Persons who chew tobacco or dip snuff have a number of changes affecting the teeth, periodontal tissues, and oral mucosa. These can be significant in habitual users.


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


To read more or access our algorithms and calculators, please log in or register.