DISSERTATION WORK MSAFIRI KABULWA.pdf

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1. INTRODUCTION
Tobacco can be used in various forms; it can be smoked, chewed, sniffed or dipped. In
whichever the form it is used, tobacco releases nicotine which is a stimulant that increases
activity in the brain just like caffeine, cocaine and amphetamine (Jarvis 2004, Jha et al 2006).
The stimulant effect of nicotine to the brain creates the desire for a person to continue using
tobacco until one becomes addicted therefore being exposed to harmful effects of other
chemicals present in tobacco (Jarvis 2004, Dennis et al 2005, Jha et al 2006, Jiloha 2010).
Unfortunately, in addition to nicotine other antigenic, cytotoxic, mutagenic and carcinogenic
chemicals that are harmful to oral and general health are also released (Behr and Nowak 2002).
The release of these harmful chemicals from tobacco may explain why tobacco use has been
strongly associated with oral cancer (Johnson and Bain 2000, Reibel 2003, WHO 2003a),
increased susceptibility to periodontal diseases (Borrell and Papapanou 2005, Do et al 2008),
reduced response to periodontal therapies (Tonetti et al 1995) and increased risk of dental
implant failure (Bain and Moy 1993). Other adverse effects of tobacco use on oral health
include tooth staining and halitosis (Johnson and Bain 2000). On general health, tobacco use
especially tobacco smoking has been associated with occurrence of lung cancer and
cardiovascular diseases (van der Vliet and Cross 2000, Shammas 2007).
In Tanzania oral cancer is a public health problem because most of the cases diagnosed with
oral cancers come to hospital at late stages of the tumors when the lesion has exceeded the size
that can be treated by conservative surgical approach. Consequent to late diagnosis majority of
the cases are treated by radical surgical intervention or palliative care which causes extensive
disfigurement leading to poor quality of life (Cubey 1974, Dandapat et al 1992). In addition
globally, the post operative survival life span of cases with lesions greater than 2cm in diameter
is short, in most cases not exceeding five years from the disease onset (Hindle and Nally 1991).
Therefore, majority of oral cancer patients who report late are likely to die within five years
after surgical/medical intervention. In cases where patients report at very late stage of the
disease only palliative radiotherapy is given as part of terminal care. There is a need to institute
appropriate intervention to reduce the occurrence of oral cancer in Tanzania. Likewise