Running Head: NICOTINE-CONTAINING PRODUCTS 1

Running Head: NICOTINE-CONTAINING PRODUCTS 1

NICOTINE-CONTAINING PRODUCTS 8

Nicotine-Containing Products

Andrea Gonzalez

Kelly Polo

Miami Dade College

Introduction

Nicotine is a chemical compound that is alkaloid in nature and is produced naturally by the tobacco plant. When inhaling or smoking, this compound reacts with the para sympathomimetic nervous system, bringing a stimulating effect. This active compound in tobacco is abused mainly through smoking, sniffing, and chewing. Evidence has proved that nicotine is one of the largest leading addictive substances, with an addiction rate as high as heroin. It is a thousand times as potent as other products such as alcohol, amphetamines and morphine and one of the major cause of diseases in the world. Currently 47.5% of men and 10.3% of women in the world are smokers. In addition to teeth discoloration and dental caries, tobacco smoking also causes periodontitis, halitosis, altered taste, and nicotinic stomatitis. (Mubeen, Chandrashekhar., Kavitha & Nagarathna., 2013).

There are several sources that have nicotine. The major classification of nicotine sources includes smoked and smokeless sources. Under the smoked form of tobacco, nicotine is obtained after the combustion of the products, which emits smoke that carries the nicotine contents. In addition, this class is associated with cigars, which contains oxidative combustion or burning and liquid tobacco forms (vaporizers and e-cigarettes), in which heat is used to atomize the nicotine without the actual oxidative combustion. These non-combustible nicotine sources (electronic nicotine delivery systems-ENDS) have been indicated as a safer source and is utilized in replacing the inhaled tobacco smoke as nicotine. Ideally, it’s used in the treatment of those patients have tobacco addictions, replacing the effects of nicotine without necessarily exposing the patient to the harmful effects of tobacco smoke (Marynak, et. al, 2017). Smokeless tobacco are substances that contain nicotine and it’s absorbed into the blood system via other means rather than smoking and they are called snus and strips. This paper will focus on smokeless nicotine-containing compounds, such as, snus, orbs strips, and hookahs, which are the newer forms of tobacco that are trending.

Background

Snus are a manufactured compound that contain considerable levels of nicotine or other harmful chemical compounds and are designed in a way that releases them in low doses. However, nicotine from snus can be released in high doses as well. The implication is that it will cause dependency upon the user but avoids the causation of cancer and respiratory diseases as well as smoked tobacco. On the contrary, the use of snus has minimal cardiovascular risks and effects to the fetus when used by pregnant mothers, although, the risk is much lower when compared to smoking. The mode of administration of nicotine in snus is dependent on the form in which the compound exists, either moist, dry, or snus. In moist tobacco, a pinch-sized amount is applied between the upper lip and the gum and must be spat while it is dry. It can be placed on the mouth or inhaled and snus’ pinch is located between teeth or gum and cheek without necessarily having to spit. The nicotine in the snus rapidly diffuses to the blood circulation where it acts on its receptors; quickly dissolving after ten minutes. Research has shown the use of snus that has assisted a substantial proportion of smokers including a 30% that quit smoking tobacco thus, reducing lung cancer or myocardial infarction risks, especially in men who were smokers (Fried, 2015).

The other form of the smokeless nicotine source is dissolvable tobacco. In this case, the tobacco that is finely ground is compressed into different forms and shapes including tablets, orbs, sticks, strips, and lozenges. These products slowly dissolve in the mouth, and after dissolving, these compounds take varied time to be absorbed into the circulation. For instance, orbs take fifteen minutes for complete absorption, while strips take three minutes. The rapid absorption of nicotine with smokeless tobacco causes the risk of nicotine overdose. The amount of nicotine in these products is one milligram, which can be considered a nicotine overdose preventive measure. An overdose of nicotine, especially in children, has been associated with side effects such as abdominal cramps, tremors, drooling, nausea, vomiting, agitation and in serious extremes, seizures, coma and death (Berg, et. al, 2015).

Hookah on the other side is different from snus, strips, orbs, and sticks and very similar to cigarettes. Hookah, which is commonly referred to as “shisha”, is just like smoking a cigarette. However, the content of tobacco in shisha is 30%, and the other constituents are flavored, from fruits, molasses, or honey. Shisha is considered by many as considerably harmful and addictive when smoked. It has been estimated that an average hookah bowl has as much nicotine as one pack of twenty cigarettes. This implies that when a person spends one-hour smoking hookah, they are exposed to a hundred to two-hundred times more smoke than compared to a single cigarette (Fried, 2015).

Discussion

Nicotine is regarded as a potentially harmful substance that has been known to exist and has numerous side effects which cut across the entire body systems. E-cigarette exposure makes people be at risk of addiction and other side effects. Despite the means in which the nicotine accesses the body, the extent of the Central Nervous System (CNS) effects remains the same with additional effects that may occur at the point of contact in the bloodstream. For instance, when smoked, lethal effects occur on the entire respiratory system. When sniffed the nose and upper respiratory system are highly affected, the same way that chewing affects the mouth to a greater extent (Berg, et. al, 2015). The effects of the nicotine occur on the teeth and the gingiva. Teeth stains and dental caries are among the prevalent effects of the tobacco on the teeth. The tobacco stains is black or brown color, an extrinsic stain that attaches itself on enamel of the tooth. the stain is due to the tar and nicotine components of the tobacco and the reaction between furfural and acetaldehyde, components of tobacco to amino group of pellicle glycoprotein. The chewable forms of tobacco have additional ingredients for sweetening, flavoring and other products that may cause abrasion during chewing. The oral effects of the tobacco in the buccal cavity that may cause teeth pathology includes; mucosa drying effects, High temperature in the mouth, change in the intraoral Ph, irritation of the oral mucosa, local alteration of the mucosal barriers and altered protection of the body to external pathogens (Mubeen, Chandrashekhar., Kavitha & Nagarathna., 2013).

