• Paan Masala (Gutkha).

• Snuff.

• Nass, Naswat or Niswar.

• Snus.

• Zarda.

• Chaw.

• Supari.

• lq'mik.

• Khaini.

• Ariva.

• Mawa.

• Shammah.

• Mishri, Mosheri or Misheri.

• Toombak.

• Qiwam or Kima.

• Chimo.

Areca nut, ash and lime are some of the main ingredients used in these mixtures.

Smokeless tobacco is used mainly by people from South Asia, South East Asia, the Middle East and East Africa.

People who use it don't always know or use the term 'smokeless tobacco', so they often don't realise that the products contain tobacco. If you aren't sure, look on the packaging for names or ingredients like those we've mentioned above.

Is smokeless tobacco linked with mouth cancer?

Yes. Mouth cancer is the most serious health risk linked with smokeless tobacco. This is because of the large amount of cancer-causing chemicals it has in it. Over time, having these poisons released in your mouth could make you four times as likely to get mouth cancer.

One of the most dangerous and popular ingredients used in smokeless tobacco is the areca (or betel) nut. This is used in ‘betel quid' which is made up of betel leaf, areca nut and slaked lime. Research shows that people who regularly chew areca nut have a bigger risk of cancers of the mouth, pharynx (throat), oesophagus (gullet), stomach and pancreas.

Smokeless tobacco users are especially likely to get throat cancer, as they regularly swallow tobacco juice. Cancers of the lip and cheek are also common, as the tobacco is pressed against the lining of the mouth.

Mouth cancer can appear as:

• A painless mouth ulcer that does not heal properly.

• A white or red patch in the mouth.
  
  
• Unusual lumps or swellings.

It is important that you visit your dental team regularly if you use smokeless tobacco. This is because part of your check-up will involve a full mouth examination when the dental team will look out for any of these signs.

How can smokeless tobacco affect my overall health?

Smokeless tobacco also harms your overall health. The nicotine causes your body to make more cholesterol and, as a result, you are more likely to get heart disease and have strokes.

Because tobacco users are more likely to have gum disease, they are also more likely to have other health problems such as:

• Type-2 diabetes.

• Premature births.

• Dementia.

• Respiratory (lung) disease.

As well as causing mouth cancer, smokeless tobacco may also increase the risk of cancer of the pancreas.

Is smokeless tobacco safer than cigarettes?

No, it isn't. Although many users still believe that smokeless tobacco is not as harmful as regular cigarettes, this is simply not true.

Like cigarettes, smokeless tobacco is a serious risk to the health of your mouth and to your overall health. Both contain nicotine, which is a very addictive drug. In fact, there is twice as much nicotine in smokeless tobacco as in an average cigarette. This causes problems for the heart by tightening blood vessels and raising blood pressure.

One can of chewing tobacco can release as much nicotine into your body as 60 cigarettes.

What are the health benefits of giving up smokeless tobacco?

Giving up smokeless tobacco can bring many health benefits. Short-term benefits include a better appetite and good digestion, as well as better teeth and gums. Long-term benefits include less chance of developing a serious disease, such as heart disease or mouth cancer. The risk of dying from a heart attack is also lessened by giving up smokeless tobacco.

How can I give up smokeless tobacco?

There are many ways you can give up smokeless tobacco. The important thing is to work out why you use it in the first place.

• You may use smokeless tobacco to help deal with stress and boredom. Dealing with stress in other ways can help you cut down. For example, you could try taking a walk, listening to music, doing deep-breathing exercises, talking with other people or joining social groups at local community centres.

• You may use smokeless tobacco to help with tooth and gum pain. If you have tooth or gum problems it is important to see your dental team for proper treatment instead of trying to deal with the pain yourself.

• Some people use smokeless tobacco because they think it helps with digestion after eating. If you do have stomach problems after eating, then drinking more water instead can help. Or your doctor will be able to offer counselling and treatment.

What will I feel like if I give up smokeless tobacco?

You may find that giving up is even harder than giving up cigarettes. This is because of the higher levels of nicotine, which is very addictive.

When you try to stop using tobacco, your body still wants the nicotine so you might get ‘withdrawal symptoms'. These can include headaches, tiredness, changes in mood, getting angry quickly and finding it hard to concentrate.

If you find it hard to give up smokeless tobacco, you can get specialist help. This can be nicotine replacement therapy, such