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No Smoke, but Plenty of Danger

By now, most of us know that smoking cigarettes isn't healthy: The smoke you inhale contains toxic compounds. They 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. Dr. Albert is an associate professor of dentistry and public health at the Columbia University Medical Center.

"Smokeless tobacco greatly increases your risk for cancer of the mouth," Dr. Albert says. "It causes periodontal disease and cavities. Smokeless tobacco contains abrasives. This means your teeth will wear away faster." These products also cause stains and bad breath, he says.

In the United States, smokeless tobacco use has declined in recent years. About 4% of adults are estimated to be smokeless tobacco users. This includes about 7% of men and less than 1% of women. The rate of use by adults varies by state. For example, 9% of men in West Virginia use smokeless tobacco, but only 1% of men in Massachusetts use it. Rates of smokeless tobacco use by U.S. adults are highest among:

  • Young men
  • American Indians
  • People who live in the South or in rural areas

Smokeless tobacco comes in four basic forms: chew, snuff, plug and snus.

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. Snus, a new smokeless tobacco product, is now being sold in the United States. It is packaged in a small bag that looks like a tea bag. This form of smokeless tobacco is popular in Sweden and Norway.

Just like cigarettes, smokeless tobacco contains chemicals. More than two dozen of them are known to cause cancer. But unlike cigarettes, smokeless tobacco is in direct contact with the inside of your mouth. This may make smokeless tobacco even more addictive than cigarettes. That's because nicotine enters your bloodstream faster. Nicotine is the addictive substance in tobacco.

Holding smokeless tobacco in your mouth for 30 minutes exposes you to as much nicotine as four cigarettes.

Using smokeless tobacco heavily or for a long time greatly increases your risk of oral cancer. "Oral cancer is a major concern with smokeless tobacco use," says Dr. Albert. "Treatment of oral cancer can disfigure 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. 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. It collects food and other debris, and sits in your mouth for hours at a time. It is also sweetened to improve the flavor. The sugars in smokeless tobacco can contribute to dental cavities.
  • People who use smokeless tobacco are more likely to develop receding gums and periodontal disease.
  • The area where the tobacco sits can become unusually dry. This increases your risk of tooth decay.
  • Using smokeless tobacco can reduce your senses of taste and smell. It can stain your teeth and cause bad breath.
  • 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 will decrease if you practice good oral hygiene habits.

Help from your dentist

Dentists and dental hygienists are encouraged to:

  • Ask patients about current and past tobacco use, including smokeless tobacco
  • Advise all patients about the harmful effects of tobacco use and the importance of quitting
  • Assess a patient’s interest in quitting
  • Assist those who want to quit

For patients who want to quit tobacco, the dental team can offer nicotine replacement therapy and suggestions for resisting the temptation to chew (or smoke).

If you’re interested in options for quitting tobacco, talk with your dentist or dental hygienist at your dental appointments.

Help from a hotline

You can also find lots of information about quitting online at Or anyone in the United States can call 1-800-QUIT-NOW (1-800-784-8669) and talk to a counselor about ways to stop. To locate a quit line in your state or Canadian province, check out this interactive map.