Smokeless tobacco

Smokeless tobacco is unburnt tobacco, which is placed into the mouth. It is estimated there are between 12 and 14 million users in the United States.

Three types of smokeless tobacco

Chewing tobacco

Consists of coarsely divided tobacco leaf that is mixed with sugar and molasses and packaged in a pouch. It is used in a plug or twist. A “quid” or “chaw” of the tobacco is chewed or sucked. Popular brands include Red Man and Chattanooga Chew.


Is a moist, more finely cut tobacco. It is usually flavored with mint, wintergreen, etc. and is sold in short round cans. This is “dipped” by placing a pinch between the cheek and gum. Brands include Skoal, Copenhagen, and Hawken.

Dry snuff

Is finely ground and snuffed through the nostrils. This is rarely used in the United States.

What is in smokeless tobacco?

Here are a few of the ingredients found in smokeless tobacco.

  • Polonium 210 (nuclear waste)
  • Formaldehyde (embalming fluid)
  • Cadmium (used in car batteries)
  • Lead (nerve poison)
  • Nitrosamines (cancer causing substances)
  • Arsenic
  • Cyanide

Who uses it?

Of the estimated 12-14 million American users, about 3.6 million are under the age of 21. The average age of first use is 10.

What are the risks?

Short term

Smokeless tobacco contains higher quantities of nicotine than most cigarettes. Nicotine is an addictive compound that leads to dependence in most users. It affects the cardiovascular system, increasing the heartbeat, constricting the blood vessels, and can increase blood pressure. It also increases the likelihood that the person will become a smoker.

Mid term

After about two years, changes often occur in the regions of the mouth where tobacco is placed. These changes include staining of teeth, recession of gums, and in over 50% of users, the development of thickened white patches or leukoplakia in the oral lining. Two to four percent of these patches may turn into cancer.

Long term

Long-term use leads to increased risk of oral cancer. Smokeless tobacco users have a four fold greater risk of oral cancer than non-users. After 50 years of use, this risk can be approximately 50 times greater. Smokeless tobacco is also linked to cancer of the esophagus and pancreas and may contribute to the cause of lung cancer.

Oral cancer

Incidence and mortality

It is estimated that about 37,000 new cases of oral cancer will be reported in the United States in 2011. These cancers occur more frequently in men than women, and are more common in people over the age of 50. In 2011, an estimated 8,000 deaths can be blamed on oral cancer.

Warning signs

  • A sore on the lip, gums, mouth that bleeds easily and doesn’t heal
  • A lump or thickening
  • Red or white patches that persist
  • Difficulty in swallowing, chewing, or moving the tongue or jaws are often late changes


Principal methods are surgery and radiation therapy. Chemotherapy is sometimes used before surgery or radiation therapy to shrink large tumors.

Early detection is important! Ask your dentist or family physician how to perform oral self-exams and do them regularly.

UI Cancer Information Services

Last reviewed: 
June 2016

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