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Flipping
through pictures of what can happen to people who use chewing tobacco
is quite an education.
Drs. Shari
Morningstar and Steve Gustafson have a series of photos in their Royal
Oak office. Some are from their university textbooks; others are from
conferences and organizations like The American Cancer Society.
They
all show the same thing, though.
“It’s just
a myth that using chewing tobacco is safe, or a safe substitute for
smoking,” says Dr. Gustafson. “In many ways it’s much more
dangerous.
“Chewing
tobacco sits in one spot in a person’s mouth. It delivers a much
higher concentration of highly harmful and addictive chemicals,” he
adds. Those chemicals include nicotine, arsenic and formaldehyde –
The American Cancer Society lists 27 others.
The pictures
show the end results. Some people, in extreme cases, are missing parts
of their jaw. Backing away from the extreme to just the serious cases,
many of the photos show people who look like their faces caved in.
That’s
because in order to keep them alive, part of their face or jaw had to
be removed because it was cancerous.
“And in
almost all cases chewing tobacco causes your gums to recede. That’s
important because your gums don’t grow back – once they’re gone,
that’s it,” Dr. Gustafson says.
The opposite
is usually true with hyper-keratinization – the technical name for
the earliest of pre-cancerous conditions. Hyper-keratinizatin becomes
visible via a small white spot on the tissue in the area where a person
holds a wad of chewing tobacco.
“It’s
white because the tissue is holding an irritant. People should make no
mistake about it. That’s a pre-cancerous condition.
“If people
stop right then, the condition almost always will reverse itself. You
don’t have to do anything else,” Dr. Gustafson says. “But if you
don’t stop right then, you run other risks.”
Dr. Gustafson
thinks that white spot should be taken seriously as a first warning. If
ignored, it can lead to the next stage, depicted in his photo library.
“The next
stage not only causes the gums to recede, but they become ulcerated and
turn red. The teeth, already deeply stained yellow by this point, are
exposed by the lack of gum tissue. When we see that, we send patients
to an oral surgeon for a biopsy.
“It’s
important to realize oral cancer is cancer, which can metastasize
(travel to another site within the body). You can think of chewing
tobacco as a self-inflicted wound. It’s very rare to see this kind of
problem if the patient hasn’t been using chewing tobacco.”
Men almost
exclusively become the victims of oral cancer due to chewing tobacco,
although some of Dr. Gustafson’s literature says smokeless tobacco is
still popular among older, Southern women.
Dr. Gustafson
says the number of patients chewing tobacco seems to be decreasing, but
he also notes the trend is cyclical. The youngest patient he’s ever
seen who chewed tobacco was 16. The worst case of oral cancer he’s
ever seen involved an older woman who ultimately had to have her entire
tongue surgically removed.
“The best
way not to have to worry about it is to just not do it,” Dr.
Gustafson says. “If you’re doing it, stop – like right now.
Chances are you’ll go through withdrawal, much like with cigarette
smoking, but we can help recommend cessation programs at hospitals,
peer counseling and even patches and nicotine gum. The most important
thing is to not start, or stop immediately.”
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