Tobacco Companies Targeting Health Professionals: Dentistry and PMI

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Dentists, like doctors, pharmacists and other health professionals, have long been targeted by tobacco companies, to help promote their products and to attempt to build trust and credibility. The tobacco industry also has a long history of attempting to influence science and medical practice, primarily in the service of their own business goals. Despite the fact that most oral cancers result from tobacco use,1 oral health is rarely considered in discussions around tobacco control policy and product regulation.2

Transnational tobacco companies have been increasingly positioning themselves as experts in this area, particularly Philip Morris International (PMI),34 as part of a broader business-focussed harm reduction strategy.

Although there have been attempts to limit and counter tobacco industry influence, some oral health practitioners continue to be co-opted in the service of commercial interests. This article highlights the tactics of tobacco companies, focussing on those used by Philip Morris International (PMI) to target the dental profession.

Background: The Tactics

Tobacco companies apply the same tactics as used towards other health professions, and to influence science more broadly. They attend conferences relating to dentistry and oral health,5 sponsoring some events;67 they conduct, commission or fund research;891011 they run training programmes;12 and have published articles in magazines aimed at oral health professionals.1213

PMI’s Strategy

PMI uses a range of tactics to target the dental profession, build relationships with organisations and practitioners, and promote its transformation narrative.14 These efforts may help to create, or expand, markets for newer nicotine and tobacco products – primarily heated tobacco products (HTPs) and specifically PMI’s flagship product IQOS.

Business objectives

A leaked 2019 internal document from Philip Morris Japan (PMJ), analysed by TCRG researchers, gives an indication of PMJ’s strategy for increasing sales of IQOS. Called “PMJ 2019 Business Objectives” it showed how, as well as targeting politicians, sports organisations and the hospitality sector, PMJ planned to build relationships with the dentistry community.3 The purpose was to gain “third-party scientific endorsement” of PMI’s approach to harm reduction in Japan – centred on the use of IQOS – which would potentially help it to secure favourable regulation in other countries.15

One activity detailed was a dentist referral programme to be piloted with “15-50” dentists in Japan.1516 For more on how tobacco companies target ‘Key Opinion Leaders’ see Tobacco Companies Targeting Health Professionals

Conducted and funded research

In September 2020, the Dental Tribune reported that PMI had presented findings from market research it commissioned in Germany in 2018, which surveyed doctors, dentists, and pharmacists. 1718 PMI stated that:

“more than half of German dentists feel that they struggle to provide advice to their patients about alternative tobacco products, owing to a lack of information”.1718

The then manager of scientific and medical affairs at PMI’s German subsidiary, Dr Charilaos Avrabos, was quoted saying that the company is:

“engaging with the scientific and medical community by presenting its research and findings in an open and transparent way at conferences, by making data and study results available in the form of brochures, and by meeting face to face with medical professionals to inform them about products.”17

No further details were given as to the methods of the market research, or whether participants were aware that it was being conducted on behalf of a tobacco company. Related media coverage referred to a dentist in Germany promoting the use of HTPs (although the supporting research it cited related to e-cigarettes).18

It is also unclear whether PMI was referring to the same market research it had promoted in May 2020. This contained some identical figures, and referred to “a series of surveys” which they would use to “initiate a dialogue” with healthcare professionals, but did not specifically mention dentists.19

PMI has also conducted and commissioned  research on the impact of HTPs on oral health . Papers published in 2016 and 2018 covered impacts on oral epithelial cells.2021 Other papers related to the effects of HTPs on dental composites (2017 and 2019),2223 and tooth enamel (2020).24  In 2019, PMI published an article on its website detailing its research on HTPs (referred to as ‘Tobacco Heating Systems’) and tooth colour.25 PMI also published papers in 2019 and 2020 which included the dental impacts of e-cigarettes.2627

The aforementioned studies are all non-clinical (i.e. not tested in human subjects). The time frames are also relatively short: the oral cells being exposed at most for 28 mins per day for 3 days and the dental composites/tissues tested for a maximum of 3 weeks.

From 2017 to 2019, PMI ran a clinical trial investigating the effects of IQOS on oral health and periodontitis treatment outcome in smokers.8 The protocol was published in 2021,28 and findings in 2022.29 No significant differences were found between switching to IQOS or continued smoking on oral health outcomes after 6 months. This clinical study did not measure tooth staining.30 In 2024, PMI updated the article, now on its PMI Science website, to include its research on HTPs and dental composites, stating:25

“As smokers switch to heated tobacco products, it becomes important from a social and oral health perspective to develop a deeper understanding of the role these products can play in reducing tooth staining as compared with cigarettes.”

