Wolfe M D, Carlos J P
Community Dent Oral Epidemiol. 1987 Aug;15(4):230-5. doi: 10.1111/j.1600-0528.1987.tb00527.x.
Recent reports have suggested that the use of smokeless tobacco is increasing in adolescents, and is particularly high in Native Americans, causing concern about possible effects on oral health. In this study, 226 Navajo Indians, aged 14-19, were interviewed regarding their use of smokeless tobacco (ST), cigarettes, and alcohol. Midbuccal and mesiobuccal sites on all fully erupted permanent teeth (excluding third molars) were examined for the presence of gingival bleeding, gingival recession, calculus, and loss of periodontal attachment. The oral mucosa was examined for evidence of leukoplakia. 64.2% (145) of the subjects (75.4% of the boys and 49.0% of the girls) were users of ST. Of these, over 95% used snuff alone or in combination with chewing tobacco. 55.9% used ST one or more days per week. 52.2% consumed alcohol, usually beer or wine, and 54.0% smoked cigarettes. 25.5% (37) of the users and 3.7% (3) of the non-users had leukoplakia. The duration (in years) and frequency of ST use (days per week) were highly significant risk factors associated with leukoplakia. However, the concomitant use of alcohol or cigarettes did not appear to increase the prevalence of these lesions. No consistent relationship was observed between the use of ST and gingival bleeding, calculus, gingival recession, or attachment loss, either when comparing users to non-users or when comparing the segment where the tobacco quid was habitually placed to a within-subject control segment. In view of these results, there is little doubt that smokeless tobacco is significantly related to the etiology of leukoplakia. As some evidence exists that smokeless tobacco use is a significant risk factor associated with oral carcinoma, intervention programs to discourage the use of smokeless tobacco by adolescents should be a public health priority.
最近的报告表明，青少年中无烟烟草的使用呈上升趋势，在美洲原住民中尤为普遍，这引发了人们对其可能对口腔健康产生影响的担忧。在这项研究中，对226名年龄在14至19岁的纳瓦霍印第安人进行了访谈，了解他们使用无烟烟草（ST）、香烟和酒精的情况。检查了所有完全萌出的恒牙（不包括第三磨牙）的颊中部和近中颊部，以确定是否存在牙龈出血、牙龈退缩、牙石和牙周附着丧失。检查口腔黏膜是否有白斑迹象。64.2%（145名）受试者（75.4%的男孩和49.0%的女孩）使用ST。其中，超过95%的人单独使用鼻烟或与嚼烟混合使用。55.9%的人每周使用ST一天或多天。52.2%的人饮酒，通常是啤酒或葡萄酒，54.0%的人吸烟。25.5%（37名）使用者和3.7%（3名）非使用者有白斑。ST使用的持续时间（以年为单位）和频率（每周天数）是与白斑相关的高度显著危险因素。然而，同时使用酒精或香烟似乎并未增加这些病变的患病率。无论是将使用者与非使用者进行比较，还是将烟草块习惯性放置部位与受试者自身对照部位进行比较，均未观察到ST使用与牙龈出血、牙石、牙龈退缩或附着丧失之间存在一致关系。鉴于这些结果，毫无疑问，无烟烟草与白斑的病因密切相关。由于有证据表明使用无烟烟草是与口腔癌相关的重要危险因素，因此，旨在劝阻青少年使用无烟烟草的干预项目应成为公共卫生的优先事项。
