Health Risks of Smokeless Tobacco
Spit or smokeless tobacco is a less lethal, but still unsafe, alternative to smoking.
Types of smokeless tobacco
Many types of tobacco are put into the mouth. These are some of the more common ones:
Chewing, oral, or spit tobacco
This tobacco comes as loose leaves, plugs, or twists of dried tobacco that may be flavored. It’s chewed or placed between the cheek and gum or teeth. The nicotine in the tobacco is absorbed through the mouth tissues. The user spits out (or swallows) the brown saliva that has soaked through the tobacco.
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 lower lip or cheek and gum. The nicotine in the snuff is absorbed through the tissues of the mouth. Moist snuff also comes in small, teabag-like pouches or sachets that can be placed between the cheek and gum. These are designed to be both “smoke-free” and “spit-free” and 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 first used in Sweden and Norway. It’s often flavored with spices or fruit, and is packaged like small tea bags. Snus is held between the gum and mouth tissues and the juice is swallowed.
Tobacco companies have created flavored, dissolvable forms of smokeless tobacco. These are available as tobacco lozenges, orbs, or pellets; strips (like melt-away breath strips); and toothpick-sized sticks. Some of these also contain 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.
What are the health risks of smokeless tobacco?
Using any kind of spit or smokeless tobacco is a major health risk. It’s less lethal than smoking tobacco, but less lethal is a far cry from safe.
No form of smokeless tobacco is a safe substitute for cigarettes. Still, tobacco companies often market these products as alternatives to smoking in places where smoking isn’t allowed.
Smokeless tobacco causes cancer
Overall, people who dip or chew get about the same amount of nicotine as regular smokers. They also get at least 30 chemicals that are known to cause cancer. The most harmful cancer-causing substances 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:
- Mouth, tongue, cheek, and gum cancer
- Cancer in the esophagus (the swallowing tube that goes from your mouth to your stomach)
- Pancreatic cancer
Smokeless tobacco causes other health problems
Mouth and tooth problems
Many studies have shown high rates of leukoplakia in the mouth where users place their chew or dip. Leukoplakia is a gray-white patch in the mouth that can become cancer. These patches can’t be scraped off. They’re sometimes called sores but are usually painless. The longer a person uses oral tobacco, the more likely they are to have leukoplakia. Stopping tobacco usually clears 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. Many regular smokeless tobacco users have receding gums, gum disease, cavities and tooth decay (from the high sugar content in the tobacco), scratching and wearing down (abrasion) of teeth, and bone loss around the teeth. The surface of the tooth root may be exposed where gums have shrunken. All this can cause teeth to loosen and fall out.
Other health problems
Other harmful health effects of smokeless tobacco include:
- Heart disease and high blood pressure
- Increased risk of heart attack and stroke
- Increased risk of early delivery and stillbirth when used during pregnancy
Smokeless tobacco can lead to nicotine poisoning and even death in children who mistake it for candy.
Smokeless tobacco causes nicotine addiction. This can lead to smoking and using other forms of tobacco. In fact, using both smokeless tobacco and cigarettes is becoming more common, especially in young people. This can lead to even greater future health risks than they would have from using either product alone.
Dissolvable tobacco is of special concern because at this time little is known about the health effects of these products. Still, it’s clear that they are another way for people, especially youth, to experiment with tobacco products and become addicted to nicotine. Because they are so tempting, they can easily poison children and pets.
Can smokeless tobacco be used to help quit smoking?
Manufacturers often imply or even claim that spit or smokeless tobacco can help people quit smoking. A lot of people believe and try this. But there’s no proof that any smokeless tobacco products help smokers quit smoking.
Unlike US Food and Drug Administration (FDA)-approved standard treatments that have been proven to work (such as nicotine replacement and certain drugs), oral tobacco products have not been tested thoroughly to see if they can help a person stop smoking. And research to date has not shown that they really help a person quit.
Even if using smokeless tobacco helps some people give up smoking, it still can cause cancer and other health problems, too. It’s also addictive and hard to quit.
For more, see our Guide to Quitting Smokeless Tobacco.
American Cancer Society. Cancer Prevention & Early Detection Facts & Figures 2015-2016. Atlanta, Ga. 2015.
Campaign for Tobacco-free Kids. Health Harms From Smokeless Tobacco Use. September 9, 2014/Ann Boonn. Accessed at www.tobaccofreekids.org/research/factsheets/pdf/0319.pdf on November 11, 2015.
Campaign for Tobacco-free Kids. Smokeless Tobacco in the United States. September 9, 2014/Ann Boonn. Accessed at www.tobaccofreekids.org/research/factsheets/pdf/0231.pdf on November 11, 2015.
Connolly GN, Richter P, Aleguas A Jr, et al. Unintentional child poisonings through ingestion of conventional and novel tobacco products. Pediatrics. 2010;125(5):896-899.
National Cancer Institute. Smokeless Tobacco and Cancer. October 25, 2010. Accessed at www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/smokeless-fact-sheet on November 11, 2015.
Popova L, Ling PM. Alternative tobacco product use and smoking cessation: A national study. Am J Public Health. 2013;103(5):923-930.
Schauer GL, Malarcher AM, Babb SD. Prevalence and correlates of switching to another tobacco product to quit smoking cigarettes. Nicotine Tob Res. 2015;17(5):622-627.
Siddiqi K, Shah S, Abbas SM, et al. Global burden of disease due to smokeless tobacco consumption in adults: Analysis of data from 113 countries. BMC Med. 2015;13:194.
Last Medical Review: November 13, 2015 Last Revised: November 13, 2015