Dentists and Smoking 1963

DENTISTS' ATTITUDES'AND PRACTICES .
IWITH REGARD :TO CIGARETTE SMOKING
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Source: http://industrydocuments.library.ucsf.edu/tobacco/docs/qzmh0121
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Ph XIX 63
DENTISTSI' ATTITUDES ANDi PRACTICES

WITI-I REGARD T'O, CIGARETTE SMOKING~
Submitted to :
P . LORILLARD COMPANY
November, 1963'
Mendota Research Group

EngLewood'.
Ph XIX 63
IN TR O'DU C TI O1V
This is asupplernent' to lufendlota's report

on physicians" attitudes and practices with
regard to cigarette smoking, prepared for
the P' . Loriillard Company in October 19'63' .
The present report is based on a sub-sample of 99 dentists ini 14 states and' the District of' Columbia (25 cities and towns),, who
were interviewed as pairt of the larger study
during the months~ of August and September,
1963 .
The sub-sample does not differ significantly
from thetotall population ofdlentists in, private practice in the United States with, respect to identifying characteristics, but because of its small size, all stati'stical resullts~
should, be viewed with caution .
The findings obtained in the larger study of
physicians are used a& a basis for comparison throughout this supplementary report .
Ph
A.
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To : what extent do dentists view smoking as a

health problern?' As a~ dental probiem?'
The typical dentist, like the typical physician, disapproves

mildly of smoking in general but takes it for granted as ai
social phenomenon and is only concerned about it in his
own practice and in the presence of specific conditions .
He attributes fewer and different toxic effects to : smoking
than the physiciani and he often prefers cigarettes to pipe
and cigars from the standpoint of oral health . .
The overwhelming majority of' medical doctors (87%) routinely inqqire about their patients" smoking, habits . The
overwhelming majority of dentists (83%) do so only under
special circumstances . On the average, fewer than ten percent of dental patients are asked' about their smoking habits,,
compared, to nearly 40 percent of'medical patients . Dentists are much less likely to advise their, patients to reduce
or curtail cigarette smoking and much less likely to obtainn
compliance when, they do so . One out of' four dent!ists, comparedl to one : out of twenty physicians, reports that none of
his patients complies with his recommendations about smoking .
Although the majority of dentists are just a~s emphatic as

physicians in agreeing that smoking is an aiddictioni and that t
there is no advantage in the wide-spread consumptioni of tobacco in our society, their disapproval is consistently less
forceful and does not bar enthusiasm about the satisfactions
of smoking if they smoke themselves .
Ph
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2'
B . Under what circumstances does the dentist become involved in the management of his patientss
smoking habits oni their initiative or his own? In
what proportioni of all his cases is : the mana~gement of smoking involved? What degree of success does he anticipate in advising patient!s to reduce or abandon smoking?
As previously noted, nearly all dentistis in this sample sometimes (but not often)inqpire, about their patients' smoking
habits . The conditions that provoke such iinquiry are : unusually heavy staining or deposits of tartar, lesions, infections and leukoplakia .
The individual dentist may or may not associate smoking

with other healthi hazards, but he does so, if at all,, as a
layman and does not consider these matters to fall within
his professional scope .
A sizeable minority of the dentists are concerned with bad
breath and/or coughing -- at'tributed to smoking -- as
problems in their own work with patients .
The leading conditions directly related to smoking, in order
of mention by the dentists in this sample, are :
Staining
Inflammations and' irritations of oral tissue
Heavy tartar deposits
Leukoplakia
Halitosis
Gingivitis
Ph XIX 6 :3
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3'
Other conditions that receive significant mention as directly related to cigarette smoking (in the sense of' calling the dentist''s attention to the patient''s smoking, habits) .
are :
Erythema
Persistence of chronic
c oughiing
Lesi~ons
Orall hyperkeratosis
Thickened mucus
C'oated or hairy tongue
Chronic sore throat
Abnormal appearance or
quantity of' saliva
Lichen planus
All of the above effects are attributed to cigar and pipee
smokiing plus lesions of the lip, loosened and displaced
teeth, inflammation and desensitization of the tongue .
Although staining~ is the effect most often mentioned by
dentists, many of them do not regard it as serious and
insist that the staining effect of nicotine merely increases the visibility of tartar deposit's that would be present
in any case . There iso also general agreement that individuals differ inexplicably in their susceptibility to : staining . Some chain smokers have no stains on their teeth at
all, according to the dentists, and some non-smokers show
very marked "tobacco stains . I"
Ph,
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The majority of the dentists agree that inhalation is not

an, important consideration as far as oral conditions are
concerned . Some of them even regard inhalation as a
favorable factor :,
"I would say we see the mosY evidence

of smoking on the oral tissues of' people
who do~ not inhale . . I assume that most
cigar and pipe : smokers do not inhale but .
I do not ask them this ."
"I think that when they don't inhale whatever prodkict the : smoke contains, I again
would assume that it is the coal tar products, it would be a natural'produ!ct of combust'.ion or sornething, of that na~ture -- are
deposited iJn the mouth rather than carried
further down the : respiratory system . "'
Dentists are even less confident than physicians of their
ability to manage, the srnoking, habits of their patients andd
seldom try to dio so . Even when their advice is solicited,
they prefer to restrict themselves to factual explanations .
19The rest is a matter of willpower and
up tol the patient himself ., "'
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C . How does the dentistl's management of smoking

fit into and interlock with his whole pattern of
treatment for oral conditions ?'
The management of smoking is not an important part of

the : dentist''s pattern of treatment for oral conditions . Two :
out of three of them recommend complete withdrawal, if
they make : recommendations at aTl,, but have no proceddres
for the patient to follow . Only one dentist in the entire samp1e has eve prescribed a drug for withdlrawal .One in fivee
recommend low sugar chewing gum or candy . Only a handful ever recommend a switch either away from or towards
cigarettes .
Ph
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&
la . Tio what extent is the dentist's concern about

smoking inflluencedi by the age, sex, occupation
and other characteristics of the patient? How
ils patient resistance influenced by the doctor's&
example as a smoker or non-smoker? .
The dentists" attitudes on these points! are identical with

those of the physicians' . Slightly over half of the dentists
say that the patient"s age is not an important consideration
in thei~r concern about smoking . The remainder have : an
almost uniform, viiewpoint containing two standard themes . .
(a) Younger patients are "worth
discouraging" because their
smoking is still elective and
because any long-term harmful effects have not yet been
incurred . .
(b) It is very difficult to influence
the smoking habits of older patients, but on the other hand,
they are much more suisceptible to : the oral symptoms that
may be aggravated! by smoking .
Alrnos!t' half of the respondents show: equal concern for male
and female patients with regard to smoking . The : remainder regard! srnoking, as a much more serious problem for
male patients because they smoke cigars~ and pipes in aidditioni to cigarettes .
Ph
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Page,
The exampl'e of the dentist as a smoker or non-smoker has

