Oral cancer after using Swedish snus (smokeless tobacco) for 70 years - a case report

Invasive oral squamous cell carcinoma induced by concurrent smokeless tobacco and creamy snuff use: A case report

Oral squamous cell carcinomas (OSCC) are caused by chronic tobacco abuse. In this regard, the carcinogenic potential of smoking and smokeless forms of tobacco, including chewing tobacco and moist/dry snuff, has been widely documented. However, the effects of tobacco-containing products such as creamy snuff on oral health have not been widely reported. Here, we report on the clinical presentation of a patient with OSCC induced by concurrent chewing tobacco and creamy snuff use. The development and progression of mucosal carcinogenesis in the context of mixed tobacco use habits is discussed. With the increased availability of newer tobacco-containing products, it is important for clinicians to be aware of these products in the marketplace, including dentifrices and nicotine pouches, and counsel their patients regarding their health risks.

Adverse effects of Sudanese toombak vs. Swedish snuff on human oral cells

BACKGROUND

The high incidence of oral cancer in Sudan has been associated with the use of toombak, the local type of smokeless tobacco. However, its specific effects on human oral cells are not known. We aimed to investigate the effects of toombak on primary normal human oral keratinocytes, fibroblasts, and a dysplastic oral keratinocytic cell line, and to compare them with the effects induced by Swedish snuff.

METHOD

Aqueous extracts were prepared from moist toombak and Swedish snuff and added in serial dilutions on in vitro monolayer cultured cells. Cell viability, morphology and growth, DNA double-strand breaks (gammaH2AX staining), expression of phosphatidylserine (Annexin V staining), and cell cycle were assessed after various exposure time periods.

RESULTS

Significant decrease in cell number, occurrence of DNA double-strain breaks, morphological and biochemical signs of programmed cell death were detected in all oral cell types exposed to clinically relevant dilutions of toombak extract, although to a lesser extent in normal oral fibroblasts and dysplastic keratinocytes. G2/M-block was also detected in normal oral keratinocytes and fibroblasts exposed to clinically relevant dilutions of toombak extract. Swedish snuff extract had less adverse effects on oral cells, mainly at non-clinically relevant dilutions.

CONCLUSION

This study indicates a potential for toombak, higher than for Swedish snuff, to damage human oral epithelium. Dysplastic oral keratinocytes were less sensitive than their normal counterparts, suggesting that they might have acquired a partially resistant phenotype to toombak-induced cytotoxic effects while still being prone to DNA damage that could lead to further malignant progression.

Effect of short-term use of oral smokeless tobacco on random-pattern skin flap survival in rats

We investigated the effects of smokeless tobacco on the survival of random-pattern skin flaps in rats. Twenty rats were divided into two groups (n=10 each). In the experimental group 200 mg smokeless tobacco (Maras powder) (1 mg nicotine) was inserted intraorally once a day for seven days under general anaesthesia. It was not given to the control group, but the rats were similarly anaesthetised with ketamine. On day 8, plasma cotinine concentrations were measured. The random-pattern dorsal skin flaps measuring 3 x 10 cm were then raised and resutured. Percentage survival area was assessed after a further eight days. The mean (SD) survival was 39 (7)% in the experimental, and 65 (8.9)% in the control, groups (p=0.0001). The mean (SD) plasma cotinine concentrations were 124.4 (73) ng/ml and <10 ng/ml, respectively. Smokeless tobacco use increased the incidence of flap necrosis in random-pattern skin flaps in rats.

Sirenomelia (mermaid syndrome): an infant from parents who used a special form of snuff

We report the first case of a fetus with sirenomelia or mermaid syndrome, whose Afghanian parents were heavy user of a special form of snuff. The case was diagnosed as a mermaid syndrome but some of the features were common to both symmelia dipus and symmelia apus, for example, the single lower extremity had the normal femur, tibia and fibula, but the single foot was rotated medially. The digestive tube ended to a massive closed saclike structure and the anus was absence. The external genital organs were rudiment and the normal testes were undescended. Aorta was divided to branches, such that the external iliac arteries were very small in comparison to the internal iliac arteries. Inferior Vena cava was placed on to the left side of the aorta and unlike the majority of reported mermaid syndrome, the bladder was present. So, the researchers believe that the present case is a rare variant of the mermaid syndrome.

Clinical, pathological, cellular and molecular lesions caused by oral smokeless tobacco - a review

While carcinogenicity of smokeless tobacco (ST) to humans is well established the oral lesions that precede development of cancer are less well characterized. The clinical appearances of ST-associated lesions are variable. Epidemiological studies show a strong significant association of risk with chronic daily use but population differences are noted because of various commercial products in use. Morphological features observed are some what different to oral lesions caused by smoking and oral dysplasia in ST-associated lesions is less common. Effects of ST on oral keratinocytes observed in vitro include alterations in cell proliferation, apoptosis and activation of inflammatory markers. Genetic aberrations caused by ST include activation of ras, uncommon in smokers but mutational hot spots in p53 encountered are similar to those in smokers.

Tobacco, oral cancer, and treatment of dependence

Tobacco dependence is recognised as a life-threatening disorder with serious oral health consequences which responds to treatment in the form of behavioural support and medication. While cigarette smoking is the most hazardous and prevalent form of tobacco use in the west, consideration also needs to be given to other forms such as bidi smoking in India, reverse smoking by several rural populations and use of snuff and chewing tobacco. The evidence that the use of tobacco is the major risk factor for oral cancer and potentially malignant lesions of the mouth is clear. Counseling to quit smoking is not applied in a systematic or frequent manner to people presenting with potentially malignant lesions of the oral cavity. This review makes recommendations for interventions by health professionals to encourage and aid cessation of tobacco use as a part of prevention of oral cancer.