NIDCR/CDC
Dental, Oral and Craniofacial
Data Resource Center

Oral Health, U.S. 2002 Annual Report

Section 12: TOBACCO

The use of oral tobacco (moist snuff and chewing tobacco) causes oral lesions in both young people and adults (Poulson et al., 1984). Histologically, these smokeless tobacco lesions (STLs) are characterized by hyperkeratinization and vacuolization of the epithelium, acanthosis, and proliferation of inflammatory cells (Axell et al., 1976). Clinically, STLs appear as changes in the color and texture of the oral mucosa (Greer & Poulson, 1983). The highly addictive nature of the nicotine in oral tobacco products makes it difficult for many users to quit (CDC, 1994). In addition STL's in school-aged adolescents may be an early indicator of increased risk for future oral cancers.

STLs are among the most prevalent oral soft-tissue lesions among adolescents in the United States (Kleinman et al., 1994). A study of STL prevalence in a nationally representative sample of adolescents in the United States found that in the 1986–7 period 1.5% of students aged 12 to 17 years had STLs. The prevalence was highest among older, non-Hispanic and white male adolescents (Tomar et al., 1997). The prevalence of STLs among oral tobacco users ranged from 23% to 59%, compared to less than 5% in individuals who did not report oral tobacco use.

SOURCES OF DATA
Analyses reported here are based on data from the 1986–1987 National Survey of Oral Health in U.S. School Children, National Institute of Dental and Craniofacial Research, National Institutes of Health (children analyses) as reported by Tomar et al. (1997) and from the Third National Health and Nutrition Examination Survey (NHANES III) 1988–1994, National Center for Health Statistics, Centers for Disease Control and Prevention (adult analyses). NHANES III includes data on STLs for persons under 18; however, the sample size was too small for analysis. Data earlier than NHANES III were not available for adults. Thus, it is currently not possible to examine national trends in STL's for either adolescents or adults.

• Children and Adolescents (12–17 years old) (Figure 12.1.1)
• The percentage of school-aged children with STLs was higher among:
• older children.
• non-Hispanic white adolescents compared to non-Hispanic black adolescents.
• males compared to females.

• Adults (aged 18 and older) (Figure 12.1.2)
• The percentage of adults (aged 18 and older) with STLs was higher among:
• persons 18– to 34–years-old and was dramatically lower among age groups older than 34.
• non-Hispanic whites and non-Hispanic blacks compared to Mexican Americans.
• males compared to females, with the percentage of males with STLs at least 15 times that of females.

Bullets reference data that can be found in Tables 12.1.1 and 12.1.2..

REFERENCES
Axell T, Mornstad H, Sundstrom B. The relation of the clinical picture to the histopathology of snuff dipper's lesions in a Swedish population. J Oral Pathol 1976;5:229–236.

Centers for Disease Control and Prevention. Reasons for tobacco use and symptoms of nicotine withdrawal among adolescent and young adult tobacco users-United States, 1993. MMWR 1994;43:745–750.

Greer RO Jr, Poulson TC. Oral tissue alterations associated with the use of smokeless tobacco by teenagers. Part I. Clinical findings. Oral Surg 1983;56:275–284.

Poulson TC, Lindenmuth JE, Greer RO. A comparison of the use of smokeless tobacco in rural and urban teenagers. CA-Cancer J Clin 1984;34:248–261.

Kleinman DV, Swango PA, Pindborg JJ. Epidemiology of oral mucosal lesions in United States schoolchildren: 1986–1987. Community Dent Oral Epidemiol 1994;22:243–253.

Tomar SL, Winn DM, Swango PA, Giovino GA, Kleinman DV. Oral mucosal smokeless tobacco lesions among adolescents in the United States. J Dent Res 1997;76:1277–1286.

Figure 12.1.1. Smokeless tobacco lesions among 12- to 17-year-olds by selected demographic characteristics

[D]

Source: The 1986–1987 National Survey of Oral Health in U.S. School Children, National Institute of Dental and Craniofacial Research, National Institutes of Health via Tomar SL, Winn DM, Swango PA, Giovino GA, Kleinman DV. Oral mucosal smokeless tobacco lesions among adolescents in the United States. J Dent Res 1997;76:1277–1286, reprinted with permission from the Journal of Dental Research.

Figure 12.1.2. Smokeless tobacco lesions among adults aged 18 and older by selected demographic characteristics

[D]

Data source: The Third National Health and Nutrition Examination Survey (NHANES III) 1988–1994, National Center for Health Statistics, Centers for Disease Control and Prevention.

Department of Health and Human Services
National Institute of Dental And Craniofacial Research (NIDCR)	CDC Division of Oral Health
National Institutes of Health

Privacy Statement | Disclaimers | Accessibility