#8 Does Zyn Cause Cancer? - A Patient's Perspective on Nicotine

Did you know that your dentist checks for oral cancer during your exam? Do you know if Zyn, chewing tobacco, or cigarettes can contribute to your risk of developing oral cancer? Today’s guest episode welcomes Jack, whose great questions prompt a discussion on the risks of various forms of nicotine consumption, which have the potential to cause oral cancer, gum recession, tooth staining, and a whole host of problems with oral health. We discuss the importance of making informed choices for maintaining a healthy smile as it relates to the use of these various nicotine-containing substances.

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Welcome to DM A dentist, your friendly neighborhood podcast where Dr. Rusty and Dr. Mike are here to make dental care approachable for everyone because everyone deserves a healthy smile without the fear.

Well, welcome back to another episode of a DM A dentist.

My name is Dr. Mike and we have someone else in the chair today. Hey, my name is Jack. I’m literally in the chair. I’m solely a patient. Oh, so we have someone that’s familiar with the dental chair, not that he is bad teeth, but he just, you know, the other side, I don’t sit in the dental chair much, but he does. So we’re going to get his perspective today. Thanks for having me. I know nothing about dentistry except from the patient’s perspective. So I’m just going to kind of ask questions and, you know, hopefully represent the audience at large. Representing the crowd. There you go. So today, we’re actually going to tackle something that’s been on the market recently, nicotine, especially with the use. That’s good stuff. So yeah, we’re going to dive into that. So welcome back and let’s get rolling. Cool. So one thing I wanted to talk about was Zyns in particular. I feel like in the last couple of years, there’s been a rise of different nicotine products and, you know, admittedly, I’ve used Zyns. Yeah. I know people who use Zyns daily all day. And they think that it’s safer because there’s no tobacco in it. You know, it’s easy. There’s no smoke. And so they think it’s a safer alternative, but I kind of get the feeling that maybe that that’s not true. Well, from a cancer perspective, Zyns have a lower risk of cancer incidents, which is good. So that’s something that it’s better in terms of to get your nicotine from a Zin than it is from a cigarette because the propensity for cancerous from a cigarette is much higher than that of a Zin. Right. Because cigarettes have so many additives and from aldehyde and a bunch of other products that are not products. But, you know, content that are harmful to the human body at large. But like, so why, I guess my question is, would be like, why is Zyn so bad? For me, my first thought is just not knowing anything about teeth, right? It’s just you’re putting it directly against your gum. It burns. Yeah. That can’t be good. Yeah. So what, like, so the thing that the problem with Zyns is it’s not necessarily like a cancer thing, even though you can probably get cancer from a Zin in dental school, we learned about smokeless tobacco and the incidence of cancers very low from smokeless tobacco. You might say like Zyns are the new age of like, uh, dipping. Stuff. Yeah. Exactly. Yeah. So, but the problem with Zyns is if you put it in the location and continually put it in that location, you start to get what’s called tobacco keratosis and keratosis is a pathology. Like it is an abnormal tissue development that when you have cells that are changing, that’s a problem, right? So you have something that’s going from normal to abnormal, even if abnormal is not cancerous, you still have something that’s problematic. So you don’t want to continually have those cells change over, then you have more of a possibility of cancer. Okay. So same more about that because you say is the word keratosis? Yeah. Because you say pathology, pathology makes me think of cancer. So what exactly does that mean? Like, why do I care if the cells are, are, are not changing over in my gums? Fair. Yeah. I mean, fair. Why would you care if it’s not going to cause cancer? So what you’ll, so what we notice, so like, okay, say you don’t go to dentist, right? You want to look in the mirror and be like, do I have a problem with my yn pouch? Sure. If I look in the mirror and I look at the spot that I put the Zin pouch at and I see like, white, like, scaly looking tissue or oral mucosa or.. Gums. Yeah. If that looks, I don’t know what you’re talking about. If that looks like a white scaly little lesion, that’s telling me that that Zyn, you’ve been using it for so long, it’s starting to cause some change in how the, the gums look, right? So change is not necessarily bad, but change is something that’s happening, right? So you’re