Smokeless Tobacco and Health Risks

Author: OncoLink Team
Content Contributor: Allyson Distel, MPH
Last Reviewed: February 23, 2024

Smokeless tobacco products can be called: dip, chew, spit, oral and spitless tobacco, and dry and moist snuff (snus). Smokeless tobacco is not a safe choice instead of cigarettes.

The facts about smokeless tobacco:

  • It is just as addictive as cigarette smoking.
  • One can of snuff contains the same amount of nicotine as 4 packs of cigarettes.
  • Dipping 8 to 10 times a day adds as much nicotine into the body as smoking 30-40 cigarettes.
  • The amount of nicotine in the bloodstream after using smokeless tobacco may be higher than that of a cigarette smoker because nicotine is easily and quickly taken in through the mouth lining.
  • Nicotine stays in the bloodstream longer with smokeless tobacco than with cigarettes.

Oral tobacco has at least 28 chemicals known to cause cancer (carcinogens). The most harmful chemicals are called tobacco-specific nitrosamines, which are known to cause lung cancer. The juice from smokeless tobacco causes sores and white patches (called leukoplakia) in the mouth that can lead to cancer.

What are the risks of using smokeless tobacco?

People who use smokeless tobacco have a higher risk of cancers of the mouth, throat (pharynx), esophagus (swallowing tube from the throat to the stomach), stomach, and pancreas. Smokeless tobacco can also lead to other health problems such as heart disease, heart attack, and stroke. Other effects of using spit tobacco are:

  • Chronic bad breath.
  • Stained teeth and fillings.
  • Gum disease and tooth decay.
  • Break-down and loss of bone that is in the jaw.

Smokeless tobacco products are not a safe choice instead of smoking. Studies have shown that those who switch from cigarette smoking to chewing tobacco were more than 2.5 times as likely to develop cancer of the mouth or throat compared to those who quit smoking altogether. Those who switch from cigarette smoking to chewing tobacco are 5-6 times more likely to develop cancer than non-smokers.

Smokeless Tobacco Around the World

The types of cancer caused by smokeless tobacco varies around the world. This is because the type of tobacco product used and what is mixed with it varies. For example, in Middle Eastern countries (India and Sudan), many chewing tobaccos are made with betel quid or areca nut, which are both known to be carcinogens. As a result, there is a higher risk of cancers of the mouth and throat in this area of the world. Studies in Asia and Africa have shown a higher risk of mouth, throat, and esophagus cancer in users of smokeless tobacco. Nordic and Northern European countries have a higher risk of esophagus and pancreas cancers due to the use of smokeless tobacco. In Sweden and Norway, snus, which is a type of moist snuff made with air-cured tobacco, water, salt, and flavorings, is the most common form of smokeless tobacco. Snus may have lower levels of carcinogens than other types of snuff but is still linked to cancer.

Are you ready to quit smokeless tobacco?

Great- that is the first step to success! It can help if you write down your personal motivations to quit and refer to them.

Quitting is not easy, but you are not alone- many people want to quit, and many do it. Surveys show that most people who use snuff or chew want to quit.

Why is quitting smokeless tobacco important?

There are many reasons why quitting is important.

  • Quitting will improve your health and lower your chances of a tobacco-related cancer or heart disease. Your risk of these diseases decreases the longer you don’t use smokeless tobacco.
  • A tobacco habit is costly, and by quitting you will have extra money to put towards other things.
  • Mouth sores will heal soon after quitting, and you will not have bad breath and stained teeth.
  • You will not have to worry about stains from tobacco juice on your clothes and in your car. 
  • You will be setting a good example for those around you, especially if you have children in your life.

Quitting Smokeless Tobacco

Talk with your healthcare provider for suggestions and support while you quit. For smokeless tobacco users, there may be a greater need to find an oral substitute to take the place of the tobacco such as sugarless candy or gum.

Symptoms of Withdrawal from Smokeless Tobacco

Stopping or cutting back on smokeless tobacco use causes symptoms of nicotine withdrawal which is the same as when quitting smoking. Withdrawal from nicotine can have both physical and mental effects:

  • Physically: the body reacts to not having nicotine.
  • Mentally: when a person is giving up an addiction, it can have an emotional impact and calls for a behavior change.

Withdrawal symptoms can happen to those who have used tobacco regularly for a few weeks or longer, and suddenly stop or greatly reduce the amount used. Symptoms often start within a few hours of the last dip or chew and get worse about 2 to 3 days later when most of the nicotine and its by-products are out of the body. Withdrawal symptoms you may have are:

  • Dizziness.
  • Depression.
  • Feeling frustrated, impatient, and angry.
  • Anxiety and irritability.
  • Trouble sleeping (falling asleep and staying asleep).
  • Trouble concentrating.
  • Headaches.
  • Tiredness.
  • Increased appetite.

Withdrawal symptoms can last for a few days to up to many weeks. These uncomfortable feelings can lead you to start using tobacco again, but remember: They will get better every day that you stay tobacco-free! Nicotine replacement products and other medications can help you get through withdrawal symptoms.

Resources for Quitting

Whether you're a smoker or someone who uses smokeless tobacco, to have the best chance of quitting and being successful, you need to know what your options are and where to go for help. Below are some resources that will help you:

Smoking cessation. Where do I start?
Start here for help in creating a quit plan, tips to coping with common obstacles and resources for support and smoking cessation programs.

There are several websites for smokeless tobacco users. These include:

Life After Tobacco

Quitting tobacco cannot get rid of the damage done by months or years of use. You should always tell your healthcare providers about your history of tobacco use and be aware of the risks associated with this history.

As recommended by the American Cancer Society, you should tell your healthcare provider about any of the following symptoms:

  • Any change in a cough (for example, you cough up more phlegm or mucus than usual).
  • A new cough.
  • Coughing up blood.
  • Hoarseness (scratchy or weak voice).
  • Trouble breathing.
  • Wheezing.
  • Chest pain.
  • Loss of appetite.
  • Weight loss.
  • Feeling tired all the time (fatigue).
  • Frequent lung or respiratory infections (like pneumonia or bronchitis).
  • Development of sores, red areas, or white patches in your mouth.

Smokeless tobacco use is harmful to your health. Ask your provider for help in quitting smokeless tobacco to help improve your health.

American Cancer Society (2020). Health Risks of Smokeless Tobacco.

Centers for Disease Control and Prevention (2020). Smokeless Tobacco: Health Effects. 

International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 100E: Betel Quid and Areca Nut.

Mehrtash, H., Duncan, K., Parascandola, M., David, A., Gritz, E. R., Gupta, P. C., ... & Wen, C. P. (2017). Defining a global research and policy agenda for betel quid and areca nut. The Lancet Oncology, 18(12), e767-e775.

National Cancer Institute (2010). Smokeless Tobacco and Cancer.

The Oral Cancer Foundation (2024).

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