookah consider it to be less harmful than smoking cigarettes, but it actually carries many of the same health risks as cigarettes.

-Due to the mode of smoking-- along with the frequency of puffing, depth of inhalation, and length of the smoking session-- Hookah smokers may absorb higher concentrations of the toxins found in cigarette smoke. Smoking Related Lesions Nicotine stomatitis:

- Often referred to as “pipe smoker’s palate” or smoker’s palate. It is a Benign condition caused by heavy pipe or cigar smoking.

Hyperkeratotic response due to heat generated from smoke. Hard palate is an overall grey-white appearance, with raise gray-white nodules. https://www.dcpbites.com/uploads/podcourse/listen_img/21_1_Oralcancer1.jpg http://www.healingtalks.com/wp-content/uploads/2010/09/whats-in-a-cigarette1.jpg http://www.darkgovernment.com/news/wp-content/uploads/2012/04/constituants-cigarette.jpg http://images.publicradio.org/content/2010/11/06/20101106_smokeless-tobacco_33.JPG http://www.tobaccofacts.info/images/20050817-oral-cancer-3.jpg http://umatter.us/wp-content/uploads/2010/10/tobacco1.jpg http://farm5.staticflickr.com/4148/5091124027_2e0f5c50f0_z.jpg https://files.nyu.edu/ap2427/public/images/hookah_parts.jpg - A typical 1-hour hookah smoking session involves inhaling 100-200 times the volume of smoke inhaled from a single cigarette.

- The charcoal used to heat the tobacco in the hookah increases the health risks by producing high levels of carbon monoxide, metals, and cancer-causing chemicals. Smoking Related Lesions Cont... Smoker’s Melanosis:

- Occurs more often in women than men.

-Gray to brown pigmentation found on the anterior labial gingiva.

-There is some correlation between the female hormones combined
with smoking that causes the pigment change. Tobacco Related Lesions Tobacco Pouch Keratosis:

- Also known as “spit tobacco keratosis” and “tobacco chewers white lesion” .
- Caused by habitually placing chew tobacco in the same area in the mucobuccal fold.
White, corrugated or wrinkled area where tobacco has been placed.
- When patient stops the use of spit tobacco, the tissues should return to normal.
- If not, a biopsy is necessary to make sure the area is not cancerous. Tobacco Related Lesions Leukoplakia:

- Clinically termed “white patch” is used to identify a white lesion that the cause is not known.

- No histologic description for clinical leukoplakia but there are several diagnoses that can be make from a biopsy or microscopic examination of any lesions in questioning. Tobacco Related Lesions - Malignant tumor of squamous epithelium.

- Started as subtle white lesions which cause could not be determined. Tobacco Related Lesions Verrucous Carcinoma: Tobacco Cessations - Improvements in pulmonary function can be observed in less than 3 months; at 1 year cardiovascular improvements can be seen and by year 10, compared to smokers, there is a significantly reduced risk of cancers, with the risk of lung cancer decreasing my 30%-50%. Tobacco Cessation Cont... - Advising patients to quit is a professional responsibility of the dental team.

- An outcomes analysis of a number of trials found that a 10%-15% quit rate can be anticipated by incorporating an effective cessation program into the dental office. Tobacco Cessation Cont.... Clinical practice guidelines recommend the use of the steps in the 5A’s: Diagnosis is based on the unique clinical appearance and the patients history of smoking. Condition is totally reversible if smoking is stopped. http://www.uiowa.edu/~oprm/AtlasMAC/N/NicotinicStomatitis1.jpg http://gr.dentistbd.com/smoker%E2%80%99s-melanosis-ppt.html http://drbarunsarkar.blogspot.com/ http://img.tfd.com/mosby/thumbs/500142-fx7.jpg Squamous Cell Carcinoma: - A definitive diagnosis can’t be made based on clinical features alone.

- Many patients are unaware that the lesion is even present. http://www.entusa.com/oral_pictures_htm/images/20071112-oral-cancer_small.jpg - “Snuff dippers’ cancer” is considered a low grade form of squamous cell carcinoma.

