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Global Study Highlights Dangers of Smokeless Tobacco Use

September 15, 2015

new analysis of the worldwide disease burden attributed to smokeless tobacco (SLT) use1 estimates that SLT consumption by adults resulted in more than 62,000 deaths from oral, pharyngeal and esophageal cancer in 2010, and the loss of an estimated 1.7 million disability-adjusted life years. The study assessed the global burden of disease due to consumption of SLT products such as chewing tobacco, moist snuff, dry snuff, snus, betel quid (a combination of betel leaf, areca nut and slaked lime, and often tobacco) or areca nut with added tobacco.

The researchers concluded that the global burden of disease attributed to SLT usage is highest in India, where 32 percent of men and 18 percent of women use various commercial SLT products or home-made variations of betel quid.1 Additional studies show that immigrants from India and Southeast Asia continue to consume betel-quid or areca-nut chewing products (e.g., paan, gutka) after migrating to the United States and other locations.2

In the United States, an estimated 8.8 million adults3 use smokeless tobacco products, including an estimated 5.8 percent of young adults aged 18 to 25. Data from the Centers for Disease Control and Prevention (CDC) also shows that smokeless tobacco use among U.S. high-school athletes increased significantly from 2001 to 2013.4 A 2014 joint report on smokeless tobacco use5 from the National Cancer Institute and the CDC found sufficient evidence that SLT products increase the risk of oral cancer and precancerous oral lesions.

Tobacco-use cessation is essential for preventing or lowering disease risk, including that of oral cancer. Dentists should ask patients about their past or current use of all tobacco-containing products, including smokeless tobacco and areca-nut and betel-quid chewing (with or without tobacco), and counsel about the risks associated with these products.

Patients should also be monitored for the following signs of exposure to tobacco-containing products (smokeless or smoked): stained teeth and tongue, dulled sense of taste and smell, slow healing after a tooth extraction or other surgery, oral mucosal lesions, and periodontal disease. To support patient health and oral cancer prevention, dentists and hygienists are strongly encouraged to take an active role in promoting tobacco-use cessation, regular visits to the dentist, and appropriate oral hygiene.


1. Siddiqi K, Shah S, Abbas SM, et al.  Global burden of disease due to smokeless tobacco consumption in adults: analysis of data from 113 countries.  BMC Med. 2015 Aug 17;13:194.

2. Changrani J, Gany FM, Cruz G, Kerr R, Katz R. Paan and gutka use in the United States: a pilot study in Bangladeshi and Indian-Gujarati immigrants in New York City. Journal of Immigrant and Refugee Studies. 2006;4(1):99–110.

3. Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.  Available at: “http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDF
”.  Accessed September 8, 2015.

4. Agaku IT, Singh T, Jones SE, et al.  Combustible and Smokeless Tobacco Use Among High School Athletes - United States, 2001-2013.  MMWR Morb Mortal Wkly Rep. 2015 Sep 4;64(34):935-9.

5. National Cancer Institute and Centers for Disease Control and Prevention.  Smokeless Tobacco and Public Health: A Global Perspective.  Bethesda, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Institutes of Health, National Cancer Institute. NIH Publication No. 14-7983; 2014.  Available at: “http://cancercontrol.cancer.gov/
”.  Accessed September 10, 2015. 

About Science in the News

Science in the News is a service by the American Dental Association (ADA) to its members to present current information about science topics in the news. The ADA is a professional association of dentists committed to the public's oral health, ethics, science and professional advancement; leading a unified profession through initiatives in advocacy, education, research and the development of standards. As a science-based organization, the ADA's evaluation of the scientific evidence may change as more information becomes available. Your thoughts would be greatly appreciated.