Oral health

Tobacco and oral health: the role of the World Health Organization

Oral Health & Preventive Dentistry (Volume 1, No. 4, 2003, 309-315)
Poul Erik Petersen, Chief, WHO Oral Health Programme
World Health Organization

This article highlights the activities undertaken by WHO Oral Health Programme to strengthen its involvement in tobacco cessation at the global level and initiatives related to co-operation with NGOs in oral health and WHO Collaborating Centres in Oral Health.


In addition to several other chronic diseases, tobacco use is a primary cause of many oral diseases and adverse oral conditions. For example, tobacco is a risk factor for oral cancer, periodontal disease, and congenital defects in children whose mothers smoke during pregnancy. The epidemic of tobacco use is one of the greatest threats to global health; sadly the future appears worse because of the globalization of marketing. The World Health Organization (WHO) has strengthened the work for effective control of tobacco use. At the World Health Assembly in May 2003 the Member States agreed on a groundbreaking public health treaty to control tobacco supply and consumption. The treaty covers tobacco taxation, smoking prevention and treatment, illicit trade, advertising, sponsorship and promotion, and product regulation. Oral health professionals and dental associations worldwide should consider this platform for their future work for tobacco prevention since in several countries they play an important role in communication with patients and communities. The WHO Oral Health Programme gives priority to tobacco control in many ways through the development of national and community programmes which incorporates oral health and tobacco issues, tobacco prevention through schools, tobacco risk assessment in countries, and design of modern surveillance systems on risk factors and oral health. Systematic evaluation of coordinated efforts should be carried out at country and inter-country levels.


The epidemic of tobacco use is one of the greatest threats to global health today. Approximately one-third of the adult population in the world use tobacco in some form and of whom half will die pre-maturely. According to the most recent estimate by the World Health Organization (WHO), 4.9 million people worldwide died in 2000 as a result of their addiction to nicotine (WHO, World Health Report, 2002). This huge death toll is rising rapidly, especially in low- and middle-income countries where most of the world’s 1.2 billion tobacco users live.

As shown in Fig 1 developing countries already account for half of all deaths attributable to tobacco (WHO, World Health Report, 2002). This proportion will rise to 7 out of 10 by 2025 because smoking prevalence has been increasing in many low - and middle-income countries even though it is decreasing in high-income countries. Developing countries also account for about half of the world’s disease burden related to tobacco as measured by DALYs (Fig 2) (WHO, World Health Report, 2002).

Within countries the prevalence of tobacco use is highest amongst people of low educational background and among the poor and marginalized. In several developing countries there have been sharp increases in tobacco use especially among men and as the tobacco industry continues to target youth and women there are also concerns about rising prevalence rates in these groups. The shift in the global pattern of tobacco use is reflected in the changing burden of disease and tobacco deaths. Sadly, the future appears worse. Because of the long time lapse between the onset of tobacco use and the inevitable wave of disease and deaths that follow, the full effect of today’s globalization of tobacco marketing and increasing rates of usage in the developing world will be felt for decades to come. Tobacco use is a major preventable cause of premature death and also a common risk factor to several general chronic diseases and oral diseases. The negative impact relates not only to smoking but use of smokeless tobacco. In addition to smoking tobacco smokeless tobacco is widely used in a number of countries of the world depending on socio-cultural conditions. Chewing tobacco is known as plug, loose leaf and twist. Pan masala or betel quid consists of tobacco, areca nuts and staked lime wrapped in a betel leaf. They can also contain other sweeteners and flavouring agents. Moist snuff is taken orally while dry snuff is powdered tobacco that is mostly inhaled through the nose. In comparison to smoking habits, the patterns of use of smokeless tobacco are less documented, particularly in developing countries.



Oral health priority action area