Healthy Mouth Healthy Body?


Provided by the Mayo Foundation for Medical Education and Research (MFMER)

Smokeless Tobacco:
Addictive and Harmful. Have you switched to smokeless tobacco to get around smoking bans in restaurants, public buildings or the workplace? Have you switched thinking you were choosing a harmless alternative to cigarettes? If you answered yes to either of these questions, you might be surprised to learn that smokeless tobacco, also called spit tobacco, has its own health risks.

What is smokeless tobacco? Smokeless tobacco is a product consisting of tobacco or a tobacco blend that is chewed, inhaled or sucked on rather than smoked. It's available in three forms:

  • Chewing tobacco. This type of spit tobacco comes in loose leaf, plugs or twists. As the name suggests, it's chewed.
  • Snuff. This product is available dry or moist and also comes in loose leaf or pouches that look like tea bags. A pinch of snuff may be placed between the cheek and the gum, or inhaled into the nostrils.
  • Betel quid. A product of India, Africa and Asia, betel quid, also known as pan masala, is produced commercially or made at home. It consists of a dried paste that often includes tobacco, areca nuts, catechu and scent or flavoring. Catechu is a plant-based product used to treat diarrhea and sometimes used for birth control in some parts of the world. Areca nuts are a plant-based product often used as a recreational drug. Betel quid is placed in the mouth, usually between the gum and cheek, and gently sucked and chewed.

Outside the United States, products sold as toothpaste sometimes include ground tobacco mixed with menthol, oil of cloves, peppermint and other flavorings. These products are marketed primarily to women.

How Does Smokeless Tobacco Affect Your Health?
Using smokeless tobacco can cause serious health problems. The most serious of these is an increased risk of oral cancer. That's because when you use smokeless tobacco, your body absorbs more than just nicotine. It absorbs 28 cancer-causing substances, including arsenic and formaldehyde. Oral cancer encompasses cancers of the mouth, throat, cheek, gums, lips and tongue. Surgery to remove the cancer from any of these areas can leave your jaw, chin, neck or face disfigured. Only 56 percent of people with mouth or throat cancer live more than five years beyond the time of diagnosis.

The use of smokeless tobacco also increases your risk of cancer of the esophagus, larynx, stomach and pancreas.

In addition, smokeless tobacco increases your risk of:

  • Gum disease. The sugar in some smokeless tobacco may contribute to tooth decay. It can also cause your gums to pull away from your teeth in the area where you hold the tobacco in place. Your gums don't grow back. Most important, over time, you can develop advanced gum disease (peridontitis) and possibly lose teeth. Tobacco also stains your teeth.
  • Precancerous sores. As quickly as one week after you start using spit tobacco, you may develop small white patches called leukoplakia (loo-ko-PLAY-kee-uh) inside your mouth. Many smokeless tobacco users have these white patches within a few months of regular use. Up to 6 percent of leukoplakias become cancerous. Red patches called erythroleukoplakia (uh-rith-row-loo-ko-PLAY-kee-uh) are even more dangerous. More than half are found to be cancerous.
  • High blood pressure. Smokeless tobacco contains high concentrations of salt, which can contribute to high blood pressure. If you already have high blood pressure, using smokeless tobacco can make it worse.
  • Cardiovascular disease. Smokeless tobacco can increase your heart rate and raise your risk of heart attack. It may also make your blood more likely to clot, increasing your risk of stroke. Smokeless tobacco may also raise your cholesterol, contributing to your risk of heart disease.
  • Nicotine addiction. Spit tobacco gets you hooked on nicotine, one of the most powerfully addictive drugs known. In fact, nicotine is as addictive as heroin and cocaine. Nicotine in smokeless tobacco is absorbed more slowly than cigarette smoke, but it stays in your body longer. And during one day's use, a smokeless tobacco user can consume more nicotine than a cigarette smoker.

Some brands of smokeless tobacco contain additives that increase the rate that nicotine is absorbed into your body. Some people become so addicted that they can't sleep without a chew in their mouth.

Consider these facts about the nicotine levels in smokeless tobacco:

  • One average-size pinch or pouch held between your cheek and gum for about 30 minutes delivers about the same amount of nicotine as three or four cigarettes.
  • Using two cans of snuff each week equals the same amount of nicotine inhaled by someone smoking a pack and a half each day.

Who uses smokeless tobacco and how is it sold?
In 2000, smokeless tobacco use was most common among young adults ages 18 to 25.

Although it's illegal to sell smokeless tobacco to anyone under the age of 18 in the United States, that doesn't stop kids from using it. The 2002 National Survey on Drug Use and Health found that 2% of all people who admitted using tobacco products during the past month were kids ages 12 to 17 using smokeless tobacco. Boys and young men were much more likely to report current use of smokeless tobacco than were girls and young women. Peer pressure is a major reason why boys and young men start using smokeless tobacco.

The World Health Organization (WHO) reports that smokeless tobacco use is a significant part of the overall world tobacco problem, with the greatest use in South Asia. More people around the world tend to use smokeless tobacco orally, rather than inhaling it into the nostrils.

How to Quit
You can quit using smokeless tobacco gradually or abruptly. But don't get discouraged if you don't succeed the first time. Stopping smokeless tobacco use can be just as difficult as stopping smoking. Most people attempt it many times before quitting for good.

These suggestions can help you kick your tobacco habit:

  • Talk to your doctor or dentist. Ask your doctor or dentist to examine your mouth for pre-cancerous sores or other damage in your mouth caused by smokeless tobacco. If damage is present, he or she can provide strong motivation for quitting. Your doctor or dentist also can help you plan a strategy to quit.
  • Make a list of all the ways you'd benefit. Examples include saving money, having better breath, enjoying healthier teeth and gums, and not getting oral or pharyngeal cancer.
  • Select a stop date. Get a stop date on the calendar and stick to it. Post the date on your refrigerator or someplace where you can see it. Make it at least one week away so you have time to prepare.
  • Use less. Cut back on the number of times you use smokeless tobacco each day before your stop date. You can also increase the time between each use or leave it in your mouth for less time. These tactics will help your body slowly adjust.
  • Try smokeless tobacco substitutes. Try gum, sunflower seeds, hard candy or beef jerky. Non-tobacco chews and pouches or herbal chews also may help curb your cravings. These products are found in grocery stores, pharmacies and places where tobacco products are sold.
  • Don't give in to cravings. Cravings usually lasts three to five minutes. During a craving, divert your attention with deep breathing, exercise or healthy snacks, such as fruits and vegetables.
  • Ask your doctor about medications to help you quit. Bupropion (Zyban) and nicotine replacement products (Nicoderm CQ, Nicorette, others) can help you quit using smokeless tobacco. Nicotine replacement products are available as gum, patches, inhalers, nasal sprays or lozenges. You'll need a prescription for nasal spray and lozenges. The others are available over-the-counter.

You've read about the risks associated with smokeless tobacco use. And you've learned some tips for quitting. Get all the support you can muster and don't let the addictive power of nicotine hold you back.


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