even les s effect on his patients than on the physi'cian' s . His
recommendations to certain patients to abandon or limitt
their smoking are based on, specific symptoms which the
denti'st himself i~s presumed not to share .
Within the limits of this sample, no, differences were dliscovered between smoking and non-smoking dentists withh
respect to the advice they give their patients or the reactions they obtain .
Ph
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E .. Do dentists ever advise patients to stop smoking

in the ahsence of a specific health condition?'
Only an insignificant minority of dentists ever advise pati!ents to stop smoking on general principles .
Ph
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P3g ;e 9
P . H'ovw dbes the dentist evaluate the sericusnes= oi'

the patient"s ne d~ to reduce or terminate smoking?
Dentists, like physicians, distinguish sharply between heavy

and moderate smokers . They do not regard mod'erate smoking, a~s an oral health problem at all .
However, they : automatically classify any p:,pe or cigar smoker as a heavy smoker . The heavy cigarette smoker is described as smoking more than a pack a day . A large minority (2'4%)~ set the limit at two packs a, day or even higher .
The : dentist's image of' the heavy smoker is marked by extreme emphasis on the single trait of nervousness -- soxrretimes translated als anxiety, tension, hypertension, apprehension, perfectionism, neurosis or compulsiveness . The
dentist' obs rves or believes that he observes heavy Emokers
to be more restless and irritable in the dental chair .
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G .To what extent't are the dentist"s attitudes and

practices influenced by his history as a sznoker?'
What is his current srnoking pattern? How about
his immediate family? '
Thirteen percent of the dentists in the sample have never

smoked at all . Thirty-two percent, smoked at some former time but have given it up . The remainder smoke currently .
These proportions are almost identical with those found
among physicians . As might be expected, both from their
working conditions and their observations of oral' symptoms,
the dentists tend to avoid pipes and cigars . More than nine
out of ten of the dentists who are current smokers smoke!
cigarettes, and the proportion who ever smoked cigars or
pipes is significantly smaller, than among, physicians .
Forrner smokers among, the dentists also favored cigalrettes when they smoked . On the average, former smokers abandoned the habit between five and ten, years ag ;o, after smoking for twenty years . Their decisions were not
much influenced by current publicity . Only two individuals
in the sampl!e gave up smoking within the past year .
The reasons why the forme r smokers gave up, smoking fall
into tliree approximately equaT categories :
(a) Because of respiratory or cardiovascular symptoms attri~buted to
smoking, .
Ph
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11
(b) Because of' apprehension about

long-term effects .
(c) 'To avoid coughing, bad breath
or nicotine-s"ained fingers, while
working on patients . .
The attitudes of dentists towards their own srnoking, are
much 1!es .s complex than those of physicians, but follow
the same general pattern ., Dentists are likely to stop
smoking because of cardiovascular or pulmonary symptomis and -- occasionally -- because of apprehension
about lung cancer . They are not significantly influenced
by oral disorders of' their own, except those that may be
involved il :-i their interaction with patlients ..
Two out of three of the current smokersi have attempted
to quit smoking and most of them succeeded for varying
periods . Their prevailing attitude -- quite unlike physicians . - - is that smoking is an attractive adr?icti-n :vhichh
they wouid give up, if they could .
The current smokers began to smeke early ; three . out of
five before the age of'twenty :, nineteen out of twenty before
the age of twenty-five . The cigarette smokers average a
pack and a half a day . Most of them smoke only a single
preferred brand and the distribution of their current preferences is as follows :
Ph
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Percents of Those
Preferred B'rands Currently: Sm_oking, Cigarettes
Kent
Winston
Camel
Physicians
Dentists
15
11
28'
19'
6
6
4
2'.
5
2
Lucky Strike
Tareyton
Phil'ip Iuto r r i s
Other brands and',
01
36
28
100 :
100
IrrTa rlb o r o
Pall Mal'l
L & IvI
Chesterfield
mixed preference
Total
Considering sample sizes the two foregoing distr ;buticns are

very similar indeed~' . Dentists are much less successful than
physicians in controlling the smoking habits of their wivess
and children, although they disapprove of it . Both their wives
and their grown children show a normal incidence of ' smoking
and nume-rous instances of very heavy srnoking .
About half the dentist!s in this sample share the belief, which
appears to be an illusion, that they and their colleagues smoke
less than the general public . The reasons they give are convincing, -- that dentists have few opportunities to smoke during the working, day and that they have persuasive reasons to
a~void cigarette smells or stains in their close contact with patients . The figures, however, do not confirm these responses . The smoking, ra~tes of the sample are close to those of
the general male population .
Ph XiX 6 :3
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13
Dentists are much less certain than physicians that there

is a trend towairds a reductioni of smoking in their professional circles . The majority are not aware of any trend
at all although it may be significant that no respondent in
the sample perceives an increalsing trend .
Unlike physicians, who show increasing concern about
smoking and whose recommendations to their patients are :
becoming, more forceful, the dentists appear to be taking
much the same attitude and giving much the same advice
about smoking, as for many years paist .
Ph
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Pag
14
H . How much variat_.ion amo :zg cigarette brands with

respect to : tars, nicotine, ad'ditives,, paper and
other physical' characteristics do dentists perceive ?What differences do they recognize in
the tobacco content of pipes, cigars and cigarettes?'
A much larger proportion of dentists than physicians (65

percent compared to 42 percent)' perceive important differenc .es among the popular brands of cigarettes on the
market today . Most of those who answered negatively are
non-smokers .
The dentist's view of' brand diffPrences is a layman's view .
Only a small minority : measure cigarettes against a scalle
of strength . Th^_s difference is readil'y explained . The :
physician''s view of' cigarettes resembles his view of certain classes of drugs . The dentist, even though he rnay
prescribe occasionally,is, relatively unfamiliar with drugs .
The key words in the dentist's image of cigarettes are derived from consumex promotion . All preferred brand's
tend to be characterized as rnild, less : irritating., and tasting bett'er . Unfiltered cigarettes, when preferred are described as having more taste or flavor, where filter cigarettes would be described as tasting better .
About a dozen respondents have obsPrved' in their own practices t'hat filter cigarettes produce less staining . No : respondent disagrees with this point,, but to the great majority of dentists, this fact has never occurred .
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The only other special element in the dentist's image : of

