Smokeless tobacco use

Many people assume smokeless tobacco products don’t carry the same dental health risks as cigarettes or hookahs, but there’s no such thing as a safe form of tobacco.

Smokeless tobacco use has been linked with the same issues caused by smoking, including:

• Gum disease that can lead to tooth loss
• Tissue and bone loss around the roots of the teeth
• Stained and discolored teeth
• Bad breath

Smokeless tobacco is a tobacco product that is not burned or smoked. Types of smokeless tobacco include:

Chewing tobacco. Comes as loose leaves, braided leaves (a twist) or compressed leaves (a plug), with or without added flavoring. Users typically place a small amount between the cheek and gum. Saliva that builds up is spit out or swallowed.

Snuff (also called dip). Finely ground tobacco that comes moist or dry and may have added flavors. Moist snuff can be placed as a pinch or a small pouch of tobacco along the gumline behind the lip or between the cheek and gum. Dry snuff, which is less common in the United States, is inhaled through the nose.

• Snus — a form of finely ground, moist snuff originally from Sweden — is used much in the same way, either loose or in pouches.

Dissolvable tobacco. Powdered tobacco pressed into lozenges, sticks or strips that may look like candy, often with added flavors and sweeteners. (These are different from nicotine lozenges used to help people quit smoking.)

Smokeless tobacco products are addictive like cigarettes, because they also contain nicotine. But learning what smokeless tobacco does to your dental health may help motivate you to make a change.

• Smokeless tobacco contains dozens of chemicals known to cause oral cancer.
• Using smokeless tobacco reduces the flow of saliva that helps cleanse away cavity-causing bacteria.
• Other cavity risks come from added flavors and sweeteners, which may contain sugar, and the sand and grit that can wear away the protective coating (enamel) on your teeth.
• Tobacco chemicals irritate your gums. Signs of gingivitis (early gum disease) include painful and bleeding gums.
• As these issues worsen, your gums can pull away from your teeth and form spaces (deep pockets) where infection can develop, a sign of severe gum disease (periodontitis).
• The bone and tissue that hold your teeth in place begin to break down, causing your teeth to loosen. Loose teeth may fall out or need to be pulled by your dentist or oral surgeon.

Untreated gum disease also has been linked with stroke, high blood pressure, heart disease and dementia.

While e-cigarette aerosol contains fewer chemicals than smokeless tobacco, that doesn’t mean vaping is safe. Vape cartridges usually contain nicotine or cannabis (THC, CBD), and researchers have also found these harmful substances in them:

• carcinogens (chemicals known to cause cancer)
• heavy metals such as nickel, tin and lead
• small particles that can be inhaled deep into the lungs
• flavorings with sugar, which contribute to tooth decay

Nicotine is highly addictive and known to affect brain development in children, teens and young adults. The amount of nicotine in e-cigarettes has increased with vaping's popularity. A study shows that over five years, the average nicotine strength in an e-cigarette increased from 1.7% to 5%, which is double the amount of nicotine you inhale from a pack of cigarettes.

A study published in The Journal of the American Dental Association (JADA) found a correlation between people who vape and people with untreated cavities, but more research must be done to determine whether those cavities are caused by vaping.

The best way to protect your dental (and overall) health is to quit smokeless tobacco products. It takes time and commitment — but millions of people have done it, and there are plenty of resources and support to help you along the way.

• Quitting smokeless tobacco (resources for adults)
• Quitting dip (resources for young adults and youth)
• Helpful tips for staying tobacco-free

Be sure to ask your dentist for suggestions and support, too. Your dentist cares about your health and is there to offer guidance and motivation to help you succeed. In the meantime, make sure to store your tobacco products where children can’t reach them, as nicotine is a toxic substance that can cause illness — and in severe cases, coma or death — if swallowed.