Dental changes:
(1) abrasion on occlusal and incisal surfaces of teeth due to gritty materials present
(2) brownish discolorations
(3) dental loss associated with periodontal disease
Gingival and periodontal changes:
(1) gingival recession and gingivitis
(2) periodontal breakdown with periodontitis and loss of alveolar bone
Mucosal changes:
(1) erythematous discoloration
(2) leukoplakia with whitish patches ("snuff dipper's keratosis")
(3) squamous cell carcinoma
Sites affected by mucosal changes associated with placement of tobacco product:
(1) mandibular gingiva
(2) alveolar mucosa
(3) mandibular sulcus
(4) buccal mucosa
Modifying factors that can accelerate changes:
(1) ethanol abuse
(2) malnutrition
(3) oral hygiene
(4) tobacco delivery technique (chewed vs nonchewed, free vs in pouch)
(5) daily duration of use - intermittent vs continuous (may be up to 24 hours a day)
(6) diabetes mellitus
(7) immunodeficiency
(8) use of acidic, glucose-rich soft drinks
