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DIMAPUR — On the eve of World No Tobacco Day, which is observed every year on May 31, a young boy in an adjoining room of the dental OPD, District Hospital Dimapur (DHD), was informed that his father had been diagnosed with cancer.
During an interaction with Eastern Mirror, one of the doctors mentioned that the cancer case was due to tobacco consumption.
“The tobacco industry is very malicious; they are very cunning and clever with their marketing strategies to attract new customers,” said Dr. Japheth Yepthomi, junior dental surgeon at DHD.
“School-going children, teenagers and young adults are particularly susceptible to this kind of marketing and advertising. One of the most common tactics is the introduction of varied flavours, which increases their appeal. While tobacco-free schools and hospitals have become familiar terms over the years, we should extend this to 'tobacco-free homes'. This is one step we can take as a society,” said the dental surgeon.
“Before smokeless tobacco entered the market, there were fewer tobacco consumers because young people were afraid to show elders that they were smoking, as it was considered an adult activity. Now, the trend has changed with the rise of smokeless tobacco products,” said Dr. N Moa Jamir, senior dental surgeon and district nodal officer, National Tobacco Control Programme, Dimapur.
Experimentation to addiction
“I did not start with tez, talab or shikhar (mixture of betel nuts, tobacco, lime and other ingredients and commonly called gutka in India) initially,” said 38-year-old Toka (name changed) from Dimapur.
“When I was in Class 3 or 4, there was something called ‘meetha supari’, which came in red packaging. I was unaware of it but my friends around me would take it and often say that it was very nice to eat because it made their mouths feel sweet and fresh. So, I was curious to try it,” he added.
Toka started with meetha supari but by the time he was in Class 5, he was introduced to tez. He said that initially a packet of tez would last for a week, but slowly it became a habit and soon turned into one packet per day.
He was unaware of the addiction aspect but there came a point when he started having mood swings if he did not chew tez, talab, shikhar, kaka sada, etc.
“I did not quit this addiction in a day. Instead, I set a routine for myself. If I was taking three packets a day, the next day I started taking two packets. I took baby steps. Then it turned to half a packet, then a quarter, and so on,” he shared.
His family warned him of its (gutka) harmful effect but he did not pay heed back then. The packets too contained warnings that consuming gutka is ‘dangerous to health’ but he assumed it was written just for namesake and did not take it seriously.
He finally decided to quit chewing the addictive tobacco products when he realised that he had difficulty opening his mouth or eat.
He has a message for young school students who are yet to get into this habit: “Do not taste it”. Once you taste it, you will get addicted for sure. Tobacco does not discriminate age or gender — once anyone gets the taste, he or she will get addicted.
Gutka and peers
Twenty-two-year-old Ren from Kohima said that chewing gutka was already a common habit among people around him when he started taking it.
“I was in Class 6 when I first started taking shikhar. It began with a group of friends taking shikhar together as a coping mechanism for stress, both mental and emotional. That is how it started,” he said.
His parents were unaware of his habit for a long time; they came to know only when he turned 19. Compared to cigarettes, shikhar does not emit smoke, so it was easier for him to take it secretly.
Quitting shikhar was an on-and-off process for him. "It is easy to quit shikhar but it is also easier to get back into it," he admitted, adding that he is also aware of the ill-effects of smokeless tobacco.
"It is acidic when you take it continuously,” he said. And as he got older, his body started trembling; has low stamina, brain fog, etc., due to the acidity present in the substance.
For 19-year-old Avizo from Kohima, who is presently studying in Delhi, the habit of chewing shikhar started when he was in Class 9, with his friends in school. “I actually just wanted to try and then leave it, but slowly I started to like it, and finally, it turned into a habit,” he said.
Thereafter, he started feeling the urge to have something in his mouth, especially after meals. Despite warnings from his parents to stop the habit, he continued to take secretly.
Confessing that he rarely takes shikhar in Delhi, as none of his friends there use it, he said his peers from Nagaland consume more shikhar than those from other states.
“Better not to even try it. This is actually the starting point where people think they can handle it, but it is the opposite,” he said.
Tobacco-related dental problems
Most patients who come for treatment has a condition in their mouths that is related to tobacco, said Dr. Temjennungsang Longchari, who runs ‘Dental Touch and Facial Aesthetics’ clinic in Dimapur.
Patients as young as 12-13 years old visit his clinic for tobacco-related checkups. “Most of them don’t open up about the reason, and at this age, they come with their parents, so they don’t open up. I then send the parents out, and that is when they slowly start opening up. The number of years of consumption varies. From 12-13 years to around 60-70 years, patients come due to tobacco-related problems,” he said.
“Some patients who come in have already reached the stage of cancer. Last week, two teenagers came in with cases where they were unable to open their mouths due to precancerous conditions. The prevalence of gutkha use is so high that I notice it immediately, even when patients come in for other checkups,” he said.
A common issue the dentist observed among patients is difficulty in opening their mouths. Patients often said that they cannot open their mouths and experience a burning sensation while eating, he said.
On examination, one can see white patches — precancerous conditions — on the cheeks, tongue, or floor of the mouth, Longchari said.
"The soft tissues of the cheeks become fibrous, which is why they cannot open their mouths. This condition is called oral submucous fibrosis. If they don't change at this stage, the next stage is cancer. Patients learn of this when we educate them and start therapy,” he added.
Most patients consume shikhar, while rajnigandha and talab are other common choices. The 'zarda' sold separately is often mixed with these products, intensifying the nicotine present and amplifying cravings. Pan masalas are particularly deceptive as they are sold in the guise of mouth fresheners.
“Home is where educating children about these matters should start, as values also begin at home. While schools play a role, they cannot cover everything. Awareness of health and the harmful effects of chewing tobacco must first be instilled in parents who can then pass it on to their children. Unfortunately, some parents send their own children to buy these products from shops, normalising the behaviour in our society,” he said.
It has become imperative to convey a clear message that smokeless tobacco addiction is a social issue — not only affecting consumers but also impacting families.