The re-packaging of tobacco under plain covers and the hiding away of cigarettes behind metal grills can only add to the branding of cigarettes as dangerous products; however a rose by another name may indeed smell sweeter.

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There has been an upsurge in ‘new’, ‘natural’ and ‘healthier’ products that can be smoked, vaped, chewed and dissolved and these are increasingly appealing (and being marketed towards), younger non-smokers.

When patients first come to the periodontist a medical history form asks if and how much is being smoked because this can affect gum disease, healing after surgery and longevity of implant placements.

But what of these other tobacco ‘substitutes’ and indeed are they substitutes at all? What impact do these alternatives have on health and in particular oral health?

SHISHA – heats the tobacco which may be fruit flavoured to make it palatable. The fumes are passed through water, which contrary to popular belief, does not remove toxins. The fact that it is cooler allows it to be inhaled more deeply. The average shisha burns for up to one hour allowing a longer smoking experience. A one hour shisha session can allow a smoker to take in a volume of smoke 100 times greater than an ordinary cigarette.

VAPING – An Electronic Nicotine Delivery System (the euphemistically named ENDS), is also known as vaping as the nicotine, without the carbon monoxide, tar and other cigarette constituents is vapourised before inhalation. Those ‘for’ and ‘against’ e-cigarettes agree that for pre-existing smokers this is the better option. However the vapour still contains carcinogens in the form of nitrosamines and other constituents such as glycol an ingredient found in antifreeze. Concerns have been raised because the flavouring of e-cigarettes with vanilla, cherry and other flavours may also appeal to younger smokers as alco-pops appealed to younger drinkers. Some of the liquids may contain high levels of nicotine and the fact that you can smoke on demand for long periods can end up delivering larger doses of nicotine compared to normal cigarettes.

SNUS – are a Swedish invention and come in a lozenge form which is placed between the check and upper lip against the mucosa. Each SNUS delivers the equivalent of one cigarette and are recommended for those smokers who are giving up but crave nicotine. However they are not harmless, they can cause tooth decay, oral lesions which are irreparable and gingival/gum recession.

KRETEKS – a ‘herbal’ alternative to tobacco also known as ‘clove cigarettes’. These are mixtures of tobacco (70%) and crushed cloves and clove oil. They also contain eugenol which is an anaesthetic which numbs the airways allowing the smoke to be inhaled more deeply.

BIDIS – a hand rolled flavoured-tobacco cigarette that can appeal to a younger audience as they look a bit like reefers. The leaf covering is non-porous which allows a higher dose of nicotine, tar and carbon monoxide to the smoker.

As dental practitioners form part of the raft of health professionals who have a role in encouraging patients to give up harmful habits it would be useful if we are aware of these newer products and the effects upon health (oral and otherwise) that they have.
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