• 11/1/2006
  • Pittsburgh, PA
  • Anita Srikameswaran
  • Post-Gazette.com

State health authorities are today launching a media campaign intended to get teenagers to chew on a few grim realities about smokeless tobacco.

According to Pennsylvania Health Secretary Dr. Calvin B. Johnson, manufacturers are on the verge of introducing new products with fruit flavors and chew that can be swallowed instead of spat, which could entice youngsters into the addictive habit.

“With these kinds of things on the horizon, we really wanted to get ahead of the curve and … be aggressive about putting other information out there,” Dr. Johnson said.

A person who uses eight to 10 dips per day gets about the same amount of nicotine as a person who smokes 30 to 40 cigarettes daily.

“That’s a two-pack-a-day person,” the health secretary explained. “That’s considered a heavy smoker.”

Rather than lecture young people about the down-the-road risks of oral cancer, the campaign’s television spots, radio ads and Web components will focus on the early, unpleasant consequences of using spit tobacco, including foul breath and stained teeth.

After all, “what kid wants to try to get a prom date with teeth missing from their mouth?” Dr. Johnson pointed out. “Those immediate things, such as discoloration, bad breath and loss of teeth, seem to have more of a persuasive effect on the kids.”

According to the health department, 11.5 percent of high school students in Pennsylvania are smokeless tobacco users. The practice is more common among white males and in rural areas.

Pediatric dentist Dr. Dennis Ranalli, senior associate dean at the University of Pittsburgh’s School of Dental Medicine, treats young athletes who use smokeless tobacco, also known as snuff or dip.

Baseball players often mimic their heroes on the diamond, he noted. “The wrestlers use it to suppress appetite because they’re looking for ways to reduce their food intake before weigh-in at matches.”

Although smokeless tobacco use is far more common in boys, “a few years ago, a school nurse called me because all of the senior girls on their field hockey team were dipping snuff,” Dr. Ranalli said.

In addition to causing bad breath and tooth discoloration, some products contain sugar, so cavities can form near the gumline, he said. Some are gritty and can wear away tooth enamel.

Yet some chew users avoid going to the dentist because they don’t want to face the music.

“As soon as I examine the inside of their lower lip, I can tell you right away whether or not they’re dippers,” Dr. Ranalli said. “It’s obvious.”

In the space where the user “parks” the chew, he typically sees leukoplakia, or “a white fluffy patch that is not easily scraped off,” he said.

Sometimes, a reddish patch forms. Both are indications of repeated irritation to the oral tissue, and could transform with time into a dangerous, cancerous lesion.

Angie Riccelli, director of Pitt’s dental hygiene program, encourages hygienists to grab a mirror and show the patch to their patients.

“Particularly when they’re young, they don’t even realize it’s there,” she said. “We point it out and give them the risks, the dangers, what could happen. Then it’s up to them.”

A study published this summer in the journal Medicine and Science in Sports and Exercise showed that smokeless tobacco use declined among the Pittsburgh Pirates between 1991 and 2000.

Initially, about 41 percent of Pirates players and coaches who volunteered for the study chewed tobacco, the researchers found. Ten years later, only a quarter of them did. Similarly, the prevalence of leukoplakia dropped.

Most of the patches will regress in weeks or months after the patient stops using chew, Dr. Ranalli said. If it doesn’t, there could be a bigger problem.

About 30,000 new cases of oral cancer are diagnosed annually in the United States, according to the Oral Cancer Foundation. Three-quarters of patients have a history of using some form of tobacco.

The combination of alcohol and tobacco compounds the risk.

Warning signs of oral cancer include pain or difficulty chewing, swallowing or speaking, a lump in the mouth or neck, hoarseness or a numb area in the mouth.

“They tend to be diagnosed relatively late,” said Dr. Jennifer Grandis, leader of the head and neck cancer program at University of Pittsburgh Cancer Institute. “The symptoms are insidious or ignored or attributed to dental problems.”

Half of all oral cancer patients die within five years of diagnosis, she said. Either the original tumor recurs or a new cancer develops.

Treatments of surgery, radiation and chemotherapy can be disfiguring, alter speech and swallowing, and change the taste of food. A recent study found that the suicide rate was higher among patients with head-and-neck cancers, which includes oral cancer, compared to those with other cancers, Dr. Grandis said.

“You can hide the treatment for other cancers, but head and neck cancer really does change your appearance and change the way you interact with the world,” she said.

Researchers are working on developing screening tests for oral cancer, much like Pap smears check for hints of cervical cancer.

The point is, smokeless tobacco “is really not harmless,” Dr. Grandis said. “It’s addictive. It’s a nicotine delivery device and it is associated with cancer.”

Quitting the habit is the answer, Dr. Ranalli said. Cessation aids such as nicotine patches, lozenges and, perhaps most appropriately, chewing gum can reduce cravings. Some people find acupuncture and hypnosis helpful, and medications also are available.

The state also provides cessation information through its free, 24-hour Quitline, 1-800-QUIT-NOW, and its Web site, www.state.pa.us/quitnow.

The second phase of the health department’s campaign will target “switchers,” namely people who turn to chew when they can’t smoke, such as on a plane or in the workplace.

According to the American Council on Science and Health, encouraging cigarette smokers to switch to chew, particularly products that contain low levels of cancer-causing nitrosamines, could substantially reduce health costs and the incidence of both lung and heart disease.

But the U.S. Centers for Disease Control and Prevention and state health authorities say that smokeless tobacco is far from harmless.

“You’re chewing on it and spitting out, like you’re getting rid of it,” Dr. Johnson said. But, “it’s just as bad, if not worse” than cigarettes.