Introduction
Tobacco comes from the leaves of Nicotiana tabacum which are raised, dehydrated and preventable cause of death, although it is Primarily a Risk factor. However, reduction in tobacco consumption is seen more effectively in developed countries as compared to developing countries. India is the second largest consumer and third largest producer of tobacco.1 Annually 7,00,000 deaths are recorded in India which are mainly attributed to tobacco consumption and is expected to rise around 1 million in next few decades.2 China followed by India are the major countries which contribute to smoking risks. (Figure 1)
In India, around 35% adults use tobacco and around 25% consume smokeless tobacco, 9% only smoke cigarettes while 5% use cigarettes as well as CIT.3 In India, annual incidence of oral cancer among males is as high as 10 per 100,000. Smokers are more prone to develop respiratory, cardiovascular and peripheral vascular diseases as compared to non-smokers. Approximately, one person dies due to tobacco consumption every six seconds.4, 5 Smoking is considered as a chronic relapsing condition, whose treatment is often difficult. As reported by American Heart Association, nicotine dependence is hardest to interrupt because its behavioural as well as pharmacological features those are equivalent to that of cocaine and heroin dependence.6
Second Hand Smoke
It is also called as passive smoking, involuntary smoking and environmental tobacco smoking. Second hand smoking is basically inhalation of tobacco smoke by persons other than the intended “active” smoker, which affect the children around (Figure 2).
Third Hand Smoke
Third hand smoke refers to the chemical residual of tobacco smoke built up for weeks and months that clings to clothing, cushions, furniture, wall, carpet, hair, skin, and other materials after the cigarette is extinguished. This normally affects the young ones who quire toxins by tongue while playing (Figure 3)
Green Tobacco Sickness (GTS)
GTS is a form of nicotine sickness/poisoning that occurs due to nicotine dermal exposure with wet tobacco leaves. Commonly seen among people who harvest or cultivate tobacco. The overall prevalence of GTS is higher (86.2%) among tobacco cultivators. Symptoms mainly includes headache, weakness, giddiness, nausea, vomiting, abdominal pain and breathlessness.
Musculoskeletal effect Review of Tobacco Consumption
Tobacco consumption has many deleterious effects on the musculoskeletal system which in turn reduces the quality of life. Studies conducted by different researchers who studied the effect of smoking on musculoskeletal system has been depicted in Table 1.
Table 1
Effect of smoking on musculoskeletal system
|
Citations |
Results |
|
Beyth et al., 20157 |
Average concentration of Bone marrow progenitor cells (BMPCs) in smokers is lower as compared to nonsmokers. |
|
Bjarnason et al., 20098 |
Bone mineral density of smokers on treatment with estradiol increases but with a less pace as compared to nonsmokers |
|
Breitling, 20159 |
The study was carried out on three different groups (i.e. never-smokers, former smokers and current smokers) and they showed an overall positive trend between calcium consumption and BMD |
|
Callreus et al., 201310 |
The relative fracture risk and bone mineral density is same in never-smokers and former and current smokers; however, the bone mineral density of femoral neck gets reduced as smoking increases. The bone mineral density is not significantly lower in young women of a longer duration of time or just started. In case of smokers the reduced levels of bone mineral density last only for 24 months and becomes equal to those of nonsmokers with 24 months of time. |
|
Cangussuet al., 201211 |
There was no significant difference between the postural balance among smokers and nonsmokers, in the study. However, the risk of fall was seen to be higher among smokers than nonsmokers in case of postmenopausal women |
|
Caram et al., 201612 |
The results of the study showed that there is an inverse joint effect of smoking and COPD on health, composition of body and exertion. |
|
Cetin et., 2009 13 |
Smokers have higher rate of osteopenia and osteoporosis as compared to nonsmokers. Less T-scores in smokers Higher activity of antioxidant enzymes in smokers than nonsmokers |
|
Chassanidis et al., 201214 |
Smokers showed less reduction of expression of bone morphogenetic proteins (BMP-2, BMP-4 and BMP-6) Also non-fractured group showed higher expression of bone morphogenetic proteins than fractured group. |
|
Dorn et al., 201315 |
High frequency of smoking is associated with less bone mineral density of lumber spine and total hip among 13-19 age group of girls Higher symptoms of depression are associated with less BMD of lumber spine |
|
Drage et al 200716 |
No significant association between bone marrow density of jaws, hips etc and years of cigarette smoking exists. |
|
Eleftheriou et al., 201317 |
Smoking adversely affects the bone marrow density and calcaneal quantitative ultrasound High bone marrow density in case of moderate alcohol intake Physical activities improve the bone mineral density |
|
Emaus et al., 201418 |
Life time bone loss was higher in smokers than in nonsmokers Body mass index effects the loss of bone in case of women |
|
Fujiyoshi et al., 201619 |
According to this study, people who were current smokers showed lower levels of parathyroid hormone as compared to old smokers. Along with this smoker also showed lowest levels of serum calcium and excretion of calcium through urine in a day. |
