Smokeless Tobacco: “Can there be fire when there is no Smoke” Part 5

Smokeless tobacco that is placed in the oral cavity also causes direct damage to the mouth (e.g., gingivitis, periodontal recession) and oral soft tissue. The risk to the user arising from use of a smokeless tobacco product varies by product and why some individuals are prone to the complications remains unknown. This is particularly so when it comes to heart complications of smokeless tobacco. All agree that the majority of individuals who use smokeless tobacco have a lesser incidence of heart problems. Why not everyone remains a mystery but is probably related to presence of other risk factors.

The use of smokeless tobacco is associated with a spectrum of oral cavity lesions, including leukoplakia, speckled leukoplakia, erythroplasia, tobacco-associated keratosis, carcinoma in situ, verrucous carcinoma, and invasive squamous cell carcinoma. The benign tobacco-related lesions can change over time and may become cancerous.

Snuff and chewing tobacco have also been associated with an increased risk for oral cancer. A single study of females in the southern United States revealed that chronic users of snuff were estimated to have a four times greater risk of developing oral cancer. In addition, a significant number of oral cancers in smokeless tobacco users developed a cancer at the site where the tobaccos was placed. However, the use of smokeless tobacco appears to be associated with a much lower cancer risk than that associated with smoked tobacco. Despite all the studies showing an increase in oral cancer with smokeless products, there is no direct correlation between use and cancer. In the US, the highest use of smokeless tobacco is in West Virginia, but the oral cancer rates are below the national average.

Recent studies from Scandinavia have suggested that the use of Swedish snuff (which is non-fermented and has lower nitrosamine levels) is not associated with an increased risk for oral cancer

Any patient with an oral lesion in the mouth must be seen by a doctor. Biopsy is mandatory for any persistent red lesion without an obvious cause. Treatment depends on the results of a histologic examination. Avoidance of tobacco and alcohol is of utmost importance.

The American Cancer Society recommends a cancer-related check-up annually and appropriate counseling should be offered to those persons who smoke cigarettes, pipes, or cigars, those who use chewing tobacco or snuff, and those who demonstrate evidence of alcohol abuse." The USPHSTF document also notes that "...both the National Cancer Institute and the National Institute of Dental Research support efforts to promote the early detection of oral cancers in individuals who use tobacco products during routine dental examinations