having some sort of pathology, whether it’s some sort of like cancer or not, it’s changing. So the longer you do it, the more possibility you have of some sort of cancerous cell getting in there, right? Okay. Also, with that type of thing, you have a decrease in the gum. So the gum covers the tooth, the tooth’s in the bone. The gum will recede over time because it doesn’t like being rubbed by this tobacco pouch. Okay. So it’s rather lack of tobacco pouch, right? Because there’s no tobacco in it’s in. It’s just nicotine. Correct. I guess. Yeah. Okay. So needless to say, the gum doesn’t like being irritated. So I mean, who likes to be irritated? I mean, I’m irritated all of the time. Yeah. It’s just a constant state. Yeah. So that’s interesting. So you mentioned like white lesions, sort of like visual indicators that maybe your gum is not happy. Is there anything other than that that Zyn users might look for? For me personally, just looking at my teeth, sometimes I’m like, I feel like my gum looks too red. Is that a thing? Or am I making that up? Yeah. It wouldn’t necessarily be red. Maybe from like inflammation, things like that. But typically tobacco keratosis has more of a whiteness to it. So yeah, that is something to like. So if you look in the mirror and you’re like, okay, I have like this white little spot and spot is not right. It would be the same size as the pouch typically. Or you have gum recession. That’s kind of a sign that there’s some impact of using the Zyn on your oral health, right? Some people don’t even notice the visual aspect to it. They notice like, oh, this area of my mouth is more sensitive. And you get more sensitivity when your gums stop covering the tooth. So if your gums are not covering your tooth, you’re more prone to sensitivity. So that’s kind of what people brings people in. They’re like, oh, what’s going on? Why is this happening? Interesting. I actually never thought of the impact of gum recession to the tooth. I always thought it would be how the gum feels. Mm-hmm. Yeah, the gum covers the tooth. It’s like an insulation almost. Interesting. Yeah. You don’t usually notice how their gums feel in terms of like, usually like a tooth-borne problem. Like, oh, my teeth are sensitive. And like, well, your gums were seated. So like, that’s how we get down to that. I see. The issue with gum recession, I will say, is you can’t really grow it back. And I say that with a caveat because you can technically grow it back with a graft. I don’t even actually know what a gum graft is. So like, if you were to burn your skin, right? And you got skin from another area of your body and you made like a graft, right? Like, you know, people know what a skin graft is for they typically cover parts. Sure. So it’s basically replacing what’s missing, what’s missing with additional material. Yeah. And I’m actually going to have my friend who’s a periodontist in Colorado, Annika, on some time. So she’ll really dive into that. So a period honest, a periodontist that differ from like a general dentist? A periodontist does extra schooling and they specialize in the period on shim. So the part that supports the tooth. The bone and the gums and the structures that hold the teeth in place. They specialize in that. So as we talk about gum recession, that would lean itself more toward a periodontist. Right. And in some general dentists do treat gum recession with grafting. It’s just, I don’t do that. But we would refer to a periodontist. And what they do is they take gum tissue off of the roof of your mouth and they place it and stitch it down where the recession is happening. It’s a bit ironic because the roof of my mouth is most often where I burn my mouth. Yeah, same. Hot pockets. So that’s kind of a weird segue. But like when I burn the roof of my mouth with hot pizza or hot pockets or whatever, that fixes itself on its own, right? Right. So is the difference between like burning the roof of my mouth from like a one off incident of hot pizza versus repeatedly using a Zyn on my gum? Is it that I’m not burning my mouth every day with pizza? Right. If you burned your mouth twice a day with pizza for the rest of your life, that would be a problem. It wouldn’t be a good candidate for a graft for the other part of my gum. Correct. Got it. You also would be at a higher, higher possibility of cancer because your cells are turning over. More damage to cells is the more possibility of some sort of cancer. Interesting. So it’s not really per se what you’re putting in your mouth. It’s how often you might be. It matters how often, but it also matters what it is. So like, of course, like if we, okay, cigarettes, right? Okay. You’re not just breathing in hot air. Hot air would not be great because it doesn’t, the gums don’t particularly love or the teeth or the supporting structures