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 Table of Contents  
ORIGINAL RESEARCH
Year : 2021  |  Volume : 12  |  Issue : 4  |  Page : 197-201

Comparison of Pigmented Lesions that Appear in the Mouth of Smokers and Passive Smokers


1 Department of Oral Medicine, College of Dentistry, University of Anbar, Al-Ramady, Anbar, Iraq
2 Department of Oral Medicine, College of Dentistry, University of Anbar, Aldoura City, Baghdad, Iraq
3 Department of Periodontology, College of Dentistry, University of Anbar, Baghdad, Iraq

Date of Submission18-Jun-2021
Date of Decision25-Jun-2021
Date of Acceptance05-Jul-2021
Date of Web Publication21-Dec-2021

Correspondence Address:
Lara Kusrat Hussein
Department of Periodontology, College of Dentistry, University of Anbar, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/denthyp.denthyp_54_21

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  Abstract 


Introduction: Passive smoker individuals whom live near the smokers and pigmentation appears on their oral mucosa due to proximity from smokers. Materials and methods: This study was carried-out on 50 patients suffering from pigmentation of the mouth that were collected from the private dental clinic were obtained and 50 individual’s neighbouring to them and considered as the passive smoking group. Discussion: For passive smoker the pigmentation increasing with duration of smoking, in non-filtered cigarettes than filtered cigarette and in heavy smokers than mild smokers The intraoral distribution of melanin pigmentations commonly observed in the buccal region, Lingual, gingival and palatal of the mouth.

Keywords: Passive smoker, pigmented lesions, smokers


How to cite this article:
Hamid RN, Ali SM, Hussein LK. Comparison of Pigmented Lesions that Appear in the Mouth of Smokers and Passive Smokers. Dent Hypotheses 2021;12:197-201

How to cite this URL:
Hamid RN, Ali SM, Hussein LK. Comparison of Pigmented Lesions that Appear in the Mouth of Smokers and Passive Smokers. Dent Hypotheses [serial online] 2021 [cited 2022 Aug 13];12:197-201. Available from: http://www.dentalhypotheses.com/text.asp?2021/12/4/197/333018




  Introduction Top


Smoker’s melanosis (oral mucosal pigmentation) considered among the most common lesions in the smokers’ mouth and 30% of the Caucasian heavy smokers have an oral melanin pigmentation.[1]

Melanin pigmentations in the oral mucosa are attached to the free radicals that produced as a result of exposure to the cigarette smoke and the polycyclic compounds such as nicotine and benzoperylene that found in the cigarette smoke, and prevents oxidative stress such as a protective barrier. This explains its increased production by melanocytes.[2] Epidemiologic studies have demonstrated that secondhand smoke contains higher concentrations of toxic compounds particularly nicotine compared to the same amount of smoked tobacco.[3]

There are several studies that have a resultant which always explain the strong association between the smoking and the melanin pigmentation of the gingiva[4],[5],[6] and the cross-sectional studies also have a resultant that indicates the prevalence of the estimated of this type of the pigmentations range between 21% and 90% among the cigarette smokers.[7]

The passive smoking (involuntary smoking), which are considered as a person who expose to the environmental tobacco smoke (ETS), or a secondhand smoking, can be defined as an individual who inhale the smoke of the cigarette of the other smoker or from the exhale of the smoker. The health of the nonsmokers can be adversely affected by the passive smoking of the all age groups.[8]

In addition, there are several studies which explain that the ETSs contain over 4000 chemical agents which affect adversely the health of the oral tissues of the passive smokers.[9],[10]

The cotinine which is considered as a nicotine biomarker has a half-life longer than the half-life of the nicotine. So that the level of the cotinine measurement is considered as a reliable and suitable objective and considered as a tool for quantitative screening for the determination of the exposure to the ETS and for the individual who are active smoker.[9] There are number of studies explained the correlations between the cotinine levels in the saliva and the plasma of the nonsmoker and the number of the cigarettes that smoked by his or her companion smokers.[11],[12]

The normal flora of the oral cavity and nasopharynx can be changed by passive smoking and can cause the gingival pigmentation in children and adults.[7]

