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Oral, Head and Neck Pathology

Tobacco and E-Cigarette Use 

The use of tobacco and e-cigarettes can present significant health risks, including oral, head and neck cancers. Among the health concerns: 

  • Cigarette smoking is the single largest risk factor for cancer, including head and neck cancer. 
  • Smokeless tobacco use appears to be associated with head and neck cancer, particularly oral cavity cancers. 
  • E-cigarettes and vaping have been recently associated with the development of lung disease in young people, and the long-term safety of e-cigarette and vaporizer use has yet been established. 

Tobacco Impact on Oral Health 

In 1964, the U.S. Surgeon General published the first report from the Advisory Committee on Smoking and Health. At the time, 42 percent of the U.S. population smoked. A 50-year report published in 2014 found that 18 percent of the population smoked. Although the percentage has dropped, Americans who smoke tobacco products are much more likely to develop certain diseases, including: 

  • Cancer 
  • Cardiovascular disease 
  • Diabetes 
  • Lung disease 

Tobacco use is one of the leading causes of preventable illness in the United States with smoking accounting for about 20 percent of deaths. While more than 20 million Americans have died from smoking, the risk extends beyond the smoker. Of those 20 million deaths, 2.5 million were nonsmokers who died due to illnesses caused by secondhand smoke. 

Secondhand Smoke 

There is no safe level of exposure to secondhand smoke. Defined as the combination of smoke given off by burning tobacco and smoke exhaled by a smoker, secondhand smoke is a known carcinogen. Research suggests secondhand smoke exposure may increase the risk of head and neck cancers, including pharyngeal and laryngeal cancers.  

Smokeless Tobacco 

Smokeless tobacco covers a range of products and refers to the consumption of unburned tobacco through chewing, spitting, dipping and snuff. Although there are no risks from firsthand or secondhand smoke from smokeless tobacco, sufficient evidence indicates that smokeless tobacco is a human carcinogen. The use of smokeless tobacco appears to be associated with head and neck cancers, with snuff being more strongly associated than chewing tobacco.  

E-cigarettes and Vaping 

The use of e-cigarettes and vaping to help with trying to quit cigarette smoking has yielded mixed evidence of its effectiveness. In addition, the long-term safety of e-cigarettes, vaping and electronic nicotine delivery systems has yet to be established. The variability of e-cigarette and vaping product delivery and chemical makeup has led the FDA to require warnings about nicotine addictiveness. 

Based on the available evidence, AAOMS cannot recommend the routine use of e-cigarettes or vaping products as an alternative to – or as a means to promote abstinence from – conventional tobacco products unless there is further evidence related to safety. 

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Last updated April 2020

The information provided here is not intended as a substitute for professional medical or dental advice, diagnosis, or treatment. It is provided to help you communicate effectively when you seek the advice of your oral and maxillofacial surgeon.