The Real Hazards of Chewing Tobacco and Snuff

What's the difference between chewing and spit (or snuff) tobacco?

Chewing tobacco ("chaw") is usually sold as leaf tobacco, and users place a large wad of it inside their cheek. Users, who tend to be older men, keep chewing tobacco in their mouths for several hours (the tell-tale bulge often gives them away). Snuff, which is much more common today, is a powdered tobacco that's usually sold in cans. Users place a pinch of the tobacco between the lower lip and the gum, usually under the canine teeth.

What are the health risks of using smokeless tobacco?

Oral cancer. This disease, which affects the mouth, tongue, cheek, gums and lips, is one of the most deadly forms of cancer. The five-year survival rate is only 59 percent.

Other cancers. Carcinogens in the tobacco also increase a user's risk for cancers of the pharynx, larynx, and esophagus. Breast cancer and cardiovascular disease have been linked to chewing tobacco.

Nicotine dependence. Nicotine levels in smokeless tobacco are even higher than cigarette tobacco. Nicotine addition can lead to an artificially increased heart rate and blood pressure.

Tooth abrasion. Grit and sand found in smokeless tobacco products scratch teeth and wear away the enamel.

Gum recession. Constant irritation to the spot in the mouth where a small wad of chewing tobacco is placed can cause the gums to pull away from the teeth, exposing root surfaces and leaving teeth sensitive to heat and cold.

Increased tooth decay. Sugar is added to smokeless tobacco during the curing and processing to improve its taste. (Also, when the gums pull away from the teeth, food can become trapped in the pockets between the teeth and the gums causing both tooth decay and gum infections.)

Tooth discoloration and bad breath. People who stop using snuff may notice a marked change in the latter.

Unhealthy eating habits. Chewing tobacco lessens a person's sense of taste and ability to smell. As a result, users tend to eat more salty and sweet foods.

But isn't smokeless tobacco better for you than cigarettes?

Not really. While smokeless tobacco users run a lower risk of lung cancer than smokers do, they run a much higher risk of oral cancer.

What are the first symptoms of oral cancer?

The most common preliminary symptom is a condition called leukoplakia. These are mouth sores that appear either as a smooth, white patch or as leathery-looking wrinkled skin, usually in the spot(s) where the tobacco is placed. If untreated, these sores can result in cancer.

Other symptoms include:

• A sore on the lip or in the mouth that does not heal
• A lump on the lip or in the mouth or throat
• A white or red patch on the gums, tongue, or lining of the mouth
• Unusual bleeding, pain, or numbness in the mouth
• A sore throat that does not go away, or a feeling that something is caught in the throat
• Difficulty or pain with chewing or swallowing
• Swelling of the jaw that causes dentures to fit poorly or become uncomfortable
• A change in the voice
• Pain in the ear

When should I see my doctor?

If you use smokeless tobacco, have your doctor or dentist check you right away. Early detection is crucial. While oral cancer has one of the lowest five-year survival rates of all major cancers (only 59 percent of oral cancer patients live more than five years after being diagnosed), this is probably because most lesions are not discovered until they are well advanced. When detected early, the probability of surviving from oral cancer is significantly better. Also, quitting now will reduce your chance of developing cancer. This point may seem obvious, says Amanda Gruber, M.D. of the Harvard-affiliated McLean hospital, but some teenagers who've chewed for years falsely assume it's already too late.

What is the treatment?

Treatment for oral cancer depends on a number of factors, including the location, size, type, and extent of the tumor, as well as the stage of the disease. Treatment can include surgery (to remove parts of the mouth, jaw, and, if the cancer has spread, the lymph nodes in the neck), radiation therapy, or a combination of the two. Some patients also receive chemotherapy.

What should I do?

The best thing to do, of course, is quit. People who stop using tobacco -- even after many years of use -- can greatly reduce their risk of oral cancer. According to the New York University College of Dentistry, survival rates can reach as high as 81 percent with early detection, compared to a survival rate of 17 percent or less if the cancer is detected late.

If quitting isn't a possibility, at least make sure your doctor and/or dentist examine you regularly for leukoplakia, the precancerous sores. Remember, if oral cancer is detectedearly, it can often be treated successfully.

References

National Cancer Institute, What You Need to Know About Oral Cancer, http://cancernet.nci.nih.gov/cancertopics/wyntk/oral

Smokeless Tobacco: Tips on How to Stop. American Family Physician, Oral Cancer Facts and Figures, New York University College of Dentistry, April 1999. Oral Cancer. American Dental Hygienists' Association.

American Cancer Society. Oral Cancer. June 4, 2008.