don’t love hot gas in the mouth, right? It’s funny because I’ve been called a hothead in my whole life. Wow. It’s not full of hot air. Wow. Yeah. That wouldn’t be great, but the problem is when you smoke, you’re breathing in a bunch of other things on top of the hot air. Right. So it’s smoke. I’ve never thought about it this way. That way it’s kind of interesting, right? So like hot pizza, it’s really hot pizza, hot air irritation. It’s the impact of how that is affecting your mouth. It seems to be more of a temperature disrupts than the disruption by the temperature plus the addition of the chemicals that you’re putting in your mouth. So it’s like twofold. Yeah. So like with cigarettes, you, so if someone who smokes cigarettes, the problem with cigarettes is the tobacco with the hot smoke restricts blood flow in the gums. And that limits the nutrients that are necessary to provide supply to the bones in the teeth. So that’s why people that smoke cigarettes tend to get more like periodontal disease or like things like that progress faster because you have the smoke and you have the chemicals. And that is decreasing blood supply. Blood supply is what provides nutrients to certain things, right? So you need blood supply to organs, new blood supply to fingers, gums, teeth, all that things. When you smoke, you are diminishing that blood supply. So then those teeth, everything’s not getting what it needs. So that’s why people get like loose teeth or like then you start to get stained teeth. Right. Yeah, I mean, that’s, it’s funny because smoking back in the day, I feel like the anti-smoking campaign started more so with like, oh, you don’t want yellow teeth. It was less about the health and it was never about the gums for sure. Yeah. And so I’m curious like for those who smoke today, like if they’re teeth are yellowing, if they’re teeth are starting to hurt, you know, is it like you have to quit smoking? Otherwise, you’re going to lose your teeth or are there any alternatives that people can look into? Does vaping is vaping better? I mean, you know, I think that’s why there’s been such a rise in these cigarette alternatives, like Zyns and like vapes because they’ve been initially deemed healthier, but we really don’t know that much about them at this point, even though they’ve been around for, you know, 10, 15 years. Yeah, it’s a bit harder. Like, I don’t know as much about vapes in terms of like long term health for the gums and things because it’s not been around as much. Right. But there are some studies coming out with the lung health and it’s not great so far. Right. But I was not to deviate too far away from teeth, but yeah, no, it’s hard because we don’t have as much in from it. Just like Zyns or, you know, way more common is there now. Whereas it used to be like, smokeless tobacco was a thing and that, you know, so we’re kind of here. Right. It’s kind of like, it’s a little bit of a devil’s advocate scenario. I feel like in the nicotine world, the tobacco world, rather do. Right. I mean, anything’s better than, I don’t say anything, some are better than cigarettes. Like cigarettes is kind of like the gold standard of the worst. Yeah. But a big tobacco. Big tobacco. But the problem is like you’re breathing in a chemical, the chemical is hot and all that has negative effects not only on your entire body, but specifically where it hits first your mouth. So we have people that are, you know, losing teeth or their teeth are becoming discolored and that’s not going to happen to everyone because everybody is different literally. So it’s just important to recognize those things and that can maybe be a motivating factor to quit. Yeah. I mean, I think that’s a good point. Like everybody is different. I’ve heard my whole, I’ve had maybe four cavities and I think three have been on the same tooth. And you know, I’m not admittedly, I’m not the best dental patient per se, but you know, I try my best. And at one point in my life, it was told to me like, you could do everything right and you’re still going to get a cavity on this, on this tooth. And so I think it’s, it’s an interesting point that you bring up that, you know, people are different. Everybody’s mouths and their compositions are different and you could do the same, let’s say, you know, tobacco or nicotine, Zyn, cigarette use as another person and you might get Periodontal disease way earlier. Yeah. Another person may not, I don’t know. Yeah. There’s, there’s a biological component. So like we have like genetic makeup that has a propensity to certain things, right? Yeah. And then you also have a biological, we also have environmental. So like if you have a biological, and then you also are doing something environmentally, you are just setting yourself up for failure. Right. But there are some people that don’t have a