Chewing tobacco: Not a risk-free alternative to cigarettes

You can call it what you want — smokeless tobacco, spit tobacco, snus, chew, snuff, pinch, plug or dip — but don't call it harmless. If you're considering making the switch from cigarettes to chewing tobacco because you think the smokeless version of tobacco won't hurt you, be forewarned — chewing tobacco also causes serious health problems. Find out why chewing tobacco is not a healthy option.

Chewing tobacco: Just one form of smokeless tobacco

Smokeless tobacco products consist of tobacco or a tobacco blend that's chewed, inhaled or sucked on rather than smoked. It's available in three main forms:

• Chewing tobacco. This type of smokeless tobacco comes in loose leaf, plugs or twists. As the name suggests, it's chewed.
• Snuff. This product is available dry or moist, in loose leaf or in pouches that look like small tea bags. A pinch of snuff may be placed between the cheek and the gum or inhaled into the nostrils.
• Betel quid. A product of India, Africa and Asia, betel quid is produced commercially or made at home. It consists of a dried paste that often includes tobacco, areca nuts, catechu, and scent or flavoring. Catechu is a plant-based product used to treat diarrhea and sometimes used for birth control in some parts of the world. Areca nuts are a plant-based product often used as a recreational drug. Betel is placed in the mouth, usually between the gum and cheek, and gently sucked and chewed.

Though the concept of chewing tobacco might conjure up images of spittoons and messy brown liquid, not all smokeless tobacco needs to be spit out during use. Tobacco companies have developed a friendlier version of chewing tobacco — a spitless tobacco — in an effort to convince more smokers to consider using smokeless products in places where smoking is prohibited.

Health risks of chewing tobacco and other forms of smokeless tobacco

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Leukoplakia

Using chewing tobacco and other smokeless tobacco products can cause serious health problems, from gum irritation to oral cancer.

Addiction
Chewing tobacco gets you hooked on nicotine, similar to the way cigarettes do. And once you're addicted, it becomes difficult to stop using chewing tobacco. Just as with smoking, withdrawal from chewing tobacco causes signs and symptoms such as intense cravings, increased appetite, irritability and depressed mood.

People who use chewing tobacco eventually develop a tolerance for nicotine and need more tobacco to feel the desired effects of the nicotine. Some people switch to brands with higher nicotine content and tend to use chewing tobacco more frequently the longer they've been using smokeless products. More severely addicted users may leave the chew in their mouths overnight and swallow the tobacco juices.

Cavities
Chewing tobacco and other forms of smokeless tobacco cause tooth decay. That's because chewing tobacco contains high amounts of sugar, which contributes to cavities. Chewing tobacco also contains coarse particles that can irritate your gums and scratch away at the enamel on your teeth, making your teeth more vulnerable to cavities.

Gum disease
The sugar and irritants in chewing tobacco and other forms of smokeless tobacco can cause your gums to pull away from your teeth in the area of your mouth where you place the chew. Over time you can develop gum disease (gingivitis) and possibly tooth loss.

Heart problems and non-oral cancer
Smokeless tobacco increases your heart rate and blood pressure. Some evidence suggests that it may put you at an increased risk of heart attack. People who use smokeless tobacco also have higher cholesterol levels than those who don't use tobacco. And a study published in June 2007 in the medical journal The Lancet showed a connection between the use of one form of smokeless tobacco (snus) and an increased risk of pancreatic cancer.

Precancerous mouth lesions
People who use smokeless tobacco are more likely to develop small white patches called leukoplakia (loo-ko-PLA-ke-uh) inside their mouths where the chew is most often placed. These mouth lesions are precancerous — meaning that the sores could one day develop into cancer. After stopping tobacco usage, the lesions usually go away in a few weeks or a few months.

Oral cancer
Your risk of oral cancer is increased if you use smokeless tobacco. Oral cancer includes cancers of the mouth, throat, cheek, gums, lips and tongue. Surgery to remove cancer from any of these areas can leave your jaw, chin, neck or face disfigured.

Smokeless doesn't mean harmless

If you aren't convinced that chewing tobacco, spit tobacco and other forms of smokeless tobacco aren't risk-free, consider the words of someone who's seen the damage tobacco can do. Joe Garagiola, a former spit tobacco user, played major league baseball and later worked in broadcasting. After retiring from baseball he became a crusader against spit tobacco — the term he prefers since "smokeless" makes tobacco sound harmless.

Joe Garagiola

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"I chewed tobacco because it seemed to be the thing to do if you were playing baseball," says Garagiola. "Everybody chewed when I was playing, and nobody knew the dangers of it." But he's seen the dangers since, losing three close friends to oral cancer and seeing the harmful effects of spit tobacco on other people.

"You won't die of gum disease or yellow teeth, but develop oral cancer and it's a terrible way to go," Garagiola says. "Here you are with oral cancer from using spit tobacco, your jaw has been removed and you have to eat through a tube. You die one piece at a time. Spit tobacco is a horrible, horrible thing. I just wish I could get this message across to everyone."

It's never too late to quit

If you're using smokeless tobacco, quit. Now that you know the dangers associated with it, you have extra motivation to give it up. Here's what to do:

• Set a quit date. Mark your quit day on your calendar and commit to it. Select a day at least one week away so that you have time to prepare for your life as a former tobacco user.
• Talk to your doctor. Tell your doctor about your goal to quit using smokeless tobacco and ask for advice. Smokeless tobacco users have more success with quitting if they talk to a doctor or dentist about strategies for quitting.
• Consider medications. Ask your doctor about medications that can help you quit, such as over-the-counter nicotine replacement products, including patches, gum, inhalers and lozenges. There are also non-nicotine prescription medications such as bupropion (Zyban) and varenicline (Chantix) that can ease nicotine withdrawal symptoms when you quit.
• Get support. Join a support group in your area. Go online. Get help and support from people who understand what you're going through. Free resources are available, so don't worry about a financial cost.

Devise a plan to deal with cravings and know that cravings typically last only a few minutes. Eating licorice, chewing gum, going for a walk or calling a friend can help you get through them. And the interval between cravings increases the longer you've stopped using tobacco and eventually the cravings will go away.