- Differentiated from squamous cell carcinoma because tumor cells don’t penetrate basement memebrane, usually doesn’t metastasize, and
therefore has a better prognosis. - Clinically appears as a slow growing tumor with a white & red pebbly surface. http://oralmaxillo-facialsurgery.blogspot.com/2010/05/smokeless-tobacco-lesions.html http://www.lchdky.org/smoking_absence_3_op_413x600.jpg - The longer the individual has been abstinent from tobacco use, the lower the risk for periodontal disease, and the lower the incidence of oral mucosal lesions.

- Former smokers can achieve a positive response to periodontal therapy, and a healing response similar to nonsmokers. Step 1: Asking
Step 2: Advising
Step 3: Assessing
Step 4: Assisting
Step 5: Arranging follow-up and support Tobacco Cessation Cont... Types of Medical Tobacco Cessation: Tobacco Cessation Cont... - Bupropion: originally developed as an antidepressant, can double the cessation rate compared with no intervention or placebo. It is a sustained release tablet taken twice daily and believed to work by reuptake inhibition of dopamine and noradrenalin.

- Varenicline: has been shown to increase the 1 year quit rate 2-3 fold compared with no pharmacological intervention, and to result in a higher quit rate for smokers than obtained with bupropion. It reduces the pleasure of smoking and helps reduce withdrawal symptoms. Tobacco Cessation Cont... Government resources:
FDA 101: Smoking cessation products

Other resources:
American cancer society
American Heart Association
American Lung Association - Nicotine replacement therapy (NRT):

- Provides controlled doses of nicotine to relieve withdrawal symptoms, and can increase cessation rates by 150-200%.
- Available as transdermal patches, gum, and losenges.

- Long term use of NRT may be necessary for highly addicted smokers to maintain tobacco abstinence. http://www.cignaturemagazine.com/wp-content/uploads/2011/11/nicotine-replacement-therapy.jpg FDA-approved non-NRT medications: http://blog.lib.umn.edu/alah0007/myblog/Stop%20Smoking.jpg http://www.youthchg.com/images/posters/poster153big.jpg http://reason.com/assets/mc/jsullum/2011_06/hookah-bar.jpg Chemicals in Smoking Tobacco -Tar
-Arsenic- mix of harmful chemicals
-Benzene- refined from crude oil
-Cadmium- used in batteries
-Formaledehyde- used in mortuaries
-Polonium-210 – highly radioactive
-Chromium- used to make dyes
-1,3 buadiene- used to make rubber
-Polycyclic armonatic hydrocarbon-(PAHs) group of dangerous DNA-changing chemicals Chemicals in Smokeless tobacco -Cadmium: used in car batteries
-Formaldehyde: embalming fluid
-Lead: a poison
-Nicotine: an addictive drug
-N-Nitrosamines: cancer-causing chemical
-Polonium 210: nuclear waste Bodies Natural Defense Against Cancer Genes are composed of molecules of DNA

