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ลำดับตอนที่ #4 : Smoker

A person's increased risk of contracting disease is directly proportional to the length of time that a person continues to smoke as well as the amount smoked. However, if someone stops smoking, then these chances gradually decrease as the damage to their body is repaired. A year after quitting, the risk of contracting heart disease is half that of a continuing smoker. The health risks of smoking are not uniform across all smokers. Risks vary according to amount of tobacco smoked, with those who smoke more at greater risk. Light smoking is still a health risk. Likewise, smoking "light" cigarettes does not reduce the risks.

Tobacco has been variously hailed as a gift from the gods, a miraculous cure-all for life's physical ills, a solace to the lonely soldier or sailor, a filthy habit, a corrupting addiction, and the greatest disease-producing product known to man. This diversity of opinion has continued unchanged for centuries and has appeared until very recently to be little affected by research results from more than 900,000 papers thus far published on the topic. It is common knowledge that cigarette smoking is the single major cause of cancer and cardiovascular disease in the United States, contributing to hundreds of thousands of premature deaths each year, yet one-fourth to one-third of American adults continue to smoke. 

The dental profession has been repeatedly warned against the use of tobacco, perhaps accounting for the very low proportion of dentists (6-8%) currently considered to be regular users.  More than 130 years ago Brodie was telling dental surgeons that "the use of tobacco in any ordinary way, by the dentist, is a practice which we consider reprehensible in point of propriety and etiquette. It is in all cases offensive and disgusting."  He emphasized that patients should not be forced to tolerate a dentist's "smoker's breath" or spitting. "How a dentist of any refinement can persist in such an infliction upon his patients is more than we can comprehend."  Today, of course, we are more concerned about the health effects and addiction potential of tobacco use by out patients, but our concern is no less ardent. 

It is especially important to understand that harmful effects of tobacco products are dose-dependent, that they depend more on abuse than on simple use. In this light its addicting aspects acquire ominous overtones. The nicotine found in substantial amounts in tobacco products is widely considered to be a powerfully addicting drug, so much so that its addictive processes and potential have been equated with heroine, morphine and cocaine. It's rapid absorption through the lungs of cigarette smokers is widely accepted, but its equally ready absorption through the oral mucosa under the alkaline conditions normally found in cigar, pipe and smokeless tobacco use is less publicized. Once in the blood stream, of course, nicotine acts on the central nervous and cardiovascular systems in identical fashion regardless of the method of absorption. 

These systemic effects have been extensively explored and reported, but the local oral effects of various tobacco habits have received little attention outside of the potential for cancer. The purpose of the present article is to summarize current concepts of such local effects, especially the nonmalignant changes in the mouth.