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tobacco, also called spit tobacco, chewing tobacco, chew, chaw, dip, plug, and probably a few other things, comes in two forms:
1. Snuff 2. tobacco

Snuff is a fine-grain tobacco that often comes in teabag-like pouches that users "pinch" or "dip" between their lower lip and gum.

Chewing tobacco comes in

shredded, twisted, or "bricked" tobacco leaves that users put between their cheek and gum.

1) 2)



Khaini Mainpuri tobacco Mawa Mishri Paan Snuff

Placed in mouth or chewed

Mainpuri tobacco

Packet rubbed to soften , mix content then


Used to clean teeth


Dry or moist Orally or nasally Applied to teeth and gingiva with help of a


contains over 2,000 chemicals, many of which have

been directly related to causing cancer. Paan

1. 2. 3. 4. 5. Betel leaf also known as paan Areca nut (supari) Lime Catechu (resinous extract from acacia tree) Tobacco

1. 2. 3. 4. 5. 6. 7. Polycyclic aromatic hydrocarbon Nicotine Phenol Benzopyrene CO Oxides of nitrogen Nitrous amine

1. Finely powdered air cured and fire cured tobacco leaves

The primary oral, mucosal, and hard tissue changes associated with SLT use include
1) 2) 3) 4) 5) 6) 7)

9) 10) 11) 12)

14) 15) 16)

SLT keratosis (STK) gingival inflammation periodontal inflammation alveolar bone damage dental caries tooth abrasion Dysplasia oral squamous cell carcinoma (SCC). Oral submucous fibrosis (OSF) Gum recession Oral leukoplakia Tooth discoloration & halitosis Nicotine dependence Unhealthy eating habits Oral cancer others

A malignant neoplasm of stratified squamous epithelium that is capable of locally destructive growth and distant metastasis .
Evidence that tobacco is strongly associated with cancers of the oral cavity . Cancer occurs more frequently in snuff user than in nontobacco users .

Contains harmful substances Tobacco specific nitrosamine , directly related with

risk of cancer

Polonium 210 in fertilizers Long term exposure to cancer-causing agents, alter normal functions of oncogenes and tumor suppressor genes in oral tissues.
These changes will eventually lead to uncontrolled cell growth and the onset of oral precancer.

Leukoplakia or erythroplakia are also known as oral precancers. Leukoplakia is a white area and erythroplakia is a red area in the mouth. Both, if left untreated, will develop into cancer. For instance, on average, it takes erythroplakia 10 year to become cancer.

A sore that does not heal A lump or white patch A prolonged sore throat Difficulty in chewing Restricted movement of the tongue or jaws A feeling of something in the throat Loosening of teeth Paresthesia of teeth and lower lip

OSF : is a condition in which fibrous tissue is laid down in the corium of oral mucosa. Simultaneous changes occur in the oral epithelium

In early phase ; small ulcers may be formed Later stages

Stiffening of oral mucosa Difficulty in mouth opening Binding down of the tongue

Clinical appearance of mucosa :

Blanched , marbled nature

Cause is not known with certainty 2) Genetic susceptibility 3) Betel nut chewing 4) Autoimmunity

clinical term used to denote mucosal conditions that produce a whiter than normal coloration of mucous membrane

Increase risk in smokers _ 16 % Appearance of lesion . Can vary from flat smooth and translucent to thick firm rough surface and raised plaques . Sites

Buccal mucosa floor of the mouth

Labial commissure
Lateral border of the tongue Mandibular and maxillary alveolar ridges

Smoke Smokeless tobacco Premalignant epithelial changes EBV infection Ill fitting dentures Candida albicans Lichen planus Genetic disorder

One or more biopsies of the lesions Small lesion_ excisional biopsy Large lesion_ incisional biopsy

Grit and sand in smokeless tobacco products scratches teeth and wears away the hard surface or enamel. Premature loss of tooth enamel can cause sensitivity and may require corrective treatment.

Constant irritation to the spot in the mouth where a small wad of chewing tobacco is placed can result in
permanent damage to periodontal tissue. It also can damage the supporting bone

structure. The injured gums pull away from the teeth, exposing root surfaces and leaving teeth sensitive to heat and cold. Erosion of critical bone support leads to loosened teeth that can be permanently lost.

Sugar is added to smokeless tobacco during the curing and processing to improve its taste.
The sugar reacts with bacteria found naturally in the mouth, causing an acid reaction, which leads to decay.


Common traits of long-term smokeless tobacco users are stained teeth and bad breath. Moreover, the habit of continually spitting can be both unsightly and offensive.

Nicotine blood levels achieved by smokeless tobacco use are similar to those from cigarette smoking. Nicotine addiction can lead to

an artificially increased heart rate blood pressure. it can constrict the blood vessels that are

necessary to carry oxygen-rich blood throughout the body. Athletic performance and endurance levels are decreased by this reaction

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, both of which are harmful if consumed in excess.