Pipe-Smoking and Health: Some Considerations
by G.T. Steel
This page is written by a pipe-smoker and not by a doctor. It is intended to provide information which might be helpful to pipe-smokers who, like myself, wish to continue to smoke, but who want to do as much as they can to avoid getting a pipe-smoking related illness.
There can be no pipe-smokers today who have not heard something about the health concerns with tobacco use. We have always been happy to believe that while cigarette-smoking has been known to be harmful for some time, pipe-smoking was comparatively safe. Most of the books on pipe-smoking, written by fellow devotees, suggest this and one was, until quite recently, told by many a doctor, that it was better to smoke a pipe than cigarettes and that it posed little real risk to health. Nowadays, it is rare to find a doctor who will condone any form of tobacco use. I am sure the views of the medical profession and the government on tobacco use include a degree of political expediency, but it does no harm to look into the matter for ourselves.
With all the medical attention now being given to other forms of tobacco use, a growing body of research is accumulating which would appear to show that pipe-smoking, while possibly less harmful than cigarette smoking overall, nonetheless is not free from health concerns. We all know pipe-smokers who have lived to a ripe old age without any problems and this may be the majority of pipe-smokers, but there are some who have succumbed to pipe-related disease.
The plus side of smoking a pipe as far as health is concerned is that the major disease associated with smoking - lung cancer - is relatively rare in pipe-smokers. Much of the research on pipe-smoking suggests that, as a group, we generally smoke less than cigarette-smokers, which serves us well. Indeed, some research has even suggested that in mean statistical terms, we live as long as non-smokers! Pipe-smoking is, as with life generally, something of a lottery.
So what are the risks with pipe-smoking? Put very simply, smoke is an irritant to the mouth and as it passes over sensitive tissues in years of persistent pipe-smoking, it can cause lesions to form. The carcinogens in smoke compound the problem and may trigger off a reaction, leading to cancer. Cancer may also take root in sore areas not initially caused by smoking, but affected by exposure to the smoke. Disease can spread quite quickly to other areas from these sites and through the bloodstream.
Pipe-smokers are not immune from cancers of the lungs, throat, larynx or oesophagus, but because we don't inhale directly, the most likely risk is from cancers of the mouth, the so-called "oral" cancers (over 80% of these cancers are in smokers and heavy drinkers), most commonly affecting the tongue (especially the sides and the back), the floor of the mouth, the roof of the mouth (i.e. the hard and soft palate) and the lower lip.
Needless to say, it is much more complex than this brief account suggests, but this outline should give you the general idea. Oral cancers are not the commonest of cancers, but they are certainly some of the most potentially devastating. Fortunately, some oral cancers can be treated succesfully if found in time. This depends, however, on each individual case. To be blunt, some pipe-smokers with oral cancer may be cured completely (with or without some form of impairment), but others may die from the disease. Approximately 50% of oral cancer subjects die within five years of the disease being diagnosed.
I have looked into the research a little myself, as far as a layman is able to do, but perhaps most importantly, I have sought the advice of an eminent head and neck surgeon and also that of a respected dental surgeon, who have both advised me in some detail on the health concerns and what one may do about them, short of giving up the pipe.
Of course, I can offer no guarantees that simply by following the suggestions made here that you will be stay free from a smoking related disease. But my hope is that this page will enable you to be more aware.
I would strongly urge you to confirm the sense of all that I have to say with your own doctor or dentist. Please read the disclaimer at the bottom of this page.
For those who are not prepared to take the risks involved, total abstention from all forms of tobacco use is the only choice.
For those who wish to continue to smoke a pipe, the following are some suggestions.
Smoking tobacco in any form poses some risk, so it makes sense to smoke moderately. If you can do without your pipe for a day, a week or even longer, this will rest your mouth a little and allow the nicotine and other harmful chemicals to eventually pass from your body. If you smoke 5 pipes or more a day, reduce this so that you enjoy a smaller number of pipes more. Moderation is the key thing here. In the medical data, "moderate" pipe-smoking is said to be 1-3 pipes a day. Pipes generate more heat in the smoke than cigarettes do and therefore are more irritating to the tissues in the mouth.
Never smoke a pipe when you have sores, lesions or ulcers anywhere in the mouth or on your lips. Smoking tobacco when you do can slow down the natural healing process and increase the chance of unprotected tissue being exposed to the carcinogens in tobacco smoke. Any persistent sores, lesions, ulcers, bumps, lumps or other irregularities such as red speckling or white or red patches (painful or painless - they are often the latter in the early stages), should be checked out with your doctor or a dentist if they haven't resolved themselves within two weeks. Other symptoms of something wrong in this area include uncommonly bad breath, a change in the taste in your mouth, lumps in the neck, facial swelling, difficulty in swallowing or moving the tongue, jaw pain or persistent earache, a bloody discharge from the mouth - all of these may be of concern and should be looked into without delay.
Don't be afraid to have things checked things out. It is far better to be safe than sorry.It may be nothing serious, or should it be so, a great deal can often be done in the early stages of the disease. And unlike some other cancers, oral cancers can often be clearly spotted early on before thay have had a chance to develop too far. Unfortunately a large number of cases are reported far too late and the consequence is death.
But even if you exhibit no symptoms, it is a good idea to have a six monthly check-up with a good dentist or oral surgeon and to inform him or her that you are a pipe-smoker and would like your mouth to be examined particularly carefully for any signs of anything untoward. In between times, get into a once-weekly habit of looking around your mouth for anything odd.(There are a number of good Web sites, which show how to give yourself an oral examination and what to look out for). This doesn't mean that you should become a hypochondriac or overly obsessive - being disturbed by every minor, benign occurrence in your mouth, but merely that you should be alert and cautious.