The term the smoker’s melanosis was explained by Hedin back in 1977 and it was consider the physical effect on oral tissue by the tobacco smoke due to the heat or the direct effect of nicotine which stimulate the melanocytes cells to produce melanin.[13]

The cigarette smoke results in the increasing of the gingival pigmentation by a certain mechanism that is by the activity of the polycyclic amines such as the benzoperylene and the nicotine which are present in the smoke of the cigarette which enter into the circulation of the blood after the inhalation, so that they are stimulate the melanocytes indirectly.[7]

The melanin pigmentation distributed intraorally[9] and have been investigated on the smoking tissues of the gingiva,[14] it was unclear whether it affects the oral mucosa in the similar way and whether the lesion distribution is differ among the nonsmokers.[15]

On the other hand, there are several studies that suggest the presence of the dose–response relationship between the smoking and the melanin pigmentations, which means a high pigmentations were present more frequently with the heavy cigarette smokers than that in the mild smokers[16] and the individuals who exposed for a shorter periods of time to the cigarette smoke were presenting less frequently with the melanin pigmentations than the individuals who exposed for a longer periods of time to the cigarette smoke.[17] The relationship between the effect of the type of the cigarette that smoked and the degree of the pigmentation has not been investigated.

Increased melanin pigmentation of gingiva in children was related to exposure to secondhand smoke at home.[18] A similar study in 2010 indicated increased gingival pigmentation in children of smoker parents compared to the control group.[19]

Secondhand smoke can compromise the health of individuals at all ages.[20] Hanioka et al. discussed that showing oral and dental problems due to active and passive smoking to smokers increases their motivation to quit smoking by at least 10%. This increase in motivation was 16.7% when a smoker subject witnessed gingival melanin pigmentation due to passive smoking in his/her family members. Also, it has been shown that between the two pictorial warnings on the cigarette packs showing a diseased mouth and a lung tumor, smokers mostly believe that the diseased mouth picture is more influential.[21]

Thus, gingival pigmentation and its adverse esthetic effects may be alarming for the families with a smoker member, focuses their attention toward the hazardous effects of cigarette smoke on the health of nonsmokers, and may enhance motivation to quit smoking. Considering the adverse effects of passive smoking on the health and esthetics, the effect of passive smoke on adults, particularly women, must be investigated as well because the serious effects of cigarette smoke have reported to be more on the health of females compared to males.[2]

The aim of our study was to investigate the association between the smoking and the oral melanin pigmentations in either smokers or passive smokers and the factors affecting the incidences of melanin pigmentations.


  Materials and Methods Top


Patients

Study protocol approved by ethical committee of the University of Anbar and all participants signed informed consent. About 50 patients suffering from pigmentation of the teeth were collected from the private dentistry hospital were obtained and 50 individuals neighboring to them and considered as the passive smoking group.

The individual who smoked at least one cigarette everyday was considered as a cigarette smoker without attempting to identify the ex-smokers.

Data obtained from the smokers

The private dentistry hospital that covers the rural and urban areas counts with clinical data obtained from the smokers that include:

Duration of the smoking: The duration of the smoking was classified to less than 1 year, 5 to 9 years, and 10 to 14 years.

Severity of the smoking: The severity of the smoking divided into: mild smokers who smoke less than 10 cigarettes and heavy smokers who smoke 10 cigarettes or more.

Types of cigarettes: The type of cigarettes divided into filtered cigarettes and nonfiltered cigarettes.

Facilities that provided the opportunity for the conducting of this cross-sectional study

The examination did not include the acute consultations due to the pain or infections and was only restricted to the intraoral examination and giving advice to the participants on how they could improve and maintain their oral health. The participants were also informed about the presence of the caries and/or the need for the dental scaling.

Exclusion criteria

The criteria of exclusion which were the diabetes that were self-reported, the hypertension that were self-reported, the patients who complains from the bleeding of the gums, the patients who received a therapy of radiation, the patients who clinically have a sign of the oral carcinoma, and there was also exclusion from the group of eligible subjects, as follows: 2 were excluded due to the alcoholism, 20 subjects were excluded because they presented with diabetes or hypertension, 27 were excluded because of pan and/or betel nut consumption, and 5 were excluded because of the presence of the oral carcinoma and due to exposure to the therapy of radiation.

