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TOBACCO - JAKARTA. Inaccurate information regarding alternative tobacco products remains pervasive in Indonesia. This misinformation is often spread despite an absence of strong or proven scientific evidence.
Realizing this, Prof. Dr. drg. Amaliya, M.Sc., a researcher and lecturer from Indonesia’s Padjadjaran University’s Dentistry Faculty, was determined to collect sufficient evidence and conduct research on alternative tobacco products by promoting a harm reduction approach. Today, eight years have passed since she began pursuing this field of expertise in tobacco harm reduction.
"It all started in 2016. I participated in the Academic Leadership Program research project on tobacco harm reduction, led by Prof. Dr. drg. Achmad Syawqie, MKes and funded by Padjadjaran University," she said in an interview on Friday (7/27).
Furthermore, Prof. Dr. Amaliya also became a panelist in a scientific discussion where she presented the results of a clinical study entitled "Nicotine and Gum Response in Vape Users vs. Smokers When Experiencing Artificial Gum Inflammation (Experimental Gingivitis)".
Prof. Dr. Amaliya explained that the study aimed to identify the impact of alternative tobacco product use, such as e-cigarettes, on gum defense against dental plaque bacteria in alternative tobacco product users who had switched from cigarettes, compared to smokers and non-smokers.
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"This study sought to observe the gum response assessed based on the degree of gum inflammation, which is an early sign of gum defense against dental plaque bacteria during a trial of gingivitis (gum inflammation) in alternative tobacco product users, compared to smokers and non-smokers," Prof. Dr. Amaliya said.
The study involved 15 participants aged 18-45 years, who were divided into three categories. First category was smokers with at least one year of cigarette consumption. The second was alternative tobacco product users, who had switched from cigarettes for at least one year.
The third was non-smokers. During the gingivitis phase of the experiment, participants were instructed not to brush their teeth for 21 days. The aim was to see to what extent the gums responded to bacteria.
"There were interesting findings from our study; alternative tobacco product users who had switched from cigarettes show a good response to plaque accumulation or bacterial infection, with the same degree of gum inflammation experienced by non-smokers," Prof. Dr. Amaliya said.
The study also revealed a new fact. Prof. Dr. Amaliya said nicotine had often been considered the primary cause of periodontal disease, characterized by constriction of blood vessels. The results of this study, however, proved that users of electric cigarettes with e-liquids containing nicotine still had gum defense against dental plaque bacteria.
"From the study, we might find that nicotine is not the cause of blood vessel constriction in the gums and that it does not mask the normal clinical signs of inflammation. Rather, it is caused by TAR," she said.
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Prof. Dr. Amaliya presented her research at national and international forums. Most recently, she attended a tobacco harm reduction conference in Warsaw, Poland, in 2023. Her active participation in conferences exposed her to much research.
Tapping into her wealth of experience in attending conferences, Prof. Dr. Amaliya became aware that the evidence of the impact of using alternative tobacco products for tobacco harm reduction was solid.
Scientific publications on these products were not only preliminary or early-stage research with limited respondents, but they had been systematically reviewed, or research conducted by systematically analyzing the evidence obtained from dozens of studies with the same theme.
Science as a Middle Ground
Prof. Dr. Amaliya admitted that the best way to promote public health is not to use tobacco altogether. She further added that scientific evidence should be able to encourage a middle ground, especially for smokers who found it a challenge or chose not to quit, allowing them to reduce the negative impact on themselves and their surroundings.
"It would be ideal to give up smoking," she said. "But despite being aware of the risks, smokers still don't quit. We need to think of alternatives so that they won’t continue with their smoking habit, which is obviously harmful, by making them switch to alternative products with a lower risk profile."
Therefore, the government receptiveness towards scientific evidence on alternative tobacco products is essential. So far, alternative tobacco products are scientifically proven to have up to 75-95 percent lower risk of exposure to harmful and potentially harmful chemical compounds than cigarettes.
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From an academic perspective, researchers need to be open (to possibilities). According to Prof. Dr. Amaliya, more encouragement is central to mobilize alternative tobacco product research involving multiple parties. Collaboration between universities, the private sector, and the public, including users of tobacco products, is crucial.
"Learning from personal experience, there are those who were initially skeptical about alternative tobacco products but gradually became interested in participating in research and collaboration," she concluded. This can be an important lesson that collaboration can help us achieve uniformity of vision and eliminate sentiment and bias in knowledge.
