Effects of smokeless tobacco

1) Alice,

My dad uses tobacco — the type you "dip" or put in between the cheek and gum and spit out. I am trying to get him to stop and need some solid facts about the harm this type of tobacco use can do to the body. There is lots of information out there on smoking, but I am having a hard time finding information on this. Please help!

— Concerned Son

2) Dear Alice,

What are the effects of using snuff (the kind that you put under your lip)? Can you get cancer within a few months?

— Spitting

Dear Concerned Son and Spitting,

What’s the stuff on snuff!  It's the case that information about the harms associated with cigarette smoking may be more widespread, but despite it's name, smokeless tobacco is linked to many of the same health risks. These include nicotine addiction, cancer, oral health problems, and, for those who are using while pregnant, child development issues. While cancer isn’t common after only a few months of use, discontinuing use is recommended to avoid a higher risk of serious health complications. Whether it’s for personal exploration or to talk with a family member about their usage, you may want to learn about the potential effects, health risks, and available resources on smokeless tobacco.     

Smokeless tobacco, also known as oral tobacco, spit or spitting tobacco, dip, chew, or snus, comes in the forms of chewing tobacco and snuff. Chewing tobacco can come in many forms, be it as the leaves themselves, twists, or bricks. It can be both chewed or just left in the mouth and is typically tucked in the cheek or lower lip. Snuff, on the other hand, is comprised of tobacco that is cut finely or powdered and may be moist or dry. Like chewing tobacco, it can be placed in the cheek or gums, but some people choose to inhale the dry snuff. It's available in many forms, such as lozenges, loose leaves or powder, or pouches that can be similar to tea bags.  

Like cigarettes, smokeless tobacco is highly addictive because of the stimulant drug, nicotine. Its use has been associated with increased heart rate, higher blood pressure, and increased levels of nicotine in the blood. If a person tries to stop using ST products, they may experience withdrawal symptoms because of their dependence on nicotine, which makes it harder to quit (even if they're motivated and committed to trying because of the health consequences). The nicotine from smokeless tobacco products may remain in the membrane of the mouth after use, and studies have shown that the amount of nicotine absorbed by way of smokeless tobacco can be up to twice the amount absorbed from cigarettes.  

Similar to other tobacco products, chewing tobacco has a number of negative health effects associated with its use. There are approximately 28 to 30 carcinogens found in smokeless tobacco that have been linked to cancer. The most prevalent carcinogens in smokeless tobacco are tobacco-specific nitrosamines (TSNA), which develop during the production of smokeless tobacco and include N-nitrosamine acids, aldehydes, uranium, and other heavy metals. Because of the abundance of carcinogens in smokeless tobacco, people who use ST products are at higher risk of developing cancer (specifically, oral, throat, and pancreatic cancer) than those who don’t. ST products are associated with eukoplakia and erythroplakia, which are referred to as oral potentially malignant disorders (OPMDs). These are sores that appear where the tobacco was placed in the mouth, and they've been associated with cancer. Other oral health issues such as gingivitis, gum recession, tooth loss, yellowed teeth, halitosis (bad breath), soft tissue lesions, tobacco pouch lesions, and, if areca nut is an ingredient, oral submucous fibrosis (OSF) are also consequences of smokeless tobacco use. Lastly, if a person is pregnant and gives birth, the heavy metals found in ST products such as lead and cadmium can lead to birth defects and stunt infant brain development.  

For those who are looking to stop using ST, you may consider reviewing Nicotine Anonymous or Smokefree.gov, which are resources that provide support and community for those trying to quit, along with information of their own. Smokefree.gov also has resources available for those supporting loved ones who may be quitting. In many states, you can find cessation support and check out the resources offered at your local health department. In addition, a dentist or health care provider may also be a good resource for tips on snuffing out this habit once and for all. While providing resources can be helpful, folks can't be forced to quit using ST, so it's wise to give them space to determine if and when they'd like to quit. 

Good luck to both of you!  

Last updated Jul 24, 2020
Originally published Dec 23, 1994

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