Clinical examination

The clinical examinations were performed by dental specialists together with the pathologist.

The examiners were not known about the information on the habits of the smoking. There were five areas in oral cavity of the participants which were examined for the presence of the melanin pigmentation which are: 1) the floor of the mouth; 2) the hard and soft palate; 3) the buccal gingiva; 4) the lingual gingiva; and 5) the buccal mucosa. The presence of a wide range of the pigmentations was considered as an “oral pigmentation.” The lesions that were without the melanin pigmentation such as Fordyce granules were not considered as a pigmented lesion.[15]

The existence of the oral melanin pigmentation was divided into (No/Yes)

In the present study, the site and the most prominent melanosis were considered at the level of the individuals.

Statistical analysis

The statistical analysis was carried out using Chi-squared test to differentiate between the groups and to differentiate between the proportions. Statistical analysis was carried out using SPSS 24 (IBM Corp., NY, US).


  Results Top


Site of pigments

[Table 1] show that the site of the pigments differ significantly (P < 0.01) among smokers and passive smokers.
Table 1 Site of pigments at different regions of the mouth

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The results showed that the incidences of pigments in the smokers of a higher level than the passive smokers as it reached to 50 (100%) in the smokers, whereas in passive smokers, it reached to 26 (52%) of the examined persons.

In the smokers, the higher pigments observed in the buccal region 20 (40%), lingual 10 (20%), gingival 8 (16%), and palate of the mouth 5 (10%).

On the other hand, in the passive smokers, the higher pigments observed in the buccal region 10 (20%), lingual 5 (10%), gingival 4 (8%), and palate of the mouth 3 (6%).

Incidences of pigments among the smoking duration or exposure

[Table 2] show that the incidences of pigments in the mouth differ significantly (P < 0.01) among the period of smoking or exposing to the smoking in passive and passive smokers.
Table 2 Number of individuals showing mouth pigmentation among different period of smoking

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The results showed that the incidences of pigments in the smokers of a higher level than the passive smokers especially with the increasing period of smoking or exposure to smoking.

In the smokers, the higher pigments observed in the period higher than 14 years (34%), followed by period of 10 to 14 years (15 [30%]), 5 to 9 years (10 [20%]), and the lowest at the period lower than 5 years (8 [16%]).

On the other hand, in the passive smoking, the higher pigments observed in the period higher than 11 years (22%), followed by period of 10 to 14 years (6 [12%]), 5 to 9 years (5 [10%]), and the lowest at the period lower than 5 years (4 [8%]).

Incidences of pigments in relation to the severity of smoking

The mild smokers who smoke less than 10 cigarettes per a day, whereas from 10 and over cigarettes per a day were called heavy smokers (4). The appearance of pigmented lesion was higher in heavy smokers [Table 3].
Table 3 Number of individuals showing mouth pigmentation according to severity of smoking

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The results showed that there was a significant difference (P < 0.01) among mild and heavy smokers.

In heavy smokers, the number of persons showed a pigment were 40 (80%), whereas in mild smokers, the number of persons showed pigment were 10 (20%). Meanwhile, in passive smoking persons, the higher pigment observed in heavy smokers 20 (40%) and in mild smokers reached to 6 (12%).

Incidences of pigments in relation to the type of cigarettes

[Table 4] showed that the incidences of pigments in the mouth differ significantly (P < 0.01) among the type of cigarettes of either filtered or nonfiltered cigarettes.
Table 4 Melanin pigments in related to the type of cigarettes

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The higher pigmentation in smokers observed in nonfiltered cigarettes 30 (60 %), whereas in filtered cigarettes, the pigmentation reached to 20 (40%). On the other hand, in passive smokers, the higher pigmentation observed in nonfiltered cigarettes 15 (30%), whereas in filtered cigarettes, it reached to 11 (22%).


  Discussion Top


This study was carried out for detecting the relationship between pigmented lesions and smoking habits in an Iraqi adult.

