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Smokeless but dangerous Published in the Asbury Park Press 09/14/04 Smokeless tobacco is as addictive as cigarettes -- and more and more younger people are hooked. By DARLA CARTER GANNETT NEWS SERVICE It's a habit that can leave you with bad breath, mouth lesions and a disfigured face, yet an estimated 7.8 million Americans use smokeless tobacco. Tobacco use carries a risk of oral cancer, but users sometimes avoid seeing a dentist, who can detect early signs, says dentist Dr. Lee Mayer. "A lot of times they don't appear in a dentist's office about anything in their mouth until they either have a toothache, or they have some type of growth or something's going on, and they realize that there's a problem and they get scared," says Mayer, director of community dental health at the University of Louisville School of Dentistry. "This is especially true with the younger crowd." Nationally, 18- to 25-year-olds make up the largest percentage of people who use smokeless tobacco, according to the federal government's 2002 National Survey on Drug Use and Health. Smokeless tobacco includes snuff, finely ground tobacco that's held between the cheek and gum, and chewing tobacco, which is bulkier and comes in leaf and plug form, according to the National Cancer Institute. "It's one of those types of things you can do in secret, you know, and once you're hooked, you're hooked," Mayer says. "There's no telltale smoke from it, and like any tobacco product, it's highly addictive." Smokeless tobacco has been acceptable and common among certain populations, such as rural people, for a long time, Mayer says. It's also popular among some athletes, including baseball players, who are known for spitting profuse quantities of tobacco juice. Among youths, use tends to be higher in the South than other regions of the country and is more concentrated in nonmetropolitan areas than metropolitan ones, according to the 2003 overview of key findings from Monitoring the Future, a national survey of eighth-, 10th- and 12th-graders. The survey of nearly 50,000 students shows that use of smokeless tobacco among youths has decreased by about half from peak levels in the mid-1990s. But there still are reasons for concern, some people say. Mohammad Torabi, interim executive director of the Indiana Prevention Resource Center, believes that smokeless tobacco is going to become a major public health problem worldwide because its use hasn't been decried as much as smoking. All users put themselves at risk of oral cancer as well as gum disease and tooth loss, says Dr. F. John Firriolo, an associate professor of oral diagnosis and oral medicine at University of Louisville. "It literally eats away the gums." Smokeless tobacco contains at least 28 known cancer-causing agents, according to the National Cancer Institute. So when you chew it, the esophagus and stomach can be affected. Users then are at risk for oral cancers as well as esophageal or stomach cancers, Mayer says. When oral cancers develop, they are tough to treat and can lead to disfiguring surgery, Mayer says. "Sometimes the surgery is really radical," he says. "I'm talking having to take a big piece of your face and your mouth." Surgery also may be required for smokeless tobacco users whose gums are pulling away from their teeth, Firriolo says. In between dental visits, users should examine their mouths for anything suspicious, Mayer says. In addition to mouth lesions, watch for tissue inside the cheek changing from shiny and sleek to leathery. There's no sure-fire way to tell which users will get oral cancer, Firriolo says.

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