cigarettes is an interest in the temperature of smoke . He
regards heat as i~rritating, to the oral tissues andl often disicu~sses the possible cooling effects of : filters ;, holders, and
extra long cigarettes . .
Kent has by far the : most favorable image ais a mild' and
better tasting cigarette containing less tars and nilcotines
because of its micronite filter .
Dentists are : much more likely tha~n physicians to believe
that all filter cigarettes contain "coarse :, cheap and inferior tobacco . " Dentists are not highly aware of paper as a
factor in cigarette smoking, and none of therni propose any
differences among brands with respect to paper .
The interviews contain two isolated and uninformative references to phenol .
Like the physilcians, the dentists are completely uninformed

about the technical characteristics of cigarettes .
Ph XIX 6 :3
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16
I . Does the dentist accept the possibility of a, perfectt

filt'er?' How familiar is he with recent statistical
studies associating cigarettes and lung, cancer? .
When asked whether it wouwld be possible to develop a filter that removes all toxicity from ci~garettes, the dentists
in this sample show a distribution of response very similar to physicians, however, the content of' their responses
is not quite the same .
Physicians tend' to view the problem in terms of the drug
effects of'tobacco,, assuming that the smoker's gratification is primarily derived :1 from the stirnul!atiion of' nicotine .
Their, view of filtration is centered on nicotine . Dentists
tend to think in terms of taste, smell, and oral sensation .
They seldom mention the stimulant effects of nicotine and
seem to be nearly unaware of them . From the dentist's
viewpoint, the perfect filter would'i be designed to eliminat'e tars or to lower the density and temperature of the
smoke : .
Seventy--one percent of the dentists ;, compared to 68 percent of the physicians, accept the relationship between cigarette smoking and lung cancer as proven, but most of their
knowledge comes from popular magazines and'' other mass
media, not from professional sources . Their opinions on
this subject tend to be perfunctory and not related to their
own practices .
Ph~
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About a third of the respondents saw some cases of oral

cancer among their own pa~tients in the past year,, and the
overwhelming majority see leukopl;akila freriuently . The
dentists are nearly unanimous ini associati'ng, both benign
and malignant oral lesions with h1eavy smoking,,, especially of pipes and cigars .
More dentists than physici3ns favor filters (64 percent
compared to 53 percent) . Among, those who, regard filters
as useful, fewer than five percent are completely satisfied
with those available ., The typical affirmative themes are
identical with those heard among the physicians :
(a) That filters reduce irritating

effects somewhat .
(b)' TF, at they may do some good
andl ca~n do no harm .
('e) That filter cigarettes are pleasanter t'o smoke .
('d) That' s,ome "'unknown irritants"'
are removed from the tobacco .
Like the physicians, the dentists are not sure whether filters
are d'iirectedl at tar, nicotine, or other elements .
The negative themes with respect to filters are much : more
limited than those expressed by physi'cians . The most irnportant a~re :
(a) That any filter decreases thee

flavor of tobacco andl the oral satisfaction obtained from smoking .
Ph!XIX
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(b) That the temperature of the smoke is

an important factor in oral irritation
and is not affectedl by filtration .
(c) That filters are less important than
the use of mild a~nd high quality tobacco in cigarettes .
A small but' significant number of dentists sometimes advilse their patients to switch from non-filter to filter brands
in the presence of specific oral conditions associated with
smoking .
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Pag,e
19
J' . What are the dentists' images of the leading tobacco companies?' How do they evaluate the efforts
of tobacc o companie s to dee rmine tobac co' s effect on health and! to develop safer cigarettes?'
The denti :sts" view of the tobacco industry is practically

identical with that of physicians, as the following figures
for identification of the leading companies show :
Company
American Tobacco Co .
Liggett & Myers
Reynolds Tobacco, Co .
P . Lorillard
Philip Morris
Percent of' Mentions

Physicians
D'ent'ists!
77
54
50
30
16
76
5'2
52
28
14 .
The dentist has less interest than the physician in current

research by tobacco companies to produce safer cigarette&
and seldom has any definite information on the subject . He
is highly aware of and highly prejudiced against the newsletters and brochures he receives from industry sources .
* Percentages non-additive
Ph
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Ordinary consumer advertisements for cigarettes have

had much rnore effect on dentists so far than the direct
mail material specifically directed to them . Eighty-one
percent of' the sample, like eighty-two percent of the
physicians, recall cigarette advertisements they have
seen recently . The leading brands in terms of' significant advertising recall are als follows :
Brand
Pie rc ent of Mention

Physi1cians
Dentists
Camel
Kent
15
16
22
19.
Winston
20
19
Sal exni
Lucky Strike
L&MI
Chesterfield
13'.
15'
10
12
17
14 .
7
6
T'otal!
The general level of interest and the media involved were
very: much the same for the two groups . .
Percent Mention:ng Recall
1yledifi
of Cigarette Ads in Ea~ch
Physicians
Dentists
Television
LIFE
75
26
80
35
Newspapers
19~
10.
LOOK
TIME
Billboa rds
Other media
13,
10
9'
59'
17
8'
13'
53'
Total
Percentages non-additive
Ph
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The promotional themes recalled are those featured in

the il'lustrations andl headlines, except for some tendency
to emphasize iinfornaation about filters .
Ph
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22
K . What would be : the characteristics of an ideal

cigarette frorn~ the dental standpoint? Too
what extent do dentists accept the possibility
of such a product?
Thirty-six percent of 'the dentists in this~ sample think

that it may be possible for laboratory research to develop a cigaret'te without health hazards, 36 percent are uncertain, and 2'8' percent reject the possibility . These
proportions are virtually identical with those obtained
in the physician sample, but the content of the responses is d'ifferent . .
Dentists distinguish sharply betweeni general! health hazards, with which they are not directly concerned, andd
oral health hazards . They regard the removal of oral
health hazards as a~ much simpler, more feasible probUem .
When dentists are asked to, describe the characteristics

of an ideal cigarette from the dental standpoint, the reduction of heat unexpectedly emerges as the leading, characteristic . The other features repeatedly mentioned a~re :
(a) Reduction of the carbon content
of the smoke,
(b) Removal of the "heavier" tars,
Ph XIX 6 :3
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2'3
(c)' Elimination of unknown irritants,

('d)', Reduction of combustion residues .
In sumrnary, dientists are more satisfied than physicians
with cigarettes presently avai'lable, and more hopeful of
improvements to, come .
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24
APPENDIX
ILLUSTRATIVE QUOTATIONS
FROM THE INTERVIEWS
I . On the Oral Effects of Cigarette Smoking

2 . On Cigars and Pipes Versus Cigarettes
3' .On the Variation in Pbpular Brands
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25 :
On the Oral Effects of Cigarette Smoking,

