Health Risks of Smokeless Tobacco

There are many different types of smokeless tobacco including dip, snuff, snus, and chewing tobacco. Recreational lozenges, strips, sticks, and small pouches of tobacco are also considered smokeless tobacco.

Some smokeless tobacco products might expose you to lower levels of harmful chemicals than tobacco smoke. But that doesn’t mean they are a safe alternative to smoking.

Types of smokeless tobacco

Depending on the product, smokeless tobacco is either inhaled or put into the mouth. It isn’t burned like cigarettes or cigars. But it is made from tobacco leaves, and it has many of the same harmful chemicals as cigarettes and cigars.

Chewing, oral, or spit tobacco

These come as loose leaves, plugs, or twists of dried tobacco that may be flavored. They are chewed or placed between the cheek and the gums or teeth. The nicotine is absorbed through the mouth tissues. The user then spits out (or swallows) the tobacco 'juices.'

Snuff or dipping tobacco

Snuff is finely ground tobacco packaged in cans or pouches. It’s sold as dry or moist and may have flavorings added.

Moist snuff is used by putting it between the gums and the lower lip or cheek. The nicotine is absorbed through the tissues of the mouth. Moist snuff also comes in small, teabag-like pouches that can be placed between the cheek and gums. These are designed to be both “smoke-free” and “spit-free.” They are marketed as a discreet way to use tobacco.

Dry snuff is sold in a powdered form and is used by sniffing or inhaling the powder up the nose.

Snus (sounds like “snoose”) is a type of moist snuff. It’s packaged in small pouches, which are held between the gum and mouth tissues. Like spit-free snuff, the juices are swallowed.

Dissolvable tobacco

Dissolvable forms of smokeless tobacco come in different shapes and sizes, such as tobacco pouches, recreational lozenges, orbs, pellets, thin strips (like melt-away breath strips), and toothpick-sized sticks. Some of these also have sweeteners or flavoring and look a lot like candy. All have tobacco and nicotine. Depending on the type, they are held in the mouth, chewed, or sucked until they dissolve. The juices are swallowed.

Heated tobacco products

Heated tobacco products (sometimes called “heat-not-burn” products) most often use an electronic heating element. This element heats specially designed sticks, plugs, or capsules containing tobacco. The heat releases nicotine (and other chemicals) that can then be inhaled into the lungs, but the tobacco doesn’t get hot enough to burn. These devices are not the same as e-cigarettes.

What are the health risks of smokeless tobacco?

Using any kind of smokeless tobacco can expose you to health risks.

Smokeless tobacco has nicotine and other chemicals that can cause health problems. Some smokeless tobacco products might expose you to lower levels of harmful chemicals than cigarette smoke. But this doesn’t mean they are safe.

No form of smokeless tobacco is a safe substitute for cigarettes.

Still, tobacco companies often market these products as an alternative to smoking in places where smoking isn’t allowed.

Smokeless tobacco causes cancer

When you use smokeless tobacco, you get about the same amount of nicotine as you do when you smoke cigarettes. You are also exposed to more than 25 chemicals that are known to cause cancer.

The most harmful cancer-causing chemicals in smokeless tobacco are tobacco-specific nitrosamines(TSNAs). TSNA levels vary by product, but the higher the level the greater the cancer risk.

Cancers linked to the use of smokeless tobacco include:

• Head and neck cancers (such as cancers of the mouth, tongue, cheek, and gums)
• Cancer of the esophagus (the tube that connects the throat to the stomach)
• Pancreatic cancer

Newer types of smokeless tobacco haven’t been studied as well as chewing tobacco and snuff, so the risk of cancer with these products isn’t as clear. But they often still have harmful chemicals that might increase your risk of cancer. The amount of these chemicals varies by product.

Smokeless tobacco causes mouth and tooth problems

Leukoplakia is a gray-white patch in the mouth that can become cancer. It is often found in the mouths of people who use smokeless tobacco placed between the teeth and gums.

These patches can’t be scraped off. They’re sometimes called sores, but they are usually painless. The longer you use oral tobacco, the more likely you are to have leukoplakia. Stopping tobacco might help clear up the spot, but treatment may be needed if there are signs of early cancer.

Tobacco stains teeth and causes bad breath. It can also irritate or destroy gum tissue. Some regular smokeless tobacco users have receding or swollen gums, tooth decay and cavities, scratching and wearing down (abrasion) of teeth, and bone loss around the teeth. When gums recede (shrink), the surface of the tooth root may be exposed. All of these can cause teeth to loosen and fall out.

Smokeless tobacco causes other health problems

Other harmful health effects of smokeless tobacco include:

• Increased risk of dying from heart disease and stroke
• Increased risk of early delivery and stillbirth when used during pregnancy

All smokeless tobacco has nicotine, which can lead to addiction. In teens, using nicotine can harm the parts of the brain that control attention, learning, mood, and impulse control. It may also increase the risk for future addiction to other drugs.

Learn more: What Parents Need to Know About Tobacco

At this time, little is known about the health effects of dissolvable tobacco products. But we do know that teens and young adults are using these products, which can lead to nicotine addiction. Also, because these products are so tempting, they can easily poison children and pets who mistake them for candy or food.