Advertised in medical and dental publications

Researchers reported in 2024 how PMI promoted HTPs to dental professionals in Japan.13 In 2018, PMI placed an advertisement in Nikkei Medical, a magazine which is widely read by health professionals including dentists. It featured comments from an oral surgeon, and implied that HTPs may help reduce periodontal disease – although at the time PMI research was still ongoing.133

In September 2021, PMI placed another advertisement for IQOS in Japan Dental News. This promoted four research studies on HTPs and oral hygiene, research which was partly funded by PMI and led by a PMI scientist.13 The researchers noted that the advertisement included quotations from dentists which were not attributed to named individuals or say whether they were paid, and it “implied that the products had been evaluated and validated in the oral health field”. According to the authors, these advertisements confirmed that:

“PMI is taking advantage of people’s trust in aesthetic dentistry professionals to promote the switch from PMI to IQOS”.13

The same month the Word Dental Federation (Fédération Dentaire Internationale, or FDI) adopted a new policy statement on the role of oral health practitioners in tobacco cessation, which stated that HTPs should not be recommended as an alternative to cigarettes or for cessation.1331

Since at least 2022, PMI has also paid for content to be placed in German magazines aimed at dental professionals.123233

Organised events for dentists

In addition to sponsoring and attending conferences relating to dentistry and oral health PMI has organised events specifically for dentists, including webinars on specialist e-learning platforms.12

PMI has run numerous webinars in Germany targeted at dentists and their practice teams.12343536

Third parties

The Foundation for a Smoke-Free World –renamed Global Action to End Smoking in 2024 – is a US based grant-giving nonprofit foundation. FSFW was solely funded by Philip Morris International (PMI) under a multi-year pledge (2018-23).37

FSFW/GAES has given grants to other third party organisations which have in turn funded work with dental and oral health professionals.

K-A-C

Knowledge-Action-Change (K-A-C) is a private organisation which receives grant funding from FSFW/GAES. In 2018 it awarded an “enhanced” scholarship to a dentistry professor for research on the effects of IQOS on oral health “in individuals from the large smoking and relatively large vaping and iQOS communities present in Romania”.38394041 This research, presented at the Global Forum on Nicotine in 2019,42 focussed solely on PMI’s brand IQOS, not HTPs more generally. The study included 20 participants who expressed an interest in quitting, and were briefed on the advantages and disadvantages of using different products, including Nicotine Replacement Therapy (NRT), snus, e-cigarettes and HTPs. The project summary stated that “Most of the patients chose to use heat-not-burn, and in particular IQOS, which is very popular in Romania.” It then stated that, apart from the 5 patients in the control group, the remainder “chose IQOS”.43 A subsequent journal paper published in 2021, did not contain any funding or conflict of interest statement.44

CoEHAR

The Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), founded in 2018 by Professor Riccardo Polosa at the University of Catania in Italy, was set up with FSFW funding as one of several “centres of excellence” for research on harm reduction. The official FSFW grantee is ECLAT SRL.45

A research project lead by CoEHAR called “SMILE” states that it “aims to assess the impact of cigarette smoking and of reduced-risk products on oral health, in four different countries, Italy, Poland, Moldova and Indonesia.”4647 484950

As with previous publications, a 2024 CoEHAR paper, on the impact of HTPs and e-cigarettes on tooth colour, acknowledges FSFW funding, stating that “ [T]the authors are solely responsible for the content, selection, and presentation of facts, as well as any opinions expressed in this study. These views should not be interpreted as reflecting the positions of the Foundation for a Smoke-Free World, Inc.”.51 In this paper the authors do not include a statement on conflict of interest.51 A protocol for a clinical trial was also published in February 2024.52

A paper on impacts on dental plaque, in users of HTPs and e-cigarettes, published in August 2024, acknowledges GAES funding and contains the statement: “Global Action played no role in designing, implementing, data analysis, or interpretation of the study results. The contents, selection, and presentation of facts, as well as any opinions expressed, are the sole responsibility of the authors and should not be regarded as reflecting the positions of Global Action to End Smoking.”53 The declaration of competing interest states that Polosa has received grants from FSFW.53 In this paper the authors include HTPs in their definition of Electronic Nicotine Delivery Systems (ENDS), seemingly conflating two distinct products types, HTPs and e-cigarettes (ENDS).53 World Health Organisation guidance states that HTPs should be treated as tobacco products and regulated accordingly,54 as per the decision taken at the eighth Conference of the Parties (COP 8) to the WHO Framework Convention on Tobacco Control (WHO FCTC).5556

