Chewing tobacco and other forms of smokeless tobacco are more harmful and addictive than you might think.By Mayo Clinic Staff
Chewing tobacco and other smokeless tobacco products often are promoted as safer than cigarettes. That's because they aren't linked to lung cancer. But these products are not harmless.
Smokeless tobacco products include tobacco that's chewed, sucked or sniffed, rather than smoked. The chemical that makes tobacco addictive, called nicotine, is absorbed through the tissues of the mouth or nose. Sometimes nicotine is swallowed.
There are many types of smokeless tobacco products. They include chewing tobacco, snuff, snus and dissolvable tobacco.
Chewing tobacco is sold as:
- Loose leaves.
- Braided leaves, also called a twist.
- Compressed leaves, also called a plug.
Chewing tobacco may be flavored. It's placed between the cheek and gum. The saliva that builds up in the mouth is either spit out or swallowed. Chewing tobacco also is called chew, spitting tobacco or spit.
Snuff is finely ground tobacco that may be dry or moist. It's packaged in tins or pouches. It may be flavored. A pinch of snuff is placed along the gumline, either behind the lip or between the gum and cheek. Using snuff also is called dipping. Dry snuff can be snorted.
Snus is a type of moist snuff that was first used in Sweden and Norway. It's sold loose or in pouches. Snus is pasteurized, meaning product makers briefly heat it at high temperatures. This process aims to kill bacteria that can produce cancer-causing chemicals. Some evidence suggests that snus users aren't at as great a risk as cigarette users are for mouth cancer, heart disease, stroke, lung cancer and other lung problems.
Dissolvable tobacco products are powdered tobacco. They're pressed into shapes such as tablets, sticks or strips. Some contain sweeteners or flavoring, and they may look like candy. The pressed tobacco is chewed or held in the mouth until it dissolves. These products are not the same as the nicotine lozenges used to help people quit smoking.
Smokeless tobacco products might expose people to lower levels of harmful chemicals than tobacco smoke. But that doesn't mean these products are a safe substitute for smoking.
Smokeless tobacco has nicotine, which can lead to addiction. It also contains dozens of chemicals that can cause cancer.
Health problems related to smokeless tobacco include the following:
- Addiction. People who use smokeless tobacco may get as much or more nicotine into their bodies as do people who smoke cigarettes. As with smoking, withdrawal from smokeless tobacco can cause intense cravings, anger and a depressed mood.
- Cancer. The use of chewing tobacco and other smokeless tobacco products raises the risk of cancer of the mouth, throat and pancreas. Smokeless tobacco also raises the risk of getting small white patches in the mouth called leukoplakia (loo-koh-PLAY-key-uh). These patches could turn into cancer. That's why you might hear them called precancerous.
- Heart disease. Some types of smokeless tobacco increase heart rate and blood pressure. Long-term use of smokeless tobacco raises the risk of dying of heart disease and stroke.
- Dental disease. The sugar and irritants in smokeless tobacco products can cause cavities, worn-down teeth surfaces, teeth staining, bad breath, gum disease, receding gums, bone loss around roots and tooth loss.
- Pregnancy risk. Using smokeless tobacco during pregnancy raises the risk of stillbirth, low birth weight and a heart rate issue in infants.
- Poisoning risk. The candy-like appearance and flavors of some smokeless tobacco products make them attractive to children. Eating these products can cause nicotine poisoning. Nicotine poisoning in children can cause nausea, vomiting, weakness, shaking, coma, trouble breathing and even death.
Product makers may suggest that smokeless tobacco will help you quit smoking. But this hasn't been proved. Because of the health risks, smokeless tobacco products aren't a good way to quit smoking.
If you use chewing tobacco or other forms of smokeless tobacco, you can get help with quitting. Your health care team can help you create a quit plan.
Resources that help people stop smoking also may help you stop using smokeless tobacco. Research shows that the following treatments work:
- Behavioral methods. These can give you support and help you learn the coping skills needed to quit tobacco. They include counseling, telephone and texting services, mobile apps, and self-help materials.
- Nicotine replacement therapy. This involves using patches, gum, lozenges, nose sprays or inhalers that contain small amounts of nicotine. These can help ease cravings for tobacco products.