"'I can't really say that any effects stand out .
Probably none in moderate smokers . In heavy
smokers you may see teeth~ stains or even leukoplakia or poor gum conditions ."
"Heavy deposits of' nicotine and tar on the tongue
and side of' the mouth, on the porc elain fi1!lingss
and plastics . They stain and turn dentures yellow . There is a heavy correlation between smoking : and gum inflarnmations . 11
"It stains the teeth and burns tissues . They cough
a lot when you are trying to~ work on them -- and~
they smell lik:ehell ! " '
"With : those that smoke heavily, th~eir mouth and
lungs are irritated . It pullls the skin on their lips .
It makes for a lousy mouth to work on from the
cleaning aspect . It decreases their orall hygiene .
This is normally poor for cigarette smokers ..
There, are tars around the teeth . "
"'Nicotine accurnulations~ and resultant tartar accurnulations ., Gingival inflammation . Epithelization of the mucus membrane ; precancerous lesions ; lichenplanus lesions in the inner cheeks -liow technical shalD I g,et? "
"Very heavy smokers will have a stained tongue . . .
looks like it is coa~ted with tars . . . people who holdd
their cigarette in one place get irritation of the .
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26
soft *.issues~ immediately adjacent to the : 3rea . . .

seen in pipe smokers too . "
"Fortunately alll Ii have observed' is heavy stain
on the teeth leading to tartar deposits ; a: few
cases of mildly excessive pigmentation of the
gingiva . 11
"Deep stains, calculus pushing down into gums
and then irritation involving bones and tissue .
Oral membranes can all be inflamed . "
"Frequently one who does smoke will exhibit
staining of the teeth ; but it is not necessarily
the products of the smoke itself that cause the~
staining . They more likely s .re stain deposits
that have formed on th~e teeth from other sources .
And it is general'ly true in mouths where the teeth
are less prone to accumulate tartar deposits or
calcareous deposits that there iis seldom any evidence of staining on the teeth, . "'
"Also ir_ heavy smokers you will find this rather
general stomatitis where all or a grea~t amount
of the mucus membranes in the mouth, the mulcosa willl be inflamed as a, result' : of' i'sritation .
If you're f'oilowing aliong, withi what gives people
diseased appearing gum t'issues,, actually drinking is even more important and it goes right
along with smoking ., You get a fellow -- during
the holiday season you, see this one - - who has
lived' it up every night for a, week and one of the
most noticeablie~ symptoms you have outside of'
being, a little tired' is a flare-up of peridental
problems . "'
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P3gz-
2'7
"I don't th :nk it reduces decay or causes decay .

People who smoke a lot have that smoker's cough .
Of course, they get that smoker's breath I don"tt
like . And isn't it a peculiar thing?' I have heavy
smokers that I treat as patients and they seem t'oo
have no tartar at all . The re i!sr_'t even any stai~n
on their teeth and I often que stion them and say,
'How is it that your teeth aren't even st3inedl?'
There's no, explanation except thatt the enamel'
is hard. 1'1'
"I don't see as it'' makes too much of sa difference
in oral hygiene, except it does discolor the teeth .
"Where there : is excessive smoking, I findl stain
on the teeth and gums ., Teeth that are stainedd
tend to have greater roughness and, therefore,
the tars can adhere easier than with, smooth,
cT'ean, teeth . "
"I believe that effects a~re caused more by pipe
smoking but, of course, I do not see enough
casesof'lesion
:s in the mouth or leakopl'akiatobe abie! to say that cigarette srnoking does not
cause bad effects too if there is heated smoke
entering the mout}i over a long time . "'
"Cigarette smoking may cause hardening of the
tiissue . Of' course, it is hard, to pin it down .
Other things can cause it as well,, such as eating, spicy foods . There can be ai change in colorr
of the tissue . I would say that there could be a
tougheniing of'the tissue to counteract leukoplakia ."
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28'
"Uisually the effects are found in gingivitis which

is aggravated1by irritants of smoke,, tobacco .
There isn't any connection whatsoever between
oral pathology and inhalation itself' -- it's the
irritants that lodge in the mouth that cause irritation and pathology .
"'I''ve never seen a nicotine stain that regula:r
prophylactic care every six months couldn't
remove . 'Ir
"Well, very often the st'aining of plastic or por- .
celain fillings will necessitate their removal . "
"Sornetime s I have to explain to my patients
that the ca:lculous deposits that most smokers
think are caused~ by smoking, are actually caused
by other things, but the smoking stains the tartar
and makes it more : noticeabie : . "'
Ph
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2'9
On Cigars andl Pipes Versus Cigarettes

"Actually pipe smoking can cause some
malocclusion, andi inflammation cf thee
tongue . Cigars contribute rr,ostly to Just
stai.-i2ng . "'
'rThe pipe itself is : the probZ!err_ . It wears
the teeth out ard' affects the facial expression . He will probably lose the .*.eetlh that
are worn down this way . The cigar smoker chews the cigar which will wear down
the teeth . The abrasive aspect of the tobacco has an effect . And snuff dippers
are awiul .
"People who have prominent front teeth
bite oni a pipe s .nd it causes the teeth to
spread forward . It''s hard and constant
pressure . . I remember seeing one Negro
man in t'He clinic at dental school who 1add
a: bad ca_e of leukoplakiu . . . which, as you,
pro-bably know ; ils pre-cancerous, and I'
.old him to stop smoking that pipe right
now . The instructor came . around and
told him the same t?-_iir_g . We saw him 1'ater and he had cleared up : a bit, but he rea1ly had a, bad case . I
"When one inhales~, the smoke does not
irritate the mouth as rnuchi. . . rnucN more
severe in pipe andl cigar smoking -- the
smoke lingers in the mouth . . . it might be
part'icularlly bad on one side of the mouth
Ph
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30
if that"s where the person generally

holds the cigar or pipe . 11
"'Leukoplakia is more prevalent among
pipe smokers, then cigar smokers next,,
and cigarette smokers less so . "'
"I don't see that kindl of smoking . Cigars
can cause greater staining but less irritation really .. Pipes are the hottest smoke
and heat is definitely part of the problem
to the dlentists . Very hard on porcelain
fitti'ng s .
"Welll, the constant clamping of the pipe

between the teeth could create a bony recessi~on around the supporting structure
of the tooth, but it doesn't always happen .
I would say that maybe 25 percent you'll
have some ill effects as far as the bony
structure is concernedl ; but the other 75
percent will not have anything . "
"There is dryness of the mouth, staining
of teeth and tissues . Gagging reflex is
greater with smokers . I can tell a pipe
smoker by the type of deposit I find' on
his teeth, sort of a tar like deposit, thick .
It is a very characteristic deposit from
pipe smoking . "'
"A long heavy cigarette holder or a holder
for cigars could cause lesi .ons in the mouth,,
the cheeks and on the 1ips . The tendlency to
Ph'
XIX'
63'
Page : 31
bite on pipe and cigar loosens the teethi