|
Kargin et al., 201620 |
Mean serum PTH level and C-terminal telopeptide levels were less in smokers than in nonsmokers. |
|
Kassi et al., 201521 |
The study revealed that smokers had comparatively less 25(OH)D level than nonsmokers. |
|
Kaume et al., 201422 |
Smoking-induced bone loss was lesser in women consuming antioxidant rich berries is less than in non-consuming group. |
|
Kleppinger et al., 201023 |
According to this study the weight, fat mass and functional muscle mass increased within a period of 16 months after quitting cigarette. |
|
Lucas et al., 201224 |
Lower levels of bone mineral density was observed in girls at the age of 17 years who consumed smoking at the age of 13 and same goes with those who consumed alcohol. |
|
Myong, et al., 201325 |
A significant linear relationship exists between smoking and bone mineral density among Korean women. |
|
Tamaki et al., 201026 |
Smokers showed less lumber spine bone mineral density as compared to smokers |
|
Dinah et al., 200727 |
The success of operative management in case of nonunion carpal scaphoid was less in smokers as compared to nonsmokers. |
|
Hernigou & Schuind, 201328 |
In case of both open as well as closed fracture smoking showed significant association with nonunion. |
|
Campos et al., 201129 |
Smoking shows negative effect on expression of alveolar bone-related markers. |
|
Adler et al., 200830 |
Smokers showed deep periodontal pockets as compared to nonsmokers. |
|
Eren et al., 201531 |
Lesser platelet-derived growth factor-AB are seen in smokers as compared to nonsmokers |
|
Heikkinen et al., 200832 |
Boys and girls who smoke showed higher calculus and periodontal pocket as compared to those who do not smoke. |
|
Hugoson & rolandsson, 201133 |
Smokers showed more significant association with severe periodontitis as compared to gingivitis. Snus users showed less significant association with gingivitis and periodontitis. |
|
Torrungruang et al., 201234 |
Periodontal conditions were compromised among smokers as compared to nonsmokers. |
|
Ata-Ali et al., 201635 |
Peri-implant parameters were compromised among smokers as compared to nonsmokers. |
|
Rodriguez-Argueta et al., 201136 |
Strong association exists between smoking and complications in case of implants. |
|
Romanos et al., 201337 |
As compared to smokers’ long term success rate of dental implants was more in nonsmokers. |
|
Shibli et al., 201038 |
Smokers showed less bone-to-implant contact and decreased bone density inside and outside the threaded area. |
|
Sverzut et al., 200839 |
Smokers showed 3.2% of early implant loss in contrast to only 2.81%. nonsmokers. |
|
Saevarsdottir et al., 201140 |
Current smokers showed lower response to treatment (MTX &TNF inhibitors). |
|
Mattey et al., 201141 |
Smokers showed high scores of Bath AS Functional Index as compared to nonsmokers. |
|
Adedoyin et al., 201042 |
Athletes who smoke showed high rate of exertion and fatigue index as compared to nonsmoker athletes. |
|
Kim & Kim, 201243 |
Smokers are more dependent on internal oblique and transverse abdominis muscles as compared to nonsmokers. |
|
Kumar et al., 201044 |
Smokers showed reduction in lumber extension strength as compared to nonsmokers. |
|
Rom et al., 201545 |
According to this study the subjects who quit smoking showed improvement in body parameters as well as strength as compared to those who continued smoking. |
|
Blackwell et al., 201646 |
Smokers showed early meniscus repair failure as compared to nonsmokers. |
|
Sanden et al., 201147 |
Requirement of analgesics was more in smokers The ability to walk after surgical treatment of lumber spine in smokers was more difficult to improve than nonsmokers. |
|
Hagnas et al., 201648 |
Babies of smoker mothers were more associated with low aerobic fitness than nonsmoker mothers. |
|
Holmberg et al., 201149 |
The bone mineral density of individuals who were exposed to second hand smoking was less than nonsmokers. |
|
Zadzinska et al., 201650 |
According to this study there are more chances of having offspring with shorter leg length in parents who smoke than in parents who do not smoke. |
Dental Health
Primarily, mouth is exposed to tobacco and most significant effects of tobacco affects the oral cavity includes precancerous lesions, oral cancers, periodontal diseases and poor wound healing. Tobacco smoke also causes tooth decay, wearing of teeth, black pigmentation of oral tissues, Gingivitis, palatal erosions, black hairy tongue, keratotic patches. Cigarette smoking during gestation has six times greater chances of having babies with birth defects like cleft lip and cleft palate formation.51 Primary caries are seen among children in case of maternal tobacco consumption.52
Conclusion
The issue of smoking, invariably triggers oral cancer in the brain but other issues cannot be too emphatically forgotten. Carcinoma is the most obvious terrifying condition, for which tobacco is a recognized risk factor but not causative agent. Present paper has been specifically designed to draw the attention of researches to the important studies on tobacco consumption and its effect on health other than cancer, for which tobacco is a causative agent by producing biological and physiochemical changes in humans. Multiple aspects are still not touched sinces they were beyond the scope of the present review.
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