By now, most of us know that smoking cigarettes isn't healthy: The smoke you inhale contains toxic compounds that increase your risk of lung cancer. But what about smokeless tobacco? Is that "little pinch" really going to hurt you?

Yes. "Smokeless tobacco is not a safe alternative to smoking," says David Albert, D.D.S., M.P.H., an associate professor of clinical dentistry at Columbia University College of Dental Medicine. "Smokeless tobacco greatly increases your risk for cancer of the mouth," Dr. Albert says. "It causes periodontal disease and cavities. Because smokeless tobacco contains abrasives, your teeth will wear away faster than the teeth of somebody who does not use smokeless tobacco products. In addition, stains and bad breath are always associated with its use"

In the United States, about 4% of men and less than 1% of women use smokeless tobacco. The rate varies by state. For example, 18.4% of men in West Virginia use smokeless tobacco, but only 2.6% of men in Arizona use it.

Rates of smokeless tobacco use among U.S. adults are highest in young men, American Indians, and people who live in the South or in rural areas.

Overall, about 22 million Americans use smokeless tobacco, which comes in three basic forms: chew, snuff and plug. Chew, or chewing tobacco, consists of shredded tobacco leaves. Snuff is loose, ground tobacco leaves. A plug is a firm compressed chunk of ground tobacco leaves. Sugar, salts or flavorings sometimes are added to improve the taste.

Just like cigarettes, smokeless tobacco contains chemicals. But unlike cigarettes, smokeless tobacco is in direct contact with the tissues in your mouth. This may make smokeless tobacco even more addictive than cigarettes, because nicotine — the addictive substance in tobacco — enters your bloodstream faster. Holding smokeless tobacco in your mouth for 30 minutes exposes you to the same amount of nicotine as smoking four cigarettes.

Using smokeless tobacco heavily or for a long time dramatically increases your risk of developing oral cancer. "Oral cancer is a major concern with smokeless tobacco use," says Dr. Albert. "Treatment of oral cancer can result in disfigurement of the mouth and jaws. I advise patients not to use tobacco products in any form."

As little as one year of use can cause a white patch to develop in your mouth. These patches should be tested because they may contain cancer cells. Don't wait for symptoms before you visit your doctor: Until it spreads, oral cancer causes no symptoms.

Using smokeless tobacco can cause other problems:

• Smokeless tobacco is a breeding ground for bacteria, collects food and other debris, and sits in your mouth for hours at a time. It is also sweetened to improve the flavor. The result? Tooth decay.



• Using smokeless tobacco has been associated with receding gums and periodontal disease.



• The area where the tobacco sits can become unusually dry, which increases your risk of tooth decay.



• Using smokeless tobacco can reduce your senses of taste and smell, and can contribute to bad breath and discolored teeth.



• You are more likely to get a coating of bacteria and debris on your tongue if you use smokeless tobacco. An advanced stage of this condition is called black hairy tongue. Your risk of these conditions decreases if you practice good oral-hygiene habits.