Protecting your oral health: the risks of tobacco use and DIY dentistry

The United Nations' Sustainable Development Goals target healthy lives and wellbeing for all, at all ages by 2030.¹ Close to 3.5 billion people worldwide are affected by oral diseases; however, oral health is an integral part of overall health.^2,3 Factors such as minimal access to dental services, poor doctor:patient ratio, burden of care, heterogeneous distribution of service providers, low oral health literacy rate, old beliefs can result in poor oral health^4,5 and different attitudes towards oral healthcare in various rural and urban regions.

The information technology boom has resulted in much freely available, but unverified information, which may lead to potential risk and irreversible damage, when applied practically. People indulge in DIY methods to save on costs, often ignoring the potential for irreversible damage.

Tobacco consumption prevalence has breached 22% globally, with 28% in urban India and 42% in rural India.^6,7 With much land suitable for farming in India, agriculture is a dominant sector, employing 45 million people.⁸ Tobacco is a short-duration, drought-tolerant cash crop that can be grown on soils where other crops cannot be cultivated profitably. Low production costs and high export market value makes its production feasible. India is a global leader in tobacco production and derives 1.1% of its GDP from it.

However, tobacco has serious ill effects on general and oral health, including cancer, heart diseases, oral cancer, gingival keratosis, and accounts for 8 million deaths across the globe, and 1.35 million deaths in India every year.⁹

In the past, tobacco was extensively chewed/smoked and people were unaware of the health complications. Although this cannot be said now, a huge global advertising budget combined with a lack of literacy and health awareness has resulted in the continuation of the habit, leading to serious dental issues, including sensitivity, staining, surface damage and erosion.

Consumption of noxious substances causes dental problems, such as tooth staining, halitosis, enamel erosion and inflammation of periodontal tissues, along with a financial burden for treatment. Fearing reprimand from parents and guardian, and the additional monetary burden for professional treatment, the adolescent consumer often resorts to home approaches to obscure the habit.

A UK survey found that 34% of 16–24 year olds resorted to DIY dentistry because of lack of access to dental care.¹⁰ The emergence of the COVID-19 pandemic further restricted access to professionals and expanded the scope of DIY dentistry. Methods included a mixture of baking soda and hydrogen peroxide, coconut oil pulling, apple cider vinegar, lemon and orange peels, charcoal, and scraping the tooth surface with sharp instruments. These methods can trigger undesired reactions within dental tissues, including surface alterations of enamel and a reduction in thickness, as illustrated in Figures 1–3. In this case, the patient resorted to using a knife to remove tobacco stains, inadvertently causing the damage. The teeth became more prone to sensitivity, caries and developed a yellowish tinge because dentine was exposed owing to the loss of enamel.

In India, the government actively promotes awareness about the ill effects of tobacco use and there are also help to quit programmes. The National Tobacco Control Program is being conducted at national, state and district levels,¹¹ with a focus on literacy promotion, emphasis on oral and systemic health, and regular check-ups. The government is sponsoring pictorial warnings and advertisements, and increasing taxes and vigilance to prevent exposure of tobacco to minors. It has been found that a tax increase that increases tobacco prices by 10%, decreases tobacco consumption by approximately 4% in high-income countries, and by about 5% in low- and middle-income countries.⁶

World No Tobacco Day, implemented by the WHO on 31st May 1987, and celebrated every year since, raises awareness of the ill effects of tobacco use. The WHO implemented MPOWER measures to control tobacco use in 2007, including monitoring its use and prevention policies, offering help to quit, and enforcing bans on tobacco advertising, promotion and sponsorship, and by raising taxes on tobacco products.¹²

Dental health professionals should also actively participate in tobacco cessation programmes and activities, with counselling for every patient. FDA-approved substances, such as nicotine patches, chewing gums, sprays and inhalers, and drugs such as varenicline tartrate and bupropion hydrochloride, must be promoted to help patients quit tobacco habits. Early detection of lesions and appropriate action is required to prevent lesions from progressing. Awareness of oral health and dental treatment services, at all levels, should be improved to ensure access for all. Adequate resource allocation, provision of professional dental care in rural areas and improving awareness about dental hygiene and its importance is also key to minimizing the risks associated with DIY dental care.