and causes more damage than the smoke
from pipe or ci'gar .'''
"As far as the : oral cavity is concerned,,
cigars or pipes would tend to irritate
more . For, one thing, they are stronger
and the smoke : stays in the mouth longer . '"
"Pipe smoking could cause leukoplakia ;;
malignant growth on the lips and so forth
muchi more than cigars . No difference :
between cigars and cigarettes that I've
noticed . "
"It's a little difficult to say . Pipe smokers with an inflamed roof of their mouth
are often seen . They also get irritations
on the lips from the stem of' the pipe . Cigars, I don''t see enough to, be able to say
one way or the other . "
"Cigars are the worst, they cause more
irritation . Like snuff, the tobacco comes
in direct contact with the saliva . With the
lip -- I watch for cancer -- plus abrasibn of the teeth with pipe and cigars .'"
"Cigars and pipes leave : heavier deposits
of stain and going back to the previouss
questions, they cause malocc]iusions and
moving of the teeth and chronic irritations
of the lip and soft tis sues ."
Ph
xIX
63
Page
32
"I think pipes are much worse . I smoke

cigars and cigarettes myself . If you ar e
a pipe smoker, and'you are careless about

cleaning it, you are asking for trouble ., " :
"As far, as the dentail picture, really very
similar . If anything the eigairsarea littlle :messier than thie cigarettes . What
seems to be a tendency -- well, the salivai changes consistency -- apparently .
Of course,, the odor is unpleasant to the
dentist ., You don't see many pipes any
more . In, our line,, of course, the pip e
is more of a hazard to the teeth that hold
the pipe and' that"s mainly our concern that
they will break these : teeth off . And it gets
to be quite a problenn if they have to wear
dentures . "
"No, I think that a cigarette can be harmfu.l as fair as lesions are concerned . Ciga~rs
can be harrnfull as far as gums are concerned . Pipes can be harmful as far as
bony tissues and teeth themselves are concerned . And also, the gurns . I think they're
in different categories . "
"The worst damage is done by pipe smokers ;

much more so than cigarettes or cigars . So
many cases of orall cancer are associated
with the constant irritation of the pipe . This
iis not the caise with cigarettes . "
Ph XIX 6 3
Page 33'
"Well,, I believe that a pipe held in the

rnouth in the wrong position can well
loosen the teeth . I had a patient who
smoked a pipe with a~ straight st'em : and
it was so heavy that in pressing on the
stem with his teeth, he loosened a~ couple of his teeth . "
"I don't believe : cigars will have the same
effect a~s cigarettes . Pipes will concentrate the damage in one area usually -one side of the mouth depending on where
the person gets in the habit of holding the
pipe in his mouth . Hot smoke is concentrated in one particular area . With cigarette
smoking there is not this concentration but
the tissue is disturbed in many different
areas of the mouth . "
""No . Pipes are, more bizarre in their effects on oral pathological indicat'ions .You,
get more dramatic effects from smoking
pipes -- more severe breakdowns brought
about through pipe srnoking, than cigarettes .
Heat of pipe causes greater harm in, mouth
area, throat too . "'
Ph
XIX
63
Page
34
On the Variation in Popular Blrands

"I'f you are to believe reports, some of them
filter out some of the tars . Kent is supposed
to filter out tairs and nicotine . 'r'
"Yes, I think so, the filter cigarettes seem

to be muchless irritating, they have less bite .
I found Kents to be less irritating than Lucky
Strikes ."
"iThe filtered and milder brands are a little
better ; such as Kents . "
"I don''t know from actual experience . I remember the Consumer Research bulletin said
Camels were the worst and Kent with the
micronite filter was the safe :t . "
""I've read articles in Reader's Digest and
Consumers' Report stating that Kents were
low in tar and nicotine . `
"Ii think there's quite adifference . I' used to

smoke Raleigh's king size . They put a filter
on them, and I didn't like them . I cut the filter off, and felt it' was cheap tobacco then . I
think with the filters, you get cheap tobacco . "'
"There is no difference between one brand and
another, although Kent, I've read, seems to be
lowest in nicotine . "'
Ph
XIX
E3
Page
35
"I would say yes . I believe the report in

the Consurners' Report is right -- a good
piece of research . The lowest was King
Sano and the second lowest wals Kent -that's all I care about -- II srnc:ke Kents . "
"~I~ enjoy Carne~ls, ~ ., -the cther~& are too mild . "~

"I think all' are the same, just like your
Cola drir_ks . Only some may h.ave slightly
differentt flavor of tcbacco . "
"Of course, t!hwt"s vyhy I. smoke Kent . The
filter brands are loures*t in t~ ;rs and r, :icotines .
Phenol! acts as an irritant on mt:.cus mernbr3ne_ . "
"Wel'l, I've read what they publish every oncee
in a while in Consumer's Research or the Reader's Digest . They have a list . 11 know tha~t
Kents are mildi . They give only the tar and
nicotine aspects of it . I1 don't know much else
about it . There was a figure butt it wasn't worth
my remembering ."
'I' can best ar_s-arer that from my own experience
that I mentioned -- that I did srrroke Chester=
fields for a long t"me . It was ai non-fi!1'tered'
cigarette,, a small- sized cigarette, not a, king
size . And then, after switching to L & IvD, I myself noticed a decided difference, yes . It's hard
for me to speak for other brands because I have
just used those two . 11
Ph
XIX
63
'
Pag
'rI've smoked Kents frorn the beginn-_'ng,. 1 like

the taste and I don't' seern to cough so rnuchi .
L'ut I think I'rr*t just used to them . I re,lly dcn't
think that there -are any real differenceu '"
"Not for F:,zrposes cr dental health, there is nc
difference . I kept records on patients with t'obacco stain=: at one time and fcund *.~_at there
was no di{ference involved in staining becausee
of the brand . Ir had more tc do with the acidity
of the mouth than anything else . "
"I think the filtered brands are probably worse
for health . We are from, tobacco country here .
We know they use worse tobaccos . "
"Ye :s, Kents has less tars and mcotine . I really don't remember the other, bbrands or, the exact
amounts in other cigarettes ., "
haven't made a study of diff'erert brands so I
don't know ., I smoke Luck2.1es ?ox their fllavorr
which has nothing to dc wirh tars ar_d nicotine ..
I am not imr-ressed with =ilt .zrs on cigarettes
at aill ."
"Kent advertises that they r :ave the least amountt
of nicotine because of' their fil!ter . I switched
to Kent but I couldn't stand them . They taste
awful -- like smokirg straw -- no taste . I
like Salem now because it is rr_entholated, but!
at first, I hated them . "
Ph
XIX
63'
P'ag
37
"Frorn what i under stand about producing th .ing s .