There is high likelihood of loss of the alveolar bone resulting in deeper pockets as compare to the non- smokers. 80% of the prevalence of oral cancers such as oral squamous carcinoma is attributed to tobacco use. Early or advanced stages of the cancer causes loss of teeth and pathological fracture of the alveolar bone. Presence of more than 55 carcinogenic products in the tobacco smoke is cause of worry for not only the oral health but also the general health of an individual. (Vellappally, Fiala, Šmejkalová, Jacob & Shriharsha, 2007).

Apart from being a CNS stimulant, nicotine has lethal side effects on other systems such as cardiovascular system, heart, endocrine/ hormones, and gastrointestinal system. While nicotine is implicated to cause improved memory and concentration, its addition is compared to that of heroin. The implication of this is that it is difficult to cease using tobacco once a person becomes addicted (Marynak, et. al, 2017).

Once it is consumed, nicotine’s immediate results are associated with sedation and stimulation. This occurs because of the adrenal glands that release adrenaline upon stimulation. With the secretion of adrenaline, various physiological processes are altered. First, the body releases glucose from which “stores” supports the subsequent rise in the heart rate, respiration rate and blood pressure. The surge in blood glucose levels is also as a result of suppression of the pancreas secretion of insulin, and the hormone that is responsible for increased utilization of blood glucose. The high pleasure and motivation that come with the use of this compound come as a result of stimulation of the brain system to produce dopamine, which controls emotions, movements, as well as pain and pleasure perception. Whether nicotine taken produces stimulant or sedation depends on the amount of nicotine taken. (Adam Felman, 2018).

Furthermore, nicotine has been associated with increased memory and concentration. The stimulation of the higher centers to release acetylcholine and norepinephrine, brain substances that are responsible for feeling awake or aroused. Other studies have also shown there is a reduction in anxiety levels from a person with nicotine intake due to the production of beta-endorphin. (Adam Felman, 2018).

The high prevalence of nicotine containing products use in the world puts more people at risk of dental related morbidity in addition to other general body conditions including carcinoma. Therefore, the dental professional’s role or the role of any healthcare provider is to identify patients that consume any of these products that contain nicotine in order to counsel them and educate them. It is highly important to encourage them to stop consuming these products and to provide studies, research, information, and facts about how harmful nicotine containing products are to your health. In addition to create awareness among your patients, it is crucial to provide support and addition professional help is it is necessary. Patients should know that there are ways to help them stop as well as, having a team that supports them and push them further to make the right decision. Healthcare providers have a task of creating awareness on the effects of nicotine containing products to oral health in a effort to tame high prevalence of tobacco related morbidity and mortality.

Conclusion

In conclusion, it is clear that the using of tobacco leads to severe oral and dental outcomes whether smoked and smokeless sources. The effects are dose dependent with more effects occurring to an individual with prolonged exposure. Major effects include teeth discoloration, abrasion, dental caries and tooth loss. The high prevalence of tobacco use in the world puts more people at risk of dental related morbidity in addition to other general body conditions including carcinoma. Based on scientific research and public health concerns of the growing risks for smoking cigarettes such as respiratory and cardiac diseases, there was the need to develop newer nicotine-containing products to offset the burden of smoke related diseases. Recently, various nicotine-containing products have been made, although the risk of the addition of nicotine remains high with overdose and dependence. References

Adam Felman (2018). Everything you need to know about nicotine. Retrieved from https://www.medicalnewstoday.com/articles/240820.php

Berg, C. J., Stratton, E., Schauer, G. L., Lewis, M., Wang, Y., Windle, M., & Kegler, M. (2015). Perceived harm, addictiveness, and social acceptability of tobacco products and marijuana among young adults: marijuana, hookah, and electronic cigarettes win. Substance use & misuse, 50(1), 79-89.

Fried, J. L. (2015). The Changing Landscape of Tobacco Products:“Vaping”, Smoking, and Chewing. Retrieved fromhttp://hdl.handle.net/10713/4832

Marynak, K. L., Gammon, D. G., Rogers, T., Coats, E. M., Singh, T., & King, B. A. (2017). Sales of nicotine-containing electronic cigarette products: United States, 2015. American journal of public health, 107(5), 702-705.

Mubeen, K., Chandrashekhar., H., Kavitha, M., & Nagarathna., S. (2013). EFFECT OF TOBACCO ON ORAL-HEALTH AN OVERVIEW. Journal Of Evolution Of Medical And Dental Sciences, 2(20), 3523-3534. doi: 10.14260/jemds/723.

Vellappally, S., Fiala, Z., Šmejkalová, J., Jacob, V., & Shriharsha, P. (2007). Influence of Tobacco Use in Dental Caries Development. Central European Journal Of Public Health, 15(3), 116-121. doi: 10.21101/cejph.a3431.