Taking a stand for good health on World No Tobacco Day

World No Tobacco Day is a World Health Organization (WHO) initiative which takes place on the 31st of May, and which seeks to educate and inform the public on the harms of tobacco use, tobacco business practices and what people can do to promote health living and protect future generations. (1)

Tobacco farming affects the environment, health of farmers and contributes to the global health crisis. WHO data indicates that the tobacco industry costs “more than 8 million human lives, 600 million trees, 200 000 hectares of land, 22 billion tonnes of water and 84 million tonnes of CO2” annually. The environmental impact of tobacco is extensive with a high carbon footprint, toxic chemicals, litter and use of water and farmland, often in countries where production of food would provide more benefit than the growth of this deadly plant. (2, 3)

Whilst the environmental impacts are dire, the health impacts of tobacco are well known to be significant and serious. The effect of obacco  on oral health includes an increased risk of gum disease, andoral cancer while decreasing the body’s capacity to defend itself and impairing wound healing. It is not solely smoking of tobacco that contributes to health concerns, of course, but with numerous forms of tobacco use such as nicotine-containing pouches and heated tobacco products available, the recognition of these alternative tobacco products and their health impacts need to be better appreciated. (4)

Australia contains 22 native species and 4 subspecies of tobacco plants or Nicotiana. Pituri or Mingkulpa refers to the botanical plant or the tobacco chew form, quid, interchangeably. Pituri, the use of which is likened to smoking commercial tobacco, is prepared by roasting and drying the leaves and stems of the plant, mixing it with ash to alkalize the mix then moistening it with saliva. The rolled package is known as quid. (5,6) 

Quid has many uses including being chewed, held in the mouth or kept behind the ear to absorb its properties through the skin (7). The numerous native species of tobacco all have different chemical compositions and their quantities of tobacco vary, with the alkalinity of the plant also variying depending on the environment and species. The absorption of nicotine improves with greater pH levels4. By adding wood ash to nicotine, pH levels are demonstrated at 10.2-11.6 (5). 

Pituri use is common and is a centuries-old custom in First Nations people. 8 The cultural impact of Pituri chewing needs to be considered with studies demonstrating use for medicinal purposes and that it has a “central role in the connectiveness of Aboriginal people to each other…it secures for them individual and community happiness and contentment”5. The health effects of Pituri are still to be researched but are also considered to be like that of commercial tobacco. (5)

Dental professionals can identify negative oral health implications of tobacco use and are well positioned to provide tobacco cessation advice. (4) Available evidence has shown that dental professionals can increase tobacco abstinence through intervention.9 However, recognition of the cultural significance of Pituri/Mingkulpa is vital when considering cessation of Pituri use. More culturally safe resources and research is required; for now, identification of use and monitoring of oral health concerns is imperative with appropriate referral when required. 

An episode on the ADA’s CPD Portal's Dental Files series, "Smoking Cessation", which discusses how dentists can contribute to reducing community smoking rates as well as exploring a range of resources available to assist patients with quitting, can help you make these conversations as effective as possible.

References

1.    World Health Organization. 31 May is World No Tobacco Day. 2023

2.    World Health Organization. WHO raises alarm on tobacco industry environmental impact. 2022 Media Release

3.    Centers of Disease Control and Prevention. Environmental Impacts of the Tobacco Lifestyle. 2022 Web Article

4.    Chaffee, BW, Couch, ET, Vora, MV, Holliday, RS. Oral and periodontal implications of tobacco and nicotine products. Periodontol 2000. 2021; 87: 241– 253.

5.    Ratsch AM, Mason A, Rive L, Bogassian FE, Steadman KJ. The Pituri Learning Circle: central Australian Aboriginal women’s knowledge and practices around the use of Nicotina spp. As a chewing tobacco. The International Electronic Journal of Rural and Remote Health Research, Education, Practice and Policy. 2017;17;4044 

6.    Sub-tropical fruit club of Qld Inc. Pituri (Duboisia hopwodii) and Arogyappacha (Trichopus zeylanicus). STFC.org.au 2023 stfc.org.au

7.    Tackling Indigenous Smoking. Facts about smoking. Australian Indigenous Healthinfonet. 2023

8.    Wan, M., Quinn, C., Butson, C. and Kingon, A. (2022), The dilemma of Pituri: a review and case report. Aust Dent J, 67: 362-365.

9.    Carr AB, Ebbert J. Interventions for tobacco cessation in the dental setting. Cochrane Database Syst Rev. 2012 Jun 13;2012(6) doi: 10.1002/14651858.CD005084.pub3.