- Medicines. Two prescription medicines that don't contain nicotine are approved to help curb nicotine withdrawal symptoms. They're pills taken by mouth called bupropion (Wellbutrin SR) and varenicline.
In the United States, you can call the National Cancer Institute's telephone quit line: Call 877-44U-QUIT (877-448-7848). Or you can find your state's quit line by calling 800-QUIT-NOW (800-784-8669). If you live outside of the United States, you can view the World Health Organization's list of toll-free quit lines in various countries.
Aug. 31, 2023
- Smokeless tobacco fact sheets. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/index.htm. Accessed Jan. 28, 2021.
- Health risks of smokeless tobacco. American Cancer Society. https://www.cancer.org/healthy/stay-away-from-tobacco/health-risks-of-tobacco/smokeless-tobacco.html. Accessed Jan. 29, 2021.
- Lawler TS, et al. Chemical analysis of snus products from the United States and northern Europe. PloS One. 2020; doi:10.1371/journal.pone.0227837.
- Kleigman RM, et al., eds. Substance abuse. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Jan. 28, 2021.
- Facts about dipping and chewing tobacco. Smokefree.gov. https://veterans.smokefree.gov/smokeless-tobacco/get-the-facts. Accessed June 13, 2023.
- Smoking, smokeless tobacco. American Dental Association. http://www.mouthhealthy.org/en/az-topics/s/smokeless-tobacco. Accessed Jan. 28, 2021.
- Glover M, et al. Potential effects of using non-combustible tobacco and nicotine products during pregnancy: A systematic review. Harm Reduction Journal. 2020; doi:10.1186/s12954-020-00359-2.
- Gupta R, et al. Risk of coronary heart disease among smokeless tobacco users: Results of systematic review and meta-analysis of global data. Nicotine & Tobacco Research. 2019; doi:10.1093/ntr/nty002.
- Dangers of smokeless tobacco. American Academy of Pediatrics. https://www.healthychildren.org/English/health-issues/conditions/tobacco/Pages/Dangers-of-Chew.aspx. Accessed Jan. 28, 2021.
- Dealing with the mental part of tobacco addiction. American Cancer Society. https://www.cancer.org/cancer/risk-prevention/tobacco/guide-quitting-smoking/getting-help-with-the-mental-part-of-tobacco-addiction.html. Accessed June 13, 2023.
- Speak to an expert. National Cancer Institute. https://smokefree.gov/tools-tips/get-extra-help/speak-to-an-expert. Accessed Jan. 28, 2021.
- Toll-free quitlines. World Health Organization. https://www.who.int/campaigns/world-no-tobacco-day/2021/quitting-toolkit/toll-free-quitlines. Accessed June 12, 2023.
- Smokeless tobacco products, including dip, snuff, snus, and chewing tobacco. U.S. Food and Drug Administration. https://www.fda.gov/tobacco-products/products-ingredients-components/smokeless-tobacco-products-including-dip-snuff-snus-and-chewing-tobacco. Accessed Jan. 28, 2021.
- Nethan ST, et al. Behavioral interventions for smokeless tobacco cessation. Nicotine & Tobacco Research. 2020; doi:10.1093/ntr/ntz107.
- AskMayoExpert. Tobacco-related oral issues (adult). Mayo Clinic; 2019.
- Quitting smoking or smokeless tobacco. American Cancer Society. https://www.cancer.org/healthy/stay-away-from-tobacco/guide-quitting-smoking/quitting-smoking-or-smokeless-tobacco.html. Accessed Jan. 29, 2021.
- Rigotti NA. Patterns of tobacco use. https://www.uptodate.com/contents/search. Accessed Jan. 29, 2021.
- Scientific review of modified risk tobacco product application (MRTPA) under section 911 (d) of the FD&C Act — Technical project lead. U.S. Food and Drug Administration. https://www.fda.gov/media/131923/download. Accessed July 7, 2023.
- Ebbert JO (expert opinion). Mayo Clinic. July 7, 2023.
- Cerezo FJG, et al. Update on new forms of tobacco use. Clínica e Investigación en Arteriosclerosis (English Edition). 2022; doi:10.1016/j.artere.2022.10.005.