biological, right? They’re not, they’re not prone to that. So like if they do an environmental issue like smoking, they’re not going to be, at, their teeth are not going to be as bad. And environmental meaning like the environment in which you surround yourself. Right. And you choose to do. Yeah. So, okay. People that are more prone to periodontal disease, they have the bacteria make up things like that in their mouth. Like they are going to get it regardless of what they do. That’s so interesting to me. So like what are some of the contributing factors to that? Like one thing I’ve always been really interested in is like, why do we produce saliva? I don’t really understand it. Yeah. Um, I know that like, for example, when I, when I did use this in, I was spitting a lot more. I felt like my mouth was full of salivating. I was salivating a lot. Well, that’s the thing about also doing, or doing also like smoking. Do you do cigarette smoke? Do you cigarette? Is the problem with that is you also are, when you smoke like that, you’re causing inflammation to the salivary glands. So the salivary glands decrease the amount of saliva they’re producing. When they do that, you don’t have as much saliva, right? Hmm. So the problem with that is saliva is important for decreasing cavities and it’s also important for buffering. So the way you get cavities is you have an acidic attack on, in your mouth. So that means like you’re eating sugar or doing things like that. So you’re changing the pH of your mouth. Saliva helps to buffer that. So that’s why when people are like, I don’t brush, hmm, I only brush once a day. I’m like, if you’re going to brush once a day, brush it night, but it, brush twice. But if you’re going to brush once, brush it night, because when you’re sleeping, you’re not talking, swallowing, speaking, talking, you’re not doing all those, doing hopefully one of those things. Yeah, you’re not doing those things. So saliva is not moving through your mouth. So it’s not able to like wash the teeth, coat the teeth. I see. So when you sleep, the bacteria just has a field day. So things like that are kind of important to recognize, brush twice a day, but if you’re going to choose one, brush it night. Right. What I kind of heard based on my, my limited experience is that I might be salivating more during a zin use, but it’s, it’s because my mouth is overcompensating for what is happening inside of it. It is funny. Like when you do eat things, or like lemons, your mouth does salivate more to like prepare. Right. But yeah, I don’t know. I don’t know the answer to that. Yeah, that’s fair. I mean, it’s, it’s more just like a, a theoretical, right? I’m just like thinking about saliva and the mouth and what happens as you use certain products. And I think lemons and other things that are, are shocking maybe to the mouth is, is it good analogy? Right. Because your mouth is overcompensating for almost like an attack. Like no one, at least not in my experience, loves eating sour things like you salivate for a reason. Yeah. Well, I, I have patients that love lemons. So. I’m just like, please. So I do want to hit on a couple of things, right? So smokeless tobacco, I’m going to put Zyns in there as well, whatever. I know it’s not, but whatever. So it causes a keratosis of the tissue, which is caused by the constant friction of the pouch. And keratosis, let’s just go back to remind ourselves is what? Keratosis is a tissue change. So it’s a change in color and appearance of the gum itself. Got it. Okay. So it’s no longer that red pink color. It’s our certain white and scaly. That’s what tobacco care to says. So I consider that even if it is then a tobacco care to say sure. So it’s a change in the color shape, texture of the tissue itself. Okay. So that tells us you’ve been using it a long time or you use it frequently. So the lesion develops, yeah, as a habitual chewing habit, right? So that’s kind of assigned to us. And then it’s also important to realize that smoking cigarettes in terms of what we’re going to discuss nicotine, smoking cigarettes twofold, right? The chemicals that go into your body, bad for your body, chemicals are also bad for your teeth and gums, sure. But you have heat, the heat component is not good for the teeth, right? The positive bacteria, positive cells, things like that, don’t love the heat. Second, the smoke is not good for things, right? You’re depriving things of oxygen. And then you have this idea that you’re reducing blood flow in certain areas, reducing blood flow, things don’t like that. So you don’t get as much tissue support. So you don’t get as much nutrients to certain areas of the body, but specifically we’re talking about the mouth. You don’t get as much blood supply. So then you’re lacking nutrients. So the body, the body is the use it or lose it. So it’ll start