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There are two main types of smokeless tobacco: chewing tobacco and snus.
Chewing tobacco usually comes as leaves or plugs which you put on the inside of your cheek and chew. Chewing the tobacco releases the flavours and nicotine, and causes your mouth to make a lot of saliva. Users generally end up spitting this out. Snus is tobacco that comes as a moist powder, or is packed in small bags, and you put it under the inside of your bottom lip.
Both types of smokeless tobacco are very addictive and can cause serious health problems.
The ingredients in smokeless tobacco are a mixture of tobacco-nicotine, sugar, salt, slaked lime, spices and flavourings. They may release hundreds of chemicals and poisons when you use them.
Among these chemicals are many dangerous cancer-causing agents (called ‘carcinogens’).
Can smokeless tobacco be part of other chewing products?
Yes. Smokeless tobacco goes by many different names, such as:
- Paan Masala (Gutkha).
- Snuff.
- Naswat or Niswar.
- Snus.
- Zarda.
- Chaw.
- Supari.
- lq’mik.
- Khaini.
- Ariva.
- Mawa.
- Shammah.
- Mishri, Mosheri or Misheri.
- Toombak.
- Qiwam or Kima.
- Chimo.
Areca nut, ash and lime are some of the main ingredients used in these mixtures.
People who use it don’t always know or use the term ‘smokeless tobacco’, so they often don’t realise that the products contain tobacco. If you aren’t sure, look on the packaging for names or ingredients like those we’ve mentioned above.
Is smokeless tobacco linked with mouth cancer?
Yes. Mouth cancer is the most serious health risk linked with smokeless tobacco. This is because of the large amount of cancer-causing chemicals it has in it. Over time, having these poisons released in your mouth could make you four times as likely to get mouth cancer.
One of the most dangerous and popular ingredients used in smokeless tobacco is the areca (or betel) nut. This is used in ‘betel quid’ which is made up of betel leaf, areca nut and slaked lime. Research shows that people who regularly chew areca nut have a bigger risk of cancers of the mouth, pharynx (throat), oesophagus (gullet) , stomach and pancreas.
Smokeless tobacco users are especially likely to get throat cancer, as they regularly swallow tobacco juice. Cancers of the lip and cheek are also common, as the tobacco is pressed against the lining of the mouth.
Mouth cancer can appear as:
- A painless mouth ulcer that does not heal properly.
- A white or red patch in the mouth.
- Unusual lumps or swellings.
It is important that you visit your dental team regularly if you use smokeless tobacco. This is because part of your check-up will involve a full mouth examination when the dental team will look out for any of these signs.
How can smokeless tobacco affect my overall health?
Smokeless tobacco also harms your overall health. The nicotine causes your body to make more cholesterol and, as a result, you are more likely to get heart disease and have strokes.
Because tobacco users are more likely to have gum disease, they are also more likely to have other health problems such as:
- Type-2 diabetes.
- Premature births.
- Dementia.
- Respiratory (lung) disease.
As well as causing mouth cancer, smokeless tobacco may also increase the risk of cancer of the pancreas.
Is smokeless tobacco safer than cigarettes?
No, it isn’t. Although many users still believe that smokeless tobacco is not as harmful as regular cigarettes, this is simply not true.
Like cigarettes, smokeless tobacco is a serious risk to the health of your mouth and to your overall health. Both contain nicotine, which is a very addictive drug. In fact, there is twice as much nicotine in smokeless tobacco as in an average cigarette. This causes problems for the heart by tightening blood vessels and raising blood pressure.
One can of chewing tobacco can release as much nicotine into your body as 60 cigarettes.
What are the health benefits of giving up smokeless tobacco?
Giving up smokeless tobacco can bring many health benefits. Short-term benefits include a better appetite and good digestion, as well as better teeth and gums. Long-term benefits include less chance of developing a serious disease, such as heart disease or mouth cancer. The risk of dying from a heart attack is also lessened by giving up smokeless tobacco.
How can I give up smokeless tobacco?
There are many ways you can give up smokeless tobacco. The important thing is to work out why you use it in the first place.
- You may use smokeless tobacco to help deal with stress and boredom. Dealing with stress in other ways can help you cut down. For example, you could try taking a walk, listening to music, doing deep-breathing exercises, talking with other people or joining social groups at local community centres.
- You may use smokeless tobacco to help with tooth and gum pain. If you have tooth or gum problems, it is important to see your dental team for proper treatment instead of trying to deal with the pain yourself.
- Some people use smokeless tobacco because they think it helps with digestion after eating. If you do have stomach problems after eating, then drinking more water instead can help. Or your doctor will be able to offer counselling and treatment.
What will I feel like if I give up smokeless tobacco?
You may find that giving up is even harder than giving up cigarettes. This is because of the higher levels of nicotine, which is very addictive.
When you try to stop using tobacco, your body still wants the nicotine so you might get ‘withdrawal symptoms’. These can include headaches, tiredness, changes in mood, getting angry quickly and finding it hard to concentrate.
If you find it hard to give up smokeless tobacco, you can get specialist help. This can be nicotine replacement therapy, such as nicotine patches or gum, and support to help you cope with how you feel. A local stop-smoking centre can also give you support.
Adverse effect of Alcoholism on Oral Health
Alcohol addiction not only affects health of the entire body but also the oral health of an individual. Alcoholics are at high risk of developing dental caries, gingival diseases and may suffer from oro-pharyngeal cancers. The risk of oral cancer further increases when alcohol is consumed along with cigarette.
