American Association of Oral and Maxillofacial Surgeons

Position Paper

Tobacco and Electronic Cigarettes
Based on currently available evidence, the American
Association of Oral and Maxillofacial Surgeons (AAOMS)
has developed this position statement on tobacco andelectronic cigarette products.

TobaccoThe first Surgeon General’s report on smoking and healthwas published in 1964, at which time 42 percent of theU.S. population smoked. In 2014, a 50-year report waspublished that noted that 18 percent of the population
smoked.1 Although the incidence of tobacco use has
decreased, people who smoke cigarettes are much more
likely than people who do not smoke to develop certain
diseases, such as cancer, cardiovascular disease, diabetes
and lung disease. More than 20 million Americans havedied because of smoking, and 2.5 million were nonsmokers
who died due to secondhand smoke. Use of tobacco is
one of the leading causes of preventable illness in theUnited States, and smoking accounts for approximately 20
percent of deaths.2 Over 36.5 million adults in the UnitedStates currently smoke cigarettes.3 Adult use of smokelesstobacco (e.g., chewing tobacco or snuff) in 2014 wasestimated to be 3.4 percent.5
Tobacco use is the single most preventable cause ofmorbidity and mortality in the United States. Cigarettesmoking is the single largest risk factor for cancer,
including head and neck cancer. In general, all healthcare
providers should actively promote cessation of use of
tobacco products in any form.
Tobacco use is the primary etiologic agent in thedevelopment of head and neck cancer in over 75 percentof cases. In addition, smoking at the time of diagnosis isassociated with increased treatment-related morbidities,
decreased survival and an increased risk for second
primary cancers. Therefore, smoking cessation is criticalto decrease the incidence of head and neck cancer alongwith decreasing the morbidity of treatment and risk ofrecurrence.

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Smoking cessation is the responsibility of all providers
involved in the care of a cancer patient. AAOMS
recommends a joint effort between medical and dental
providers to encourage early tobacco cessation for all
patients. These programs should offer education on risksof continued smoking and counseling on different
cessation methods – from pharmaceutical options
to behavioral modification techniques.

Smokeless Tobacco
Smokeless tobacco refers to the consumption of unburned
tobacco in the form of chewing, spitting, dipping andsnuff. There is sufficient evidence that smokeless tobacco
is a human carcinogen, and therefore remains an important
public health concern. Smokeless tobacco use appears tobe associated with head and neck cancers, especially oralcavity cancers, with snuff being more strongly associatedthan chewing tobacco.

E-cigarettes, Vaporizers and other Electronic
Nicotine Delivery Systems
There is mixed evidence to demonstrate the efficacy
of e-cigarettes in promoting abstinence from cigarette
use and exposure to carcinogenic compounds in the shortterm. The long-term safety of e-cigarette consumption has
not been definitively established. Recent events related tothe development of lung disease in young people appear
to be related to the use of e-cigarettes; however, further
investigation is warranted. In recognition of the variability
in the delivery and chemical composition of various
e-cigarette and vaping products, the FDA has included
a requirement for nicotine addictiveness on productpackages and advertisements.
Based on the available evidence, AAOMS cannot
recommend the routine use of e-cigarettes as an alternative
to or as a means to promote abstinence from conventional
tobacco products unless there is further evidence related
to safety.

Position Paper

Secondhand Smoke
Secondhand smoke is defined as the combinationof the smoke given off by burning a tobacco productand the smoke exhaled by a smoker. It is a known
human carcinogen. There is no safe level of exposure
to secondhand smoke. Research has not yet definitively
proven that secondhand smoke causes head and neckcancers. However, research does suggest that secondhand
smoke exposure may increase the risk of these cancers,
including pharyngeal and laryngeal head and neck cancer.
Further studies are needed to confirm this magnitudeof risk associated with secondhand smoke exposure.

Tobacco Impact on Oral Health
AAOMS is working with policymakers to help prevent
oral and pharyngeal cancer as well as other oral andsystemic diseases associated with tobacco use. The
Association is especially concerned about the oral healthimpact of the latest generation of tobacco products,including e-cigarettes and vaping.

References:
1. U.S. Centers for Disease Control and Prevention (CDC). The HealthConsequences of Smoking – 50 Years of Progress: A report of theSurgeon General. Rockville, Md.: U.S. Department of Health andHuman Services, Office of the Surgeon General 2014
2. Levy JM, Abramowicz S. Medications to Assist in Tobacco Cessation
for Dental Patients. Dent Clin North Am 2016;60(2):533-40.
3. Jamal A, King BA, Neff LJ, et al. Current Cigarette Smoking AmongAdults – United States, 2005-2015. MMWR Morb Mortal Wkly Rep
2016;65(44):1205-11.
4. Centers for Disease Control and Prevention. Available at
CDC.gov/tobacco/data_statistics/fact_sheets/smokeless/use_us/index.htm. U.S. Department of Health and Human Services.
Accessed April 10, 2018.dental practice. BDA Occasional Paper 6:
1-36, 2000.

©2020 American Association of Oral and Maxillofacial Surgeons.
No portion of this publication may be used or reproduced without
the express written consent of the American Association of Oral andMaxillofacial Surgeons.

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