Avoid keeping your pipe in one position. Move the pipe about as much as possible. The pressure and heat of the stem of the pipe on one particular part of your lip can lead to lip cancer. Also, if the stream of smoke goes to one particular part of your tongue, the roof of your mouth or inside lining, over many years of irritation you are more likely to develop pre-cancerous and cancerous "patches". Therefore, it is better to hold your pipe in your hand rather than with your lips and teeth. It is irritation which we should most avoid. It is a good idea to space your pipe-smoking sessions as far apart as possible, giving your mouth a rest between bowls. Some pipe-smokers have had their dentists make up "palate guards" for themselves. These plastic guards, which look like a dental plate or retainer without the teeth, are slipped over the roof of the mouth and attach to side teeth when smoking. They protect the hard palate from a direct flow of smoke onto this region.
There is some medical evidence to suggest that those who are both smokers and heavy drinkers are much more likely to develop oral cancers through the effect of the alcohol and tobacco smoke "pooling" together in their saliva. Therefore, it may be more sensible not to smoke and drink concomitantly. The following may be a sensible precaution: If one has been drinking alcohol and wishes to smoke, rinse the mouth out with water first and vice-versa. While smoking, regularly rinse your mouth out with water. At the end of a smoking session, again rinse your mouth out thoroughly with water, gargling to clear your throat.
Avoid using harsh mouthwashes, especially those containing alcohol - most do. These irritate the mouth's tissues and the alcohol content is of concern in a smoker. A much more soothing and harmless mouthwash can be made from a teaspoon of kitchen salt dissolved in a glass or warm (not hot) water, with which you rinse and gargle thoroughly, especially just before going to bed. This salt wash is not recommended for frequent use, but only when you have oral problems. Your saliva has its own natural antiseptic qualities and it should be allowed to do its work without the aid of any mouthwash.
Also avoid drinking boiling hot drinks, which can irritate your mouth. Spicy or acid foods which sting your mouth, or those with sharp edges such as potato crisps, can also cause irritation or cuts and abrasions, so avoid them if you find they do and stop smoking until anything resulting from their consumption has repaired itself.
Many toothpastes contain sodium lauryl sulphate, and in some people this is known to irritate the linings of the mouth through the frothing "detergent" action. It may even cause mouth ulcers (canker sores) in some people. There are milder, more natural toothpastes on the market, which won't sting or irritate when you use them. Use a pea-sized amount of toothpaste and always wash your mouth out very thoroughly after using any toothpaste.
Keep your pipes clean. Don't let tars and tobacco juices build up in your pipes (tars particularly cling to the mortise of the shank). Regularly clean out your pipes and stems with pipe-cleaning fluid or drinking spirits and leave them to dry out thoroughly before smoking again. If you use charcoal, balsa-wood or paper filters, replace these after every smoke. Don't economize with them. It may be more harmful to smoke through an old, dirty filter than with no filter at all. Also, try to avoid "wet smoking" as it is possible to suck up the tobacco juices into your mouth.
If your mouth gets sore from smoking or you are suffering from tongue bite, give your mouth a rest for a few days. Use the salt and water solution 2-3 times a day for a few days.
Remember that many "drugstore" brands of cheaper tobaccos have numerous additives (chemicals) in them to give them a long shelf life, to prevent mold developing, to keep them moist and to add flavour, and these additions may not be harmless. Some of the more expensive pipe tobaccos are much more pure and have few, if any, additives. You may also find from experience that some tobaccos cause you less irritation than others. Those with a low nicotine content, such as latakia, are said by some to be less irritating.
When you smoke a pipe, don't inhale. Pipe smoke is heavier than cigarette smoke. The pleasure you get from smoking pipe tobacco is different from that of cigarettes, and doesn't need to be inhaled to be enjoyed.
Try to smoke gently, not hurriedly or nervously. If you smoke furiously the pipe will burn hot and the temperature of the smoke will increase, making the smoke more irritating.
Ensure good oral hygiene by brushing your teeth gently, but thoroughly, three times a day, and don't forget to floss your gums. Tongue brushing (very gently) may also be helpful. Have tobacco stains removed by your dentist every six months. This will assist your dentist in his job of thoroughly examining all dental surfaces. It is important to have any sources of abrasion such as sharp teeth, rough fillings or ill fitting false-teeth, seen to. Constant irritation from any source can encourage the onset of cancer. Therefore, if you have dental problems, get these checked out promptly and stop smoking until you have.
Because of the toll tobacco places on the body, ensure a good balanced diet and include lots of fresh fruit and vegetables. Recent research suggests that there may be some risk in taking large doses of vitamin and mineral supplements previously recommended to smokers, especially vitamins A and beta-carotene, C and E and selenium. Rather than taking supplements, it may be more sensible to ensure that your diet is rich in the foods which naturally contain these vitamins and minerals. Any physical exercise you can do will further enhance your body's immune system.
Be sensible with your smoking. If you find that you get a sore mouth easily, experience any increase in your heart rate, easily get a sore throat or a cough or have any other adverse reaction which you can relate to your pipe-smoking, give up the pipe; it is not for you. If you have got into a cycle of heavy pipe-smoking, then discipline yourself to reduce or give up. Most of us would rather smoke a few pipes than none at all. I hope that this site may be found helpful to pipe-smokers.