like that,, the filters~ merely allowed the use of
tobaccos that may have beer_ a little too sharp
for uSe in non-filtered, so that the net result is
pretty much the same . ,,
'rl don''t know but I don't think there''s any difference . I don't thirlc ary : has any advantage over
another, if it's filtered' or unfiltered or if it"s
one brand over another . lf they're going to do
l.arm, they're going, to do harm whether you''re
smoking this one or that one .'"
''Ma.~L :,:~ the filters do a better job . The darnnedd
filters do get stained up ; so they must' be pick~ing up something that otherwise would get into
the system 11
','They are supposed to cut down some tars . But
the b~_rber did a test for me one tirr. :e . He blew
smoke from a plain cigarette like Luckies on a
clean towel 3nd' then ; e did the : sarne with a fi1tered cigare .t.te and I could *_iot see any difference as far as the deposits on the towel were
concerned . Iunderstand the micronite filter
that Kent uses is supposedl to cause silicosis -so I was told by a professor at Howard University who developed a cough from srnokir_g Kents .
He told me he learr ed from a .~ journal he read
that Kent fil :er will cause this cough . "
"Kent is the best filtered smoke according to the
literatz: re ,i^d advertising 'i see . But Chesterfield uses better tobacco, Go it all adds up to the
Ph
XIX
63'
Page
38'
same thing . The filtered cigarettes use thee

worst tobacco -- strongest and most rarmfLl
in the long run .
"Kent was written up : in Ccnsamer"s Report as
having a mi :.zeral based filter that made it corrnplletely free of ill effects . < also read about it
in the Dental Journa1 . But they solid rn.uch le3s
because the cigarette was too, milldi and people
stopped'', b- ;y,ng t?7.em . "
"I thir_k some filters are more ef .fLcientt than
others . Parliaments filter out evervthing,,
even tl_-~e taste, Larks and Kent do the same .
"Frorn a persor3l' viewpoir_t ., `i'lters have no
advantGge : . . . some have more menthol . . . since
we : don't know what the cancer producing agents
are -- they could be in the paper -- what difference does the filter rr_a .ke?r .r
r'Well,, jradgi :n g onl'y by the figures, which ii .= on,
filtered smoke, we know that the smoke is less
noxilous and it's probably; the filter, ;o probably
Kentt and L .fe and a couple of these other mild
ones do have more effective filters . "
"'On,Ty cne I can rnention by narr_e i s Kent because : of' their advertising on their filter . But
they use the lowest grad'e of tobacco -- stronger -and resi-a!ts are,, therefore . worse . Salem is a
subterfuge withi mentholated smoke and a different fl :~vor ., "'
Ph XIX 6 3
Page 3'9~
"Kent is to me, sati'sfactory . I't is mild and yet

stimulating in an oral way . That's why we smoke,
oral satisfaction .That's why i gained . I went
from one oral satisfaction, smoking, to : one off
eating . "
o 03 o 782 i .
I
.
Ph XIX 63'
A . CHARACTERISTICS O'F' THE' SA1VIiPLE .
Ph~ XIX 63'
Tab'_e 1
Distribution Of' The Sample

By Age
D'~e~nt i sts~
A~g e~~
(Percents)
33
34
44
54
years or less
- 43 years
- 53' years
- 63 years
More than 63
17'
27
31
25
--
Tot'al
100
Ph XIX 63 '
Table 2'
Distribution Of The Sample

By Volume Of' P'rs.ctic e
Patients Per Sample Week
Dentists
(Pe rcents),
25 or lless
26 - 50 '
51 - 75
I
38
32
15
76 - 100
10' 1, - 150'
11511 - 200
20'1'~ or more
9
3
Total
100,
Ph XIX 6 3
Table 3'
Distribution Of The Sample

By Region
Region
Dentists
(P'ercents)
Northeast
56
South
23
North
Central
13
West
8
Total
100'
Ph XIX 63
T'abl e 4
D'istriibutim f The Sample

By Community Size
1960
Population
Dentists
(Percent's) .
C3ve
r
one
million
9
79
250, G00 - 1, 000,000 :
:0Q
Under
2'50,
000
1'2
Total'
100
Ph XIX 63
T'abi e 5
Distribution C2f' The Sample

By Religious Affiliation
Rel'~ig~ious, ~ Affiliation Dentists

(Percents)
Protestant
56
Roman
Ca~tholic
2'1
Jewish
23'
Total
100.
Ph XIX 6 3
Table 6
Distribution Df The Sample

By EZeadiness To Adopt New Products
Readiness To~A~dopt .
New
Prod!ucts
Dentists
(Pexcents) .
Conservative
69'
Partial
innovator
17
Innovato
Total
14
100 .
Ph XIX 63'
B . ATTITIiJDES' AND PRACTICES'

REGARDING PATIENTS" S1'VTOICINGI
Ph XIX 6 3'.
Table 7
Concern About Patient's' Use Of Tobacco, .

Physici~ans And Dentists Compared
Degree
Of
Concern
Physicians
Dentist's
(Percents)
Seriously concerned 61 33'
Somewhat
concerned
22
43
U'nc!onc
rnedl
Total'
17'
100,
24
100
Ph XDK 6 3'.
Table 8
Proportion Of Each Ph}rsician! s And Dentist's

Patients Asked About Smoking Habits
Proportion Of
Patients Asked
Physicians
Dentists
(Percents) .
0' 11 41 100
10' percent 23 70
40' percent 20 22
9'9' percent 23 2
percent
34
6
Total
100 :
1000
Ph xIXX 6 3
T abi e9 ~
Physicians" And Dentists' Tendency To Inquixe

About Their Patients' Smoking, Habits
Tendency To Inquire Physicians D'entists

'
~
(Percents)'
Inquires
routinely
Inquires under special

circumstances
Does
not
inquire
87
10
3'
'Il"otal, 100'
100
Ph XIX 6 3
Table 10
Clinical Conditions Iin~ Which Smoking Is

C'ontraindicated According To Dentists
General
Conditions
D'ent'ists .
('Percents)'
Peridontal
problems
Cosmetic
problems
Pre
andpost
68'
surgery
4
12
Specific Disorders
Leukoplakia
Oral
cancer
Infections
Total
38'
16
16
" Percentages non-additive
Ph XIX 63'
Table 11
Physicians' And Dentists' Responses T'o The Question,