CoEHAR has partnered with the faculty of dentistry at a university in Indonesia, in the SMILE project, and another called REPLICA.57 There appeared to be a proposal to establish CoEHAR as a “leading centre for harm reduction in Asia” at the university.57

Relevant Links

Tobacco Tactics Resources

TCRG Research

“Let us all work together for the larger public health good.” Philip Morris targeting German dental professionals, B.K. Matthes, L. Graen, K. Schaller, Tobacco Control, Published Online First: 22 July 2025, doi: 10.1136/tc-2025-059527

“Keep it a secret”: leaked documents suggest Philip Morris International, and its Japanese affiliate, continue to exploit science for profit, S. Braznell, L. Laurence, I. Fitzpatrick, A.B. Gilmore, Nicotine and Tobacco Research, Published Online First: 27 June 2024, doi:10.1093/ntr/ntae101

Seeking to be seen as legitimate members of the scientific community? An analysis of British American Tobacco and Philip Morris International’s involvement in scientific events, B. K. Matthes, A. Fabbri, S. Dance, L. Laurence, K. Silver, A. B. Gilmore, Tobacco Control, 2023, doi: 10.1136/tc-2022-057809

The Science for Profit Model—How and why corporations influence science and the use of science in policy and practice, T. Legg, J. Hatchard and A.B. Gilmore, Plos One, 2021, 16(6), doi:10.1371/journal.pone.0253272

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References

  1. ↑P. Chaturvedi, A. Singh, C-Y. Chien, S. Warnakulasuriya, Tobacco related oral cancer, BMJ, 5 June 2019;365:l2142, doi: 10.1136/bmj.l2142
  2. ↑S.L. Tomar, The Transnational Tobacco Industry and Oral Health, Community Dental Health, 30 May 2019, 36(2):163-168, doi:10.1922/CDH_SpecialIssueTomar06
  3. ↑abcS. Braznell, L. Laurence, I. Fitzpatrick, A.B. Gilmore, “Keep it a secret”: leaked documents suggest Philip Morris International, and its Japanese affiliate, continue to exploit science for profit, Nicotine and Tobacco Research, Published Online First: 27 June 2024, doi:10.1093/ntr/ntae101
  4. ↑T. Hirano, T. Hanioka, Philip Morris International advertisements target the oral health field in Japan, contrary to the latest World Dental Federation Policy Statement, Tobacco Control, 2024;33:279-280, doi: 10.1136/tc-2021-057191
  5. ↑B. K. Matthes, A. Fabbri, S. Dance, et al Seeking to be seen as legitimate members of the scientific community? An analysis of British American Tobacco and Philip Morris International’s involvement in scientific events, Tobacco Control, 2023, doi: 10.1136/tc-2022-057809
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  8. ↑abPhilip Morris Products, Effect of Switching From Cigarette Smoking to the Use of IQOS on Periodontitis Treatment Outcome, 2017-2019, ClinicalTrials.gov ID: NCT03364751
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  49. ↑G. Conte, S.A. Pacino, S. Urso et al, Repeatability of dental shade by digital spectrophotometry in current, former, and never smokers, Odontology, 110, 605–618 (2022), doi:10.1007/s10266-022-00692-x
  50. ↑G. Conte, A. Amaliya, S. Gupta S et al, Repeatability of dental plaque quantitation by light induced fluorescence technology in current, former, and never smokers, BMC Oral Health, 2023 Jul 13;23(1):480, doi: 10.1186/s12903-023-03154-0
  51. ↑abS. Gupta, V. Sahni, R. Emma et al, E-cigarettes and heated tobacco products impact on dental color parameters, Heliyon, Volume 10, Issue 3, 2024, e24084, doi:10.1016/j.heliyon.2024.e24084
  52. ↑G. Conte, S.A. Pacino, S. Urso et al, Changes in Oral Health and Dental Esthetic in Smokers Switching to Combustion-Free Nicotine Alternatives: Protocol for a Multicenter and Prospective Randomized Controlled Trial, JMIR Res Protoc, 2024;13:e53222, doi: 10.2196/53222
  53. ↑abcG.R. Maria La Rosa, A. Di Stefano, D. Gangi et al, Dental plaque quantitation by light induced fluorescence technology in exclusive Electronic Nicotine Delivery Systems (ENDS) users, Journal of Dentistry, Volume 147, 2024, 105223, doi:10.1016/j.jdent.2024.105223
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  57. ↑abCoEHAR, New collaborative projects between Padjadjaran University and the University of Catania for studies on harm reduction in Indonesia, CoEHAR Press Release, 4 July 2024, accessed July 2024

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