to decrease the gums, decrease the supporting tissue of the teeth. So that’s like why it’s important to kind of avoid those things. Yeah. It’s really interesting talking about this to me because I’ve never thought about the heat component as it relates to damaging the gums of the teeth or just the mouth in general. And it’s almost like a double whammy, right? It’s like, I think heat and then also irritation. Maybe I can combine those two if we’re talking about cigarettes and then sins. It’s the initial impact to the mouth that kind of like hurts it. And then it’s what’s inside that like further hurts it. Yeah. Does that make sense? Yeah. No, that’s true. So it’s like it’s something that we need to combat, but the youth love it. Yeah. Yeah. You know, it’s, yeah, it’s a tricky subject. I agree. So if we get to, so if you were to have a patient in your chair and I guess coming from someone who would be maybe embarrassed to admit it, right? They say, do you smoke, do you do sins, smokeless tobacco? Even if I did it occasionally, I would say no. Yeah. And so you can tell, right? Typically. Yeah. I would say it’s not 100%. It’s not 100%. I mean, if someone’s been using it for a long time, totally. Yeah. Right. And so if I say no as a patient and you’re like, okay, I can tell that they do, let’s say I need a graft, right? How do you, as a dentist, maybe approach that conversation or how do you maybe suggest as a patient that I be more forthcoming? Because it’s something that I think tobacco use, nicotine use in general is shame. I don’t, I don’t, I don’t, I don’t want to speak for everybody, but I feel like typically people are ashamed to say like, yes, I do that. Yeah. And so do you care? I mean, sort of what’s your opinion on? Yeah, I don’t, I think that everyone has a vice, I don’t care what people do. Yeah. So they get some credit. You’re not there to judge us. No. I think that, you know, this brings back to some point when like someone was talking to me about like, so in Portland, we are still trying to figure out a way to ethically help homeless people like, you know, throwing money at the problem is not fixing the problem, right? We’re trying to figure that out. People told me like, you can’t get mad, like people get mad at, uh, houseless people for using drugs or things like that, right? And they were like, well, what, what do like, we do when we have a hard day, we go get a beer. What do we do when we, we go? Some people like, we’ll smoke a joint. Like, you know what I mean? Right. So like, it’s important to recognize that everyone has something in their life that they use to cope. Yeah, absolutely. Whether it’s good or bad coping. Yeah. So if I may interject in your stream of consciousness, you know, there’s a very famous author, his name’s Alan Carr and he writes books about how to quit different vices if you want to call it that. He has one on alcohol, he has ones on cigarettes, et cetera. And one thing, and I did read one of them and one thing that stuck out to me was he compared to nicotine addicts to like drug addicts. And he’s like, the mindset is the same, right? And you, you don’t look at it the same way because it’s accepted by society that people smoke. It’s okay. It’s okay that you have a couple of beers after work or whatever. And we don’t view it the same as something that something like heroin. Yeah. It’s viewed. And I think it’s important to realize that everyone has their own thing, right? So don’t, don’t feel like you’re being judged. I mean, we ask it on our intake form, obviously, and I’m sure people don’t really answer it. Yeah. But no, it’s important. I mean, I would bring it up and just say something like, you know, I’ve noticed something on your gums. I wouldn’t say it’s concerning, but it’s something I want to address, right? Like it’s important that we’ve a figure out why it’s happening, but be kind of come up with a game plan long term to see what we want to do about it. So we go into that discussion and I mean, we do tobacco counseling at work, really as dentists, yeah. It’s the same more. We can prescribe drugs to help quit, like Chantix, like we can do all of that. But yeah, we talk about tobacco, we talk about, yeah, that’s part of our training. That’s interesting. I don’t think a lot of people know how much dentist can provide outside of your, just your teeth. Yeah. No, we do tobacco counseling. Hygienists do it. We were taught it. Yeah, it’s wild. You also do a sleep apnea. We do do sleep apnea, right? Yeah, we should talk about that in another podcast. That’d be fun. Yeah, it’s a good idea. We definitely will. Well, I hope everyone enjoyed this little nicotine adventure. Jack, thanks for being here. I hope you enjoyed it. Thanks for having me. Yeah, of course. And thanks again for tuning into DM a Dentist. We’ll see you next week. Bye.