"Do Cigars And Pipes Have The Same Effect On The
Conditions You Just Mentioned As Cigarette Smoking?
Classification
Of Response
Physicians
Dentists
(Pe rcents),
Affi rmati ve
38
Negative
Undeci ded
Total
34
3
7
2'5
10'~0~~
48
11:8'
100 ~
Pli XIX 63
Table 12
Effects Dentists Ascribe To

Cigarette S'molting, In Oral Conditions
Effects
Dentists
(Percents)
None
Staining,
4
66
Inflamrnation and irritation of '

oral tissues
41
Heavy tartar degosits
19
Leukoplakia
19
Halitosis
12'
Gingiviti s
5
Total
f, Percentages non-additive!
Ph~ xIX 6 3'
Table 13'
Effects D~entists Ascribe To

Pipe And Cigar Smoking In Oral C'onditions
Effects
Dentists
(P'e rc e nt s)
None
Sarne as cigarette smoking :
Sarne as cigarette smoking

but more pronounced
Stains and tartar
Lip involvement
Loosened or spread teeth
Inflarnmation or d'iesensitation
of the tongue
4
37
28
2'3
10
11
11
Total
- Percentages non-additive
Ph XIX 6 3
Table 14
Whether Patients Request Adwice About

Smoking On Their Own Initiative, .
Physicians And Dentists Compared
Whether Patients Request Physicians Dentists

(Percents)
Yes
No
91
9
Total
100
78
22
'
100'
Ph XIx 63,
Table 15
Proportion Each Physician''s And Dentist's Pa :tients

Requesting : Advice On Smoking On Their Own Initiative
Proportion Requesting Physicians Dentists

(Pe~rc~ents)',
None
6
110
percent
67
11
More
40
than
percent
40
19
percent
Total
10&
4
80'
11
8'
10'0
Ph XIX 63
Table 1'6
Physicians' And Dentists' Responses T'o The Question,

"D'o You Ever Recommend That A Patient Switch To .
Cigar Or Pipe?"'
Classification
Of Respons
Physicians
D'entists
('P'e r c e nts ).
Yes
36
No
64'
Total
12
88
100
100
Ph XIX 63'
Table 17
P'roportion Of Patients Who Compl!y With Physician's

Or Dentist's Recommendation To Give Up Smcking
Proportion Of
Patients Clomplying Physicians Dentists
(,P'ercents)
None :
4'25
1 - 10 percent 52' 53'
11 - 400 percent 23 15
More than 40 percent 21 7
Total
100
100
Ph XIX 63'
Table 18'
Proportion Of Patients Who Comply With Physician's .

Or Dentist's Recommendation To Curtail Smoking
Proportion Of
Patients Complying Physicians Dentists
(Percents) :
None
20'
1 - 110 percent 36
11'
More
4!0
than
percent
40'
20'
percent
Total
27
38
27'
24
100'
100
Ph XIX 63 '
T'abl e 19
Physicians' And Dentist's'' Responses To The Question,

"Do You See Any Advantage In ; The Widespread
Consumption; Of Tobacco In Our Society?"
Classification
Of
Response
Physicians
D.entists
('Percents)'
Affirmative:
16
Negative
59'
5 7
Doubtful
2'5
27 '
100
110'0
Totai!
16
Ph XIX 63
C . RESPONDENTS' SMOKING HISTORY
Ph XIX 63
Table 2'0
Distribution Of Physi:cians' And Dentists'

Smoking Habits
Smoking Habits
P'hysilcians Dentists
( P'e rc ent's )'
Never smoked
Former sntioker
Current smoker
T otal
14
31
55
13
32
55'.
10'0'
100
Ph XIX' 63'
Table 2'l
Distribution Of Physicians Ar.d'i Dentists

Currently S'rnoking,By Type of Smoking .
Type Of Smoking Physicians Dentists

(Percents)
Cigarettes only 53' 73' .
Cigarettes, pipe and cigars 20 7
Pipe and cigars only 23' 18
Other
combination
4
2
Tot'al
10'0
100 .
Ph XIX 6 3
Table 22
Distribution Of Physicians And~ Dentists

Who Formerly Smoked, By Type of Smoking ;
Type
Of
Smoking
Physicians
Dentists
(Percents)~
Cigarettes
only
65
65
Cigarettes, pipe and cigars 18' 6

Pipe and cigars only 13' 13'
Other
combination
Total
I00
16
100
Ph XIx 63
Table 23'
Amount Smoked By Physicians And Dentists Who

Were Former Smokers, At The Time They Quit
Amount S'moked'~
Physicians Dentists
(P'ercents)'
Cigars or pipe only
2'7
12
Less than one pack a day
2'7'
14
A pack a day
21
25
--
41
10'0'
100
One to two~ packs a day
lvlore than two packs a day

T ots.l
30
Ph XIX 63
Table 24
Physicians And Dentists Who Formerly Srnoked, .

Reasons For Abandoning Smoking
Reasons For Stopping Physicians Dentists

(Percents).
Harmful
Result
No
special
Other
to
of
health
illness
reason
admitted
reason
otal
35
27'
26
1'2'
100
'
24
32'
20
24
100 :
Ph XIX 63
T'able 25
Amount Srnoked By Physicians And Dentists

Who Are Current Smokers~
Amount Smoked Physi~cian~s D'entists .

( ;Percents)~
Cigars or pipe only 34Les& than, one pack a day 18'

A
pack
a
day
22
One to two packs a day 20'
19
26
33
14
More than two packs a day 6
Total
100'
100'
Ph XIX 63
Table : 26~.
Leading Brands Smoked By Physicians And Dentists

Currently Smoking Cigarettes
Brandis
Physicians
Dentists
(P'ercents)
Ken
t
15
Winston
11
Other
Mixed
brands
59'
preferences
Total
28
19 :
100
15
25
28
100 .
Ph XIX 63
Table 2'7
Whether Physician, Or Dentist Currently

Smoking Has Ever Attempted To Quit Smoking
Attempted To Quit Physi~cians DD'entists

( P'e rcents)
Yes
65
No
3'5
Total
66
34
10&
100
Ph XIX 6 3'
Table 28
Physicians' And Dentists'Attitudes Toward

Smoking By Members Of' Their Immediate Family
Attitudes
Physicians
D'ent'ists .
(Percents) :
Disapproving,
56
57
Neutral
18
17
Ivtix
edl
26
26
Total
100'
100
Ph XIX 63
D .IIvMAGES OF CIGARE T TE
BRANDS AND COMPANIES
Ph XIX 63 '
Table 29
Proportions Of Physicians And D' .entist's

Perceiving, Differences Among, Popular
Brands of' Cigarettes
Diff'erenc e
Perceived
Physicians Dentists
('Percents)'
Yes
No
Total
42
58
65
35
100
100
Ph XIX 6 3
Table 3'0 .
Whether Physicians And Dent'ists

Perceive Differences Among Filters
Whether
Difference Perceived Physicians Dentists
(Percen:ts)
Yes
1Vo
52
48
Total
56
44
100
100
Ph XIX 63'
Table 3'1
Physicians' And Dentists' Responses To

The Question, 'rAmong The Current Filter
Bxandls, Are Sorne Clearly Superior To Others? rr
Classification .
Of Response
Physicians
DentiQts
(Percents):
Yes
No
17'
28'
42
3
5
Uncertain
Total
41
100
37
100
Ph XIX 63
Table 32
Physici'ans" And Dentists' Responses To The .

