A clinical, histomorphological and histochemical study on snuff‐induced lesions of varying severity

Abstract

The oral lesions in 50 habitual snuff‐dippers were graded on a four‐point scale. The patients' tobacco and drinking habits were studied by means of a questionnaire. From each patient a biopsy was taken for histomorphological and histochemical analysis. A correlation between snuff habits and the clinical degrees was found, as well as between the snuff habits and certain superficial and deeply located cell changes. The incidence of keralinized lesions, sialadenitis and slight dysplasia (based on subjective evaluation under a light microscope) was higher than previously reported. Presence of dysplastic changes could not be predicted by means of the parameters which characterise the snuff habit or from the clinical grade. The histomorphological and histochemical results were interpreted as showing that the mucosa react to snuff inducing hyperplasia in the basal cell layers. In the surface layer indications of lethal damage were found. The overall stromal reaction to snuff was weak. However, the salivary glands and excretory ducts exhibited degenerative changes which were found to be more severe than the pathological changes in the surface epithelium.

Surgical approach to snus-induced injury of the oral mucosa

“…Among other factors that may affect the severity of lesions and ISIOMI are the placement of the snus (one versus multiple sites) and the total exposure (TE), as estimated by TE = A × B × C, where A is the number of years of snus use, B the daily duration of use (hours), and C the amount of snus used daily (grams) (6,7).…”

A Receptor-Mediated Mechanism of Nicotine Toxicity in Oral Keratinocytes

“…The thickness of hyperkeratosis correlates directly with the amount of tobacco use, and the use of snuff is more frequently associated with development of oral mucosal lesions compared with chewing tobacco (Daniels et al, 1992). These tobacco-related lesions may become dysplastic (Andersson et al, 1989;Hirsch et al, 1982;Kaugars et al, 1989) and even undergo a malignant transformation (Sundstrom et al, 1982).…”

“…The thickness of hyperkeratosis correlates directly with the amount of tobacco use, and the use of snuff is more frequently associated with development of oral mucosal lesions compared with chewing tobacco (Daniels et al, 1992). These tobacco-related lesions may become dysplastic (Andersson et al, 1989;Hirsch et al, 1982;Kaugars et al, 1989) and even undergo a malignant transformation (Sundstrom et al, 1982).In this study, chronic stimulation of the nicotinic pathways of ACh signaling in the oral epithelium of the exposed rodents resulted in premature squamatization of OKC, manifested by rapid acquisition of abundant amounts of the CK 1 and CK 10 squamatization markers. We have reported previously that long-term incubation with Nic markedly increases the number of epidermal keratinocytes forming cornified envelopes and staining with antibodies to the cell differentiation markers CKs 10 and 11, filaggrin, involucrin, and transglutaminase type I, and that Mec can prevent this enhanced expression (Grando et al, 1996).…”

Oral Mucosal Lesions in Smokeless Tobacco Users

“…Hirsch et al reported slight epithelial dys plasia in 18 percent of the lesions. 3 The authors emphasized that the dysplastic changes were found in all four clinical de grees. but that patients with dysplasia had been snuffdipperslongerthantheothers.…”

“…When the total exposure was compared between the four clinical de grees, significant differences were also found; the longer the exposure to snuff, therefore, the more pronounced the clinical changes of the oral mucosa. 3 Greer and Poulson4 modified the clas sification by Axéll et al2 by reducing the four types of change into three. Degree 1 is a superficial lesion with color similar to that of the surrounding mucosa, with slight wrinkling and no obvious thickening; de gree 2 is a superficial whitish or reddish lesion, with moderate wrinkling and no ob vious thickening; and degree 3 is a red or white lesion with intervening furrows of normal mucosal color and obvious thick ening and wrinkling.…”