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All healthcare professionals need to become aware of the extent and seriousness of smokeless tobacco use. In this article, the authors briefly review the current status of smokeless tobacco and describe its usage patterns and practices, pharmacologic (addictive) aspects, and associated health problems. They also suggest ways that primary care physicians can discover or prevent smokeless tobacco use in their patients.

Dental personnel have an ethical responsibility to inform their patients about the hazards of tobacco use. Because oral health team members generally see their patients on a frequent and recurring basis, these treatment providers have unparalleled opportunities to educate and help those who smoke to adopt a smokefree lifestyle. Dental practitioners can readily incorporate smoking cessation efforts into their routine dental practices by using an eight-phase smoking intervention program. The overall focus of this program is to: "Ask" patients about smoking or smokeless tobacco usage; "Advise" tobacco-using patients to quit; "Assist" interested patients in quitting; and "Arrange" for supportive follow-up. By providing these services, dental professionals can do their part to help create a smokefree America by the year 2000.

Two studies were conducted to explore the effects of twice daily topical applications of NaF, SnF2, and an amine fluoride at equivalent fluoride concentrations (0.1%) upon plaque and gingivitis in the dog. Although some trends toward modest benefits were noted in certain instances, none of the agents exerted a significant effect upon either parameter.

Weanling rats were given high-sucrose cariogenic diets containing 2 per cent lauric acid, linoleic acid, nonanoic acid or monolaurin. Plaque accumulation was determined on the incisors of half the animals during only the last 3 days of the study and on the remaining animals at the conclusion of a 21-day test period when both sulcal and smooth-surface caries were assessed. No significant differences between the test groups in food consumption were observed nor were there any differences in body weight gain. The least amount of plaque was observed in the animals given monolaurin; the other fatty acids exerted no significant effect upon plaque accumulation. The smooth-surface caries data indicated that the least number of lesions occurred in the animals on the diet containing monolaurin. Nonanoic acid was significantly more effective in limiting sulcal caries than any of the other fatty acids studied. Thus both monolaurin and nonanoic acid have significant cariostatic activity in the rat.

Four studies were performed in rats and hamsters concerning the cariogenicity of cereals and the role of sucrose in that process. The findings indicate that sucrose content per se does not necessarily reflect the cariogenic potential. Presweetened cereals were more conducive to the formation of smooth surface caries in the hamster than were nonpresweetened cereals while no major differences between the cereals were observed in occlusal caries in rats.

A double-blind clinical trial was conducted to determine whether the use of a chewing gum containing 2.0 mg nicotine (as an adjunct to a stop-smoking program) had any effects upon oral health. A total of 193 adults who smoked cigarettes volunteered with informed consent, were given routine dental prophylaxes, and were examined for the presence of plaque, stained pellicle, gingivitis, calculus, and general oral pathosis. The subjects were then randomly assigned to use either a nicotine-containing or a placebo chewing gum. After 15 weeks the subjects were recalled and re-examined. Smoking cessation was determined through questionnaire and analysis of the carbon monoxide content of alveolar air. At the completion of the study, 79 subjects had used the placebo gum and 78 had used the nicotine gum. Data analysis indicated that the nicotine chewing gum had no significant influence on any of the oral health parameters graded, as compared to the placebo gum. The continuation of smoking, however, was associated with significant increases in gingivitis and calculus rates.

During the past several years, excessive stress has come to be recognized as a threat not only to quality but also to length of life. There is increasing evidence that the emotionally distressed individual may have an increased susceptibility to a number of pathologic conditions. Physical activity, in the form of aerobic exercise, is a very fruitful means for coping with stress. The popular forms of aerobic activities that are most often pursued in order to help general cardiovascular condition may, in effect, improve the mental health of the individual. There are no guarantees that if you follow these recommendations you will live longer. However, the life you live will be healthier, happier, more productive, and less stressful.

Two studies were conducted to assess stain accumulation in beagle dogs following four wk of treatments with water or chlorhexidine. Clinical stain assessments were made by two examiners using different grading procedures. Both scoring methods demonstrated increased stain associated with chlorhexidine usage, and the results for both examiners appeared to be reproducible from one study to the other.

The use of smokeless tobacco (ST) within the United States has increased greatly in recent years, especially among adolescent boys and young men. Recent national data completed from several large scale studies indicate that 10-12 million Americans use some form of ST. Representing a significant systemic and oral health risk, ST usage can produce a wide range of negative effects on both soft and hard oral tissues. These oral conditions include bad breath, discolored teeth and restorative materials, excessive tooth surface wear (abrasion), decreased ability to taste and smell, gingival (gum) recession, advanced periodontal soft and hard tissue destruction, tooth loss, soft tissue erythema and leukoplakia. Long-term ST usage is directly correlated to an increased risk of cancer of the mouth, larynx, throat and esophagus. Much of the destruction of oral tissues is related to the localization of the tobacco quid; i.e., it is habitually held in only one spot in the mouth. Nicotine from ST can activate the sympathetic nervous system thereby significantly increasing heart rate, blood pressure, cardiac stroke volume and output and coronary blood flow. A common misconception is that ST is a 'safe' alternative to smoking cigarettes. Several recent Surgeon General's Reports list ST as being addictive. It is highly possible that ST users will 'graduate' to cigarettes if they eventually conclude that these products are socially unacceptable, inconvenient or out of vogue. Health professionals, educators, parents and schoolchildren need to be informed about the significant health risks associated with ST use.

Two studies were performed in beagle dogs to determine the effect of 0.2% hexetidine upon plaque and gingivitis. In both instances, hexetidine exerted no significant effect while 0.2% chlorhexidine resulted in reductions in both plaque and gingivitis of about 45 and 50%, respectively.

This study was designed to compare various salivary parameters between smokers and non-smokers and to determine the influence of a nicotine-containing chewing gum (used to aid in quit-smoking efforts) upon these same parameters. At the baseline examination, subjects were assigned to one of three groups: non-smokers who did not utilize any gum, smokers provided a nicotine-containing gum, and smokers provided a placebo gum. Saliva was collected from all subjects and analyzed for acidogenicity and buffer pH as well as for levels of thiocyanate, lactoperoxidase, lysozyme, lactoferrin, and secretory IgA. After 15 weeks of gum usage, saliva was again collected from each subject and the identical analyses performed. Significant differences were observed between smokers and non-smokers with regard to three parameters: The saliva of smokers contained greater concentrations of thiocyanate and lower concentrations of lactoferrin, at the baseline examination and after the 15-week test period. In addition, the CO content of alveolar air was higher in smokers at both examination periods. In contrast, the use of the nicotine gum per se had no effect on any of the test parameters.

Two rat caries studies were conducted in which oat hulls, sodium trimetaphosphate, and combinations thereof were incorporated into two different caries-producing diets. The type of diet used was found to influence the anti-caries effects of oat hulls. In many instances, the cariostatic effect of the two agents was additive or even synergistic.

Two studies were performed on rats to determine the post-eruptive cariostatic effects of lithium alone and in combination with fluoride. The results failed to demonstrate any cariostatic effects of lithium when evaluated in this manner, nor any enhancement by lithium of the cariostatic activity of fluoride.