Question, "Are Any OfThese Filter B'rand&
Completely Satisfactory?"'
Cla s sificadon
Of Response
Physicians
D : n t ists
(Percents)
Yes
Nb
Doubtful
6
81
Total
113
4
82
14
100
100'
Ph XIX 6 3
Table 33
Physicians" And Dentists Responses To : The

Question, ""Would It Be Possible To Develop A
Filter That Removes All Toxicity From Cigarettes?"
C1as sification
Of Response
Physicians
D'entists
;',P~e rc ents
Yes
24
No
41
Doubtful
3
Total
27
48
5
25
100
100 '
Ph XIX 6 3
Table 34
Physicians' And Dentists' Acceptance Of

Association Between Cigarette Smoking
And Lung, C'ancer .
Classification
Of Response
Physici3nS Dentists .
(Percents)
Accepts as proven
68
71
Not entirely convinced
2'6 :
24
Regards as unproven
&
5.
Total
100
100.
Ph XIX 6 3
Table 35
Cases Of Oral Cancer Seen Last Year

In Dentist's OWn Practice
Number Of Cases Seen
Dentists
('P'ercents),
Nlone
67
1-2
3' - 4
5 - 10
28
3
1
1' 1 o r n*i o e
Total
100
Ph XIX 63 '
Table 36
Physicians' And Dentists' Auv~a~reness~ Of '

Current Research By T'obacco Cornpanies
Towards Safer Cigarettes, By Specialization
Awareness
Physicians
Dentists
(:'P'e r c e n t s ;
Unawa
r
e
Aware
Unc
44'.
36
rtain
Totali
30 '
48
20
100
22
100'
Ph XIX 63 '
Table 37'
The Leading Tobacco Cornpanies As

Perceived By Physicians And Dentists
Compa~nie~s~~ Phys~icians~ Dentists

(Percents)~
American Tobacco Co .
77
77
ReynoTd'is Tobacco Co .
50'
52
Liggett
&
Myers
54
52'
P.
Lorillard
Philip
Morris
Brown
&
30
16
Williarnson
Others
Total!
10 :
28
14
8
1 .3'
6
'C
,~' Percentages non-additive .
Ph~ XIX 63 :
Table 3'8'
Physicians' And Dentists' Not!ice Of

Recent Cigarette Advertisements
Whether
Noticed
Physicians
Den*ists
i:Percents)
Ye s
No
Doubtful'
Total
8'2'
15
3
811
17
2
100'
100
Ph~ XIX 63
T'abl e 39'
Physicians' And Dentists' P+Tot'rce!

Of' Recent Cigarette Advertisements,
By Leading Brands 1Woticed .
Brands
Physicians Dentists
(Pe rc ents ),
110
20
112 '
115
15
13
16
15
6
L&lvl
tiWinston
Clie ste rfieid
Camel
Lucky Strike :
Salem
K ent
Ivla rlib o r o
Pall Mall
7
1I9
6.
22'
14
17'
19'
4
1
Total
= Percentages non-additive

Dentists and Smoking 1963

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Dentists and Smoking 1963

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DENTISTS' ATTITUDES'AND PRACTICES .

IWITH REGARD :TO CIGARETTE SMOKING

T-H 2", i!I_Jafi :O .V J

DENTISTSI' ATTITUDES ANDi PRACTICES

Mendota Research Group

This is asupplernent' to lufendlota's report

To : what extent do dentists view smoking as a

The typical dentist, like the typical physician, disapproves

Although the majority of dentists are just a~s emphatic as

The individual dentist may or may not associate smoking

The majority of the dentists agree that inhalation is not

"I would say we see the mosY evidence

C . How does the dentistl's management of smoking

The management of smoking is not an important part of

la . Tio what extent is the dentist's concern about

The dentists" attitudes on these points! are identical with

The exampl'e of the dentist as a smoker or non-smoker has

E .. Do dentists ever advise patients to stop smoking

P . H'ovw dbes the dentist evaluate the sericusnes= oi'

Dentists, like physicians, distinguish sharply between heavy

G .To what extent't are the dentist"s attitudes and

Thirteen percent of the dentists in the sample have never

(b) Because of' apprehension about

Considering sample sizes the two foregoing distr ;buticns are

Dentists are much less certain than physicians that there

H . How much variat_.ion amo :zg cigarette brands with

the tobacco content of pipes, cigars and cigarettes?'

A much larger proportion of dentists than physicians (65

The only other special element in the dentist's image : of

Like the physilcians, the dentists are completely uninformed

I . Does the dentist accept the possibility of a, perfectt

About a third of the respondents saw some cases of oral

(a) That filters reduce irritating

(a) That any filter decreases thee

(b) That the temperature of the smoke is

The denti :sts" view of the tobacco industry is practically

Percent of' Mentions

The dentist has less interest than the physician in current

Ordinary consumer advertisements for cigarettes have

Pie rc ent of Mention

of Cigarette Ads in Ea~ch

The promotional themes recalled are those featured in

K . What would be : the characteristics of an ideal

Thirty-six percent of 'the dentists in this~ sample think

When dentists are asked to, describe the characteristics

(c)' Elimination of unknown irritants,

I . On the Oral Effects of Cigarette Smoking

On the Oral Effects of Cigarette Smoking,

soft *.issues~ immediately adjacent to the : 3rea . . .

"I don't th :nk it reduces decay or causes decay .

"Uisually the effects are found in gingivitis which

On Cigars andl Pipes Versus Cigarettes

if that"s where the person generally

"Welll, the constant clamping of the pipe

bite on pipe and cigar loosens the teethi

"I think pipes are much worse . I smoke

a pipe smoker, and'you are careless about

"The worst damage is done by pipe smokers ;

"Well,, I believe that a pipe held in the

On the Variation in Popular Blrands

"Yes, I think so, the filter cigarettes seem

"Ii think there's quite adifference . I' used to

"I would say yes . I believe the report in

"~I~ enjoy Carne~ls, ~ ., -the cther~& are too mild . "~