Alcohol and salivary glands and dental caries (tooth decay)
The salivary glands, notably parotid glands, may become swollen in long term alcohol drinkers. This condition is known as sialadenosis and it is associated with ethanol induced peripheral neuropathy. This condition results in disturbances in the metabolism and excretion of the salivary glands . Reduced salivary secretion along with diminished buffering capacity and less attention to oral hygiene may lead to increased risk of dental caries and gingival disease. Other detrimental factors consist of consumption of sugared drinks and cariogenic food along with alcohol. Acidic nature of alcoholic beverages and consumption of carbohydrate rich food leads to production of acids upon metabolism and it leads to decrease in salivary pH below critical level. Ultimately it may lead to development of dental caries. Also, Alcohol consumption increases Blood Lead Levels (BLLs) in humans and BLLs have been correlated with caries.
Alcoholics generally have a high incidence of decayed teeth which leads to either extraction of teeth (missing) or restoration (filling) of teeth. In particular, alcoholics suffer from more number of missing teeth as compared to non-alcoholics.
Alcohols and gingival/periodontal diseases
Periodontitis is regularly described as having a systemic hostmediated element. Literature search reveals many studies have tried to recognize and appreciate associations between periodontitis and potential systemic conditions such as genetic disorders, diabetes, osteoporosis and alcoholism. Prolonged alcohol drinking is associated with multiple systemic effects with the likelihood of altering the host-mediated response and affecting risk.
Alcohol abuse can lead to periodontal disease for a number of reasons including: irritation to gingival tissue; poor oral hygiene habits among chronic alcohol drinkers; poor eating habits resulting in nutritional deficiencies among chronic alcoholics leading to poor immunity; poor immune response to penetrating harmful chemicals; dehydration from alcohol consumption causes bacteria and plaque build-up as they are not washed away by saliva; ignorance of early symptoms of gingival diseases resulting in progression of diseases to more serious condition leading to periodontal diseases. Alcoholics have severe risk of developing chronic generalized periodontitis associated with gingival inflammation, blunting of the interdental papillae and deep pockets with related bone loss. Alcoholic men more frequently suffer from horizontal bone loss and calculus as compared to women. One study assessed effect of binge pattern ethanol 20% exposure on orthodontic tooth movement in male Wistar rats. Binge-pattern 20% ethanol promoted less bone resorption at the end of tooth movement, thereby suggesting delay in tooth movement.
Effect of Alcohol on Tongue
Alcoholics taking disulfiram may have changed taste sensation, most commonly a metallic taste. Besides direct harmful effects on oral health, alcoholics suffer from a number of indirect effects which manifest as a result of lack of adequate nutrition. The most common effects are tongue inflammation (glossitis) , inflammation of the gingiva (gingivitis) and sometimes, inflammation of corner of mouth (angular cheilitis). Early stages of glossitis show painful and smooth tongue, but sometimes show swollen fungiform papillae. In later stages, tongue suffers from burning sensation and becomes intensely red followed by atrophy of filiform and fungiform papillae. Angular cheilitis results in development of painful cracks at the corners of the mouth; while gingivitis establishes as necrotic areas on the top of interdental papillae.
Alcohol and wasting diseases, mainly dental erosion
People addicted to alcohol are at increased risk of developing dental erosion. This is because alcohol consumption has the potential for increasing the degradation rate mechanisms and by the direct and indirect ethanol effects in the organic systems. Regular and prolonged consumption of acidic drinks such as wine makes oral cavity as well as the teeth surface acidic in nature. This acidification dissolves surface enamel and makes teeth surfaces more vulnerable to mechanical damage due to tooth-brushing, teeth clenching, etc. Lower esophageal sphincter relaxes under influence of alcohol and this result in frequent vomiting. Acidic content of stomach enters mouth because of vomiting and results in erosion of the enamel. This acidification is further assisted by reduced salivary secretion and ultimately reduced buffering capacity which increases the risk of enamel erosion. Most commonly affected tooth surfaces due to erosion are palatal surfaces of upper teeth followed by occlusal surfaces of posterior teeth. The lower teeth and buccal surfaces of the upper teeth are least affected by erosion.
The acidic nature of the wine causes discomfort to the teeth of the people who make and taste the wine. Wine merchants, wine tasters and winemakers most commonly suffer from dental erosion. This is because they keep wine in their mouth for longer time, which is considered to be an occupational hazard. Several epidemiological studies have reported a time-dependent association between alcoholism and enamel erosion, with prevalence values as high as 50%. Alcoholic patients show more wearing of teeth than age and sexmatched controls. Males continuously drinking alcohol are most commonly affected by tooth-wear.
Alcohol and oral cancer
Indeed, alcohol drinking is considered as a potential risk factor for Oral cancer, but when it is consumed along with tobacco increases the risk because of synergistic interaction. However precise role of alcohol in the development of oral cancer is not completely understood. Not all the people who drink alcoholic beverages develop oral cancer, while not all the oral cancer patients consume alcohol. Role of alcohol in oral cancer causation is challenging to understand, mainly because alcohol consumption histories are difficult to confirm, vary over time, both with respect to type and amount of beverage and are frequently consumed along with tobacco.
However, certain mechanisms have been proposed which explain carcinogenic effects of alcohol in pathogenesis of oral cancer, which are :
• Dehydrating effect of alcohol on cell walls enhances mucosal permeability to other toxins and carcinogens.
• Change in mucosal morphology with a reduction in epithelial thickness.
• Metabolism of ethanol produces acetaldehyde which causes damages DNA of oral epithelial cells and oncogene expression of oral keratinocytes.
• Ethanol disrupts salivary gland function by reducing secretion of epidermal growth factor which protects oral mucosa from injuries caused due to acids which results in increase in the risk of oral mucosal ulcerations.
• Nutritional deficiencies associated with heavy drinking can lower the body’s natural ability to use antioxidants to prevent the formation of cancers.