The first cultivation of tobacco is thought to have been around 6000 BC, with earliest reports of use amongst indigenous Americans around the first century BC. By the 16th century it was being used worldwide.With 1.3 billion current tobacco users in the world predicted to rise to 1.6 billion by 2030, this is not an epidemic that is going to go away in the lifetime of present readers of this preamble. There was no shortage of early warnings on the harmfulness of tobacco on dental health. For example, Dr Joel Shew wrote in 1849 in a book entitled Tobacco: Its History, Nature, and Effects on the Body and Mind (1). “The pernicious effects of tobacco on the teeth are easily proved … the teeth of tobacco chewers, who have continued the practice for a considerable length of time, are generally bad, as any one may observe. It was once said in the presence of clergyman of our acquaintance, that tobacco was good for preserving the teeth, upon which he answered, ‘That is not true, for on one side my teeth are perfectly good, while on the other side, the one in which I have always kept my cud, there is not a stump left.’” A PubMed online search in May 2005 for “tobacco” and “oral” yields over 2,500 published articles in medical journals, but 150 years ago Dr Shew identified most of the oral health effects of tobacco as we know them today – on the teeth, gums, throat, taste, voice, and including cancer, albeit much of his evidence was anecdotal. He also identified the struggle to quit tobacco use: “I have known some well- meaning, pious people brought into the habit, and when once it is fixed upon them, not one of a hundred has the power to leave it off.” He thus identified the need for primary prevention…

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