In this study, agreeing with other studies, there was a strong relationship between the occurrence of oral pigmentations and the exposure time for cigarette smoking which means the number of cigarette smoking[7] and the number of years exposed for cigarette smoking.[14]

The results on the site of pigments showed that the incidences of pigments in the smokers of a higher level than the passive smokers. In the smokers, the higher pigments observed in the buccal region, lingual, gingival, and palate of the mouth. On the other hand, in the passive smokers the higher pigments observed in the buccal region, lingual, gingival, and palate of the mouth.

The presentation of intraoral melanin pigmentation for smokers appears on buccal mucosa, whereas for nonsmokers, the pigmentations present on lingual mucosa; these results agree with another study.[7] On the other hand, in other study among Swedish reported that the attached gingiva was the most common place for pigmentations.[4]

In addition, our results on the incidences of pigments in relation to the severity of smoking showed that in heavy smokers, the pigmentation increased with the increasing level of smoking than the mild. Meanwhile, in passive smoking, a higher pigment observed in heavy smokers than in the mild smokers reached to 6 (12%).

Our results on the type of cigarettes and the incidences of pigments in the mouth showed that the higher pigmentation in smokers observed in nonfiltered cigarettes than the filtered cigarettes, and also in passive smokers, the higher pigmentation observed in nonfiltered cigarettes than in the filtered cigarettes.

Our results showed that there is a significant relationship between the highly presentation of melanin pigmentation and the type of cigarette smoked. Nonfiltered in passive smokers is novel for the oral sites investigated but is not agree with another study that concerning “reverse smoking” that said for nonfiltered cigarette smokers. The palatal mucosal changes are more frequent.[16]

Our findings show the degree of exposure to smoking and the type of cigarette. The socioeconomic position of a smoker may be a cause for the habit of smoking the cigarettes without filter. Melanosis decreases when smoking reduces.[13]

Our results concluded that the oral pigmentation in smokers increased with the increasing duration of smoking and in heavy smokers than the mild smokers and in those smoking filtered cigarettes than those smoking nonfiltered cigarettes. The individuals near the smokers, those called passive smokers commonly affected by pigmentation of the mouth due to their proximity to smokers. The intraoral distribution of melanin pigmentations commonly observed in the buccal region, lingual, gingival, and palatal of the mouth.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Axéll T, Hedin CA. Epidemiologic study of excessive oral melanin pigmentation with special reference to the influence of tobacco habits. Scand J Dent Res 1982;90:434-42.  Back to cited text no. 4
    
5.
Araki S, Murata K, Koichi U, Sakai R. Dose-response relationship between tobacco consumption and melanin pigmentation in the attached gingiva. Arch Environ Health 1983;38:375-8.  Back to cited text no. 5
    
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Mumcu G, Cimilli H, Sur H, Hayran O, Atalay T. Prevalence and distribution of oral lesions: a cross-sectional study in Turkey. Oral Dis 2005;11:81-7.  Back to cited text no. 6
    
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Soliman MM, Al Thomali Y, Al Shammrani A, El Gazaerly H. The use of soft tissue diode laser in the treatment of oral hyper pigmentation. Int J Health Sci (Qassim) 2014;8:133-40.  Back to cited text no. 10
    
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Hedin CA, Pindborg JJ, Axéll T. Disappearance of smoker’s melanosis after reducing smoking. J Oral Pathol Med 1993;22:228-30.  Back to cited text no. 13
    
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Haresaku S, Hanioka T, Tsutsui A, Watanabe T. Association of lip pigmentation with smoking and gingival melanin pigmentation. Oral Dis 2007;13:71-6.  Back to cited text no. 14
    
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Meleti M, Vescovi P, Mooi WJ, van der Waal I. Pigmented lesions of oral mucosa and perioral tissues: a flow-chart for the diagnosis and some recommendations for the management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:606-16.  Back to cited text no. 15
    
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Mercado-Ortiz G WD, Jiang DJ. Reverse smoking and palatal mucosal changes in Filipino women. Epidemiological features. Aust Dent J 1996;41:300-3.  Back to cited text no. 16
    
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Hanioka T, Tanaka K, Ojima M, Yuuki K. Association of melanin pigmentation in the gingiva of children with parents who smoke. Pediatrics 2005; 116:e186–90.  Back to cited text no. 18
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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