How does smokeless tobacco affect your health?

There are many reasons to stick it out through withdrawal and quit using smokeless tobacco for good. Health reasons are the most obvious ones. Harmful health effects include:

  • Mouth, cheek, and gum cancer
  • Cancer in the esophagus (the swallowing tube that goes from your mouth to your stomach)
  • Pancreatic cancer
  • Possible increase in risk of heart disease, heart attacks, and stroke
  • Addiction to nicotine (which can lead to smoking and using other forms of tobacco)
  • Leukoplakia (white sores in the mouth that can become cancer)
  • Receding gums, gum disease (gums shrink from around the teeth)
  • Bone loss around the roots of the teeth
  • Abrasion (scratching and wearing down) of teeth
  • Cavities and tooth decay
  • Tooth loss
  • Stained and discolored teeth
  • Bad breath

Mouth lesions

Leukoplakia is a white patch in the mouth that can become cancer. These are sometimes called sores but they are usually painless. Many studies have shown high rates of leukoplakia in the mouth where users place their chew or dip. One study found that nearly 3 out of 4 daily users of moist snuff and chewing tobacco had non-cancerous or pre-cancerous lesions (sores) in the mouth. The longer you use oral tobacco, the more likely you are to have leukoplakia.

Tobacco can irritate or destroy gum tissue. Many regular smokeless tobacco users have receding gums, gum disease, tooth decay (from the high sugar content in the tobacco), 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.

Heart disease

Smokeless tobacco may also play a role in heart disease and high blood pressure. Results from a large American Cancer Society study showed that men who switched from cigarettes to snuff or chewing tobacco had higher death rates from heart disease, stroke, cancer of the mouth and lung, and all causes of death combined than former smokers who stopped using all tobacco products. It’s unclear if the heart disease was caused by the smokeless tobacco products in this study.

Later studies have found mixed results. Some show a slight increase in heart disease among users of smokeless tobacco. One Indian study that looked at countries where smokeless tobacco use is high found that the risks of heart attack and sudden death were higher in those who used smokeless tobacco, and even higher in those who both chewed and smoked. They also found more high blood pressure and clotting problems in those who used smokeless tobacco. Studies in Sweden found no increase in heart attacks, but snuff (snus) users were more likely to die from their heart attacks than non-users. Other Swedish studies have found that high blood pressure and heart failure are seen at higher rates in snus users compared to peers who do not use tobacco.

More US studies are needed to identify heart disease related to use of smokeless tobacco.


The snuff and chewing tobacco products most widely used in the United States have very high levels of cancer-causing agents (carcinogens) called tobacco-specific nitrosamines. These carcinogens cause lung cancer in animals, even when injected into their blood. There are other cancer-causing agents in smokeless tobacco, too, such as benzo[a]pyrene and other polycyclic aromatic carcinogens. These carcinogens may be why several types of cancer are linked to use of smokeless tobacco (see above list).

How do the risks of using smokeless tobacco compare with cigarette smoking?

Looking at large numbers of people, smokeless tobacco products are less lethal than cigarettes: They kill fewer people on average than cigarettes. But smokeless tobacco hurts and kills people all the same. Even though smokeless products are marketed as a less harmful alternative to smoking, they can be deadly. Mouth and throat cancer kill far fewer people than lung cancer – a little more than 8,000 per year out of the 42,000 or so that get it. But imagine losing part of your mouth, jaw, face, or neck to cancer. Some people lose their ability to eat or speak. For more on the treatment of mouth and throat cancer, see our document Oral Cavity and Oropharyngeal Cancer.

Smokeless tobacco has not been proven to help smokers quit. And smokers who delay quitting by using smokeless products between cigarettes greatly increase their risk of lung cancer. They also set themselves up for new health problems caused by smokeless tobacco.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: February 20, 2014 Last Revised: June 23, 2016

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