•Protooncogenes act to regulate the growth of the cells

•Tumor suppressor gene that produces substances that inhibit uncontrolled growth

•Caretaker and Mutator genes
IF anything interferes with these genetic controls, neoplasia can occur. Development or Process of Cancer Growth Proto-oncogenes, tumor-suppressor genes, caretaker or mutator genes are essential to control cellular growth
If proto-oncogenes mutate, they become oncogenes which encourage/accelerate growth of a cell.
Most Common Proto-oncogene mutations
-Alter one or two nucleotide base pairs from DNA strand
-Translocation of genetic material from one chromosome to a different chromosome.
When tumor suppressor genes are inactivated by genetic mutation, cell division and growth can also go unregulated. -Nitrosamines- DNA- damaging
-Acrolein- Formerly used as chemical weapon
-Nicotene- highly addictive drug to keep smokers hooked
Carcinogens- Cancer-causing http://www.google.com/url?sa=i&rct=j&q=tobacco&source=images&cd=&cad=rja&docid=MrhaaaDwiwBCIM&tbnid=CmwFS1o6QwAXHM:&ved=0CAQQjB0&url=http%3A%2F%2Fwww.talktofrank.com%2Fdrug%2Ftobacco&ei=35kZUfW9F4SiqQGatIHIDg&psig=AFQjCNE6e8qkiuSi-EBhr1Fe0svKJVWjXQ&ust=1360718670771191 -Acetaldehyde: irritant
-Hydrazine: toxic chemical
-Benzopyrene: cancer-causing chemical
-Uranium 235: used in nuclear weapons
-Sodium: salt, can cause high blood pressure
-Sugar: can cause cavities
-Fiberglass and Sand: abrasives http://www.google.com/url?sa=i&rct=j&q=tobacco%20chemicals&source=images&cd=&cad=rja&docid=kbopM3nLH0ffBM&tbnid=6s1Jyr-vqhm3sM:&ved=0CAQQjB0&url=http%3A%2F%2Fwww.ehow.com%2Ffacts_7376901_chewing-just-harmful-smoking-cigarettes_.html&ei=FJUZUYXLM4jdrAHO6YH4CQ&psig=AFQjCNG3mkdmWZOhs0dz2NxP0_F0JjWJIA&ust=1360717266207751 http://www.google.com/url?sa=i&rct=j&q=protooncogenes&source=images&cd=&docid=sJdKTACxgBt7cM&tbnid=rzdQ8WRAWQfDgM:&ved=0CAQQjB0&url=http%3A%2F%2Fwww.cancer.gov%2Fcancertopics%2Funderstandingcancer%2Fcancergenomics%2FAllPages&ei=VJsZUdD-PMqaqQGus4Bw&psig=AFQjCNFzslqqmjKCAVrSHZQ3FXibSnPbfw&ust=1360718920725287 Line of Defense
Caretaker or mutator genes -Contained in the genetic material of every cell. -Supervise the DNA integrity and regulate repair or destruction of involved cells -If all the mentioned genetic functions are lost, cells with errors in DNA will be allowed to replicate -If errors involve a neoplastic change, neoplastic growth will occur. -**Genetic mutations ( which can be caused by carcinogens in tobacco) are involved in the initiation of neoplasia.** Citations Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 13 Dec. 2012. Web. 12 Feb. 2013. <http://www.cdc.gov/tobacco/data_statistics/fact_sheets/index.htm>.

Collins, Fiona M. "Tobacco Cessation and the Impact of Tobacco Use on Oral Health." (n.d.): n. pag. Web. 7 Feb. 2013. <chfs.ky.gov/NR/rdonlyres/31D160F5-8270.../TobaccoCessation.pdf>.

DeLong, Leslie, and Nancy W. Burkhart. General and Oral Pathology for the Dental Hygienist. Baltimore, MD: Lippincott Williams & Wilkins, 2008. Print.

The Gruen Von Behren Story." The Gruen Von Behren Story. N.p., n.d. Web. 12 Feb. 2013. <http://www.hypnotismwithattitude.com/hypno2_013.htm>.

"Hookah: A Disturbing Trend." N.p., n.d. Web. 12 Feb. 2013. <http://www.lung.org/associations/states/oregon/assets/docs/programs/tobacco/alao-hookah-fact-sheet.pdf>. Citations Cont... Ibsen, Olga A.C. "Diagnosing Smoking-Related Lesions." Dimensions of Dental Hygiene. N.p., n.d. Web. 7 Feb. 2013. <http://www.dimensionsofdentalhygiene.com/>.

"Quit Smoking Resources." CDC - How to Quit Smoking. N.p., 31 Jan. 2013. Web. 7 Feb. 2013.

"Smoking and Cancer: What's in a Cigarette?" : Cancer Research UK. N.p., 25 May 2012. Web. 7 Feb. 2013. <http://www.cancerresearchuk.org/cancer-info/healthyliving/smokingandtobacco/whatsinacigarette/smoking-and-cancer-whats-in-a-cigarette>.

"Types of Tobacco." Types of Tobacco. Oral Cancer Foundation, 13 Sept. 2010. Web. 12 Feb. 2013. <http://oralcancerfoundation.org/tobacco/types_of_tobacco.htm>. http://24.media.tumblr.com/tumblr_m7c65yAvyG1rn2f0oo1_500.gif http://www.cheapcigarettes4you.com/images/pictures/news/smoke-rings-(page-picture-large).jpg
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