Smokeless Tobacco: What You Need to Know
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What is smokeless tobacco?

No Alt TextChewing tobacco, snuff, snus, and dissolvable tobacco in the shape of sticks, pellets, and strips are all types of tobacco products that are not smoked but used in other ways. All types of smokeless tobacco contain nicotine and chemicals known to cause cancer (carcinogens). 

Chewing tobacco

Chewing tobacco comes in 3 forms: loose leaves, plugs, and twists or rolls of tobacco. A piece (plug, wad, or chew) of tobacco is placed between the cheek and gum. Users chew on it for several hours and spit out the tobacco juices and saliva as they build up. 

Snuff and snus

Snuff and snus are ground tobacco. Moist snuff and snus are sold in cans or sachets (pouches that look like tea bags). Users put a pinch (dip, lipper, or quid) of moist snuff between the cheek or lip and gum. Sachets are placed between the cheek and gum. Dry snuff is a powdered form sold in cans. A pinch of dry snuff can be placed in the mouth or sniffed up the nose. 

Other forms of smokeless tobacco

The newest forms of smokeless tobacco are finely ground dissolvable tobacco that is flavored and shaped into sticks, pellets, or strips. These forms melt in the users' mouth within 3 to 30 minutes, delivering nicotine. These new stick forms of smokeless tobacco contain 3 times more nicotine than an average cigarette. 

Smokeless tobacco is addictive

Nicotine in smokeless tobacco is what gives users a buzz. It also makes it very hard to quit. 
Every time smokeless tobacco is used, the body gets used to the nicotine and starts to crave it. Craving is one of the signs of addiction. Another sign of addiction is called tolerance. This is when the body adjusts to the amount of tobacco needed to get a buzz. With continued use, more and more tobacco is needed to get the same feeling. 
Many smokeless tobacco users say it is harder to quit smokeless tobacco than cigarettes. 

Smokeless tobacco is not safe

Some people believe smokeless tobacco is OK because it does not cause health problems from smoke and smoking. This does not make smokeless tobacco safe, however. Some smokeless tobacco delivers more nicotine than cigarettes, making addiction more likely. There are also direct effects of smokeless tobacco on the mouth. 
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    Bad breath. Smokeless tobacco can give you really bad breath and discolored teeth. This will not help anyone's social life.
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    Dental problems. Smokeless tobacco's direct and repeated contact with the gums causes the gums to recede and become diseased, leading to loose teeth. Many forms of smokeless tobacco also contain sugar. This mixes with the plaque on the teeth to form acid that eats away at tooth enamel to cause cavities and chronic painful sores.
  •  
    Cancer. Cancer of the mouth (including the lip, tongue, and cheek) and throat can occur most often at the spot in the mouth where the tobacco is held. Surgical removal of cancer is often needed, and parts of the face, tongue, cheek, or lip must often be removed too.
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    Leukoplakia. A white, leathery-like patch called leukoplakia may form in the mouth. The patches vary in size and shape and can become cancerous. If you have a patch in your mouth, your doctor should examine it right away.

Other harmful effects

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    Heart problems. The constant flow of nicotine into your body causes many side effects including increased heart rate, increased blood pressure, and sometimes irregular heartbeats, which may increase risk for sudden death from a condition (ventricular arrhythmias) in which the heart does not beat properly.
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    Nicotine poisoning. The new forms of smokeless tobacco look like candy or breath strips, making them attractive to all ages, even children. While tobacco from a cigarette tastes bitter and unpleasant, the new forms are minty and flavorful, increasing their potential for poisoning.

Tips to quit

Trying to quit can be difficult, but it is not impossible. Here are some tips. 
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    Pick a quit date and throw out all of your smokeless tobacco products.
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    Ask for help. You can successfully quit with help and support!
     
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      Call your doctor.
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      Go online to a smokeless tobacco quitting resource, such as http://Chewfree.com.
    •  
      Call a national toll-free telephone counseling resource, such as 1-800-QUITNOW.
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      Ask your friends, family, teachers, and coaches for support and encouragement. Tell friends you are quitting and ask them to not offer you smokeless tobacco or other nicotine products. Ask a friend to quit with you.
  •  
    Chew on something else. A few good examples are sugarless gum, pumpkin or sunflower seeds, or apple slices.
  •  
    Stay busy with healthier activities. You could work on a hobby, listen to music, or volunteer your time. Exercise can help relieve any tension caused by quitting. Try biking, walking, running, or other sports.
  •  
    Everyone is different, so develop a personalized plan that works best for you. Set realistic goals so you will be more likely to achieve them.
  •  
    Reward yourself. Save the money that you would have spent on smokeless tobacco and use it for something special. Treat yourself to your favorite restaurant, a special purchase, or an event. Spend time with family and friends who are supportive.

Early signs of oral cancer

Your chances of being cured are higher if oral cancer is found early. Check your mouth often, looking closely at the places where you hold the tobacco. See your doctor right away if you have any of the following: 
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    A sore that bleeds easily and does not heal
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    A lump or thickening in your mouth or neck
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    Soreness or swelling that does not go away
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    A red or white patch that does not go away
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    Trouble chewing, swallowing, or moving your tongue or jaw
If you use smokeless tobacco, your doctor and dentist should carefully examine your mouth at each checkup. 

For more information

American Academy of Pediatrics Julius B. Richmond Center of Excellence 
1-800-QUITNOW (telephone counseling resource) 
800/QUITNOW (800/784-8669) 
American Cancer Society 
800/227-2345 
Centers for Disease Control and Prevention 
Office on Smoking and Health 
Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this publication. Phone numbers and Web site addresses are as current as possible, but may change at any time. 
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