Tobacco based dentifrices: still not squeezed out

Dear Editor,

Thirty-five percent adults (274.9 million) consume tobacco in India in some form or other with 21% (163.7 million) adults using only smokeless tobacco, 9% (68.3 million) only smoking and 5% (42.3 million) users of both smoking and smokeless tobacco.[1] The history and cultural rooting of smokeless tobacco when compared to smoking represents a distinctive challenge in India's tobacco control measures. The usage of tobacco based dentifrice may sound improbable and odd but it is very frequently practiced in rural areas of South Asia. The overall national prevalence of usage of tobacco based dentifrices was found to 5% in patients aged above 15 years in India.[1] However, tobacco based dentifrices are worryingly more frequently used by females (6.3%) in contrast to males (3.3%) and are also popular in children, thus posing a unique conundrum to tobacco control advocates.[1,2] Tobacco toothpaste (creamy snuff) and tooth powder are perhaps the most commonly marketed tobacco based dentifrices.[2] The various other tobacco based dentifrices used commonly are Gul (a pyrolyzed tobacco product), mishri (roasted and powdered tobacco), gudakhu (paste of tobacco and molasses), tapkeer (dry powdered snuff) and tobacco water (manufactured by passing tobacco smoke through water used only for gargling) that are commonly used in various parts of rural Asia.[1]

The presence of nicotine in these dentifrices, even in small quantities, could lead to addiction and these dentifrices can lead to pathologies in oral cavity such as abraded teeth, dentinal hypersensitivity, pulpitis, teeth staining, gingival recession and oral mucosal premalignant lesions.[2] The usage of tobacco based dentifrices should be dealt with more seriousness and should be dissuaded sharply. There is a need to develop evidence based, culturally appropriate economic intervention for control of tobacco based dentifrice usage and an analysis of motivating influences for its practise should be conducted as there is a lack of research on factors leading to its usage.[3] Overall, the public health challenge of smokeless tobacco (especially tobacco based dentifrices) merits far greater interest and action than it has so far received.[4]

Though there is a legislative ban of usage of tobacco in dentifrices, the effectiveness of this ban needs to be implemented properly as there is an easy availability of these dentifrices.[5] Moreover, the perceived prevalent misconceptions about efficacious use of tobacco based dentifrices in teeth cleaning need to be dismissed. Tobacco industries also deceptively market their products as herbal based, mouth freshener, and teeth whiteners that further increases the vulnerability of the less educated residents in rural areas. Growing prevalence of tobacco related cancers can be controlled only if there is a greater sustained public awareness about manifold risks of tobacco in its various forms and a better scrutiny of tobacco based dentifrices, especially in rural areas.