Licit or illicit, the real thing or a substitute: All Tobacco is harmful - World No Tobacco Day (31 May)

The Australian Dental Association (ADA) is urging Australians to steer clear of all forms of Tobacco as part of World No Tobacco Day (WNTD). WNTD this year is focusing on the illicit trade of tobacco products, which essentially involves the international movement of contraband and counterfeit cigarettes. Illicit tobacco accounts for as much as one in every 10 cigarettes consumed globally and impacts on the level of tax and customs revenue generated which could otherwise be dedicated to public health programmes.

Illicit tobacco is part of the global tobacco epidemic that kills nearly 6 million people each year, of which more than 600,000 are non-smokers dying from breathing second-hand smoke. Unaddressed, the epidemic will kill more than 8 million people every year by 2030.

Dr Peter Alldritt, Chair of the ADA's Oral Health Committee said "while we urge policy makers to prioritise ending the illicit trade of tobacco products, we also want to get the message out there during WNTD that whether tobacco is illicit or not, all tobacco use (including substitutes) is harmful to a person's health."

Tobacco is one of the major factors contributing not only to cardiovascular disease and lung disease but also to increasing the risk of periodontal (gum) disease and oral cancer. Every day, at least three Australians are diagnosed with oral cancer. Oral cancer is a very aggressive disease which often goes undetected until it is at an advanced stage; with a survival rate of only 50% over 5 years.

The signs and symptoms of oral cancer include:

• A sore, irritation, lump or thick patch in the mouth, lip, or throat
• A chronic ulcer or blood blister in the mouth that does not heal
• Difficulty chewing or swallowing
• Difficulty moving the jaw or tongue
• Prolonged swollen glands
• A sore throat that does not go away
• Difficulty speaking, or a change in the voice
• Numbness in the tongue or other areas of the mouth; and
• Swelling of the jaw that causes dentures to fit poorly or become uncomfortable.

Dr Alldritt continued: "While Australians in recent years have reduced their use of tobacco, we cannot be complacent. There are anecdotal reports suggesting that the use of e-cigarettes and water pipe smoking (also known as nargila, argileh, hubble bubble, hookah, shisha and goza) is a form of soft-substitution for traditional tobacco smoking.

"Let's set things straight: a water-pipe smoker may breathe in as much smoke during a typical one-hour session as a cigarette smoker would inhale from 100-200 cigarettes. Water-pipe smokers of either tobacco or non-tobacco products face the same health risks as cigarette smokers, including cancers, heart disease, lung disease and problems in pregnancy such as low birth weight."

While non-tobacco water pipe smoking may not contain the nicotine found in tobacco, the smoke contains highly toxic substances. The addition of fruit flavouring and sweeteners does not reduce the harmful effects of the smoke.

There is also little research on nicotine delivery systems (e-cigarettes) effects on the long term health risks to users and non-users and almost nothing on the oral health effects of the contents.

Dr Alldritt concluded: "In the interest of public health, there must be greater focus and investment into researching the health impacts of e-cigarettes. If history is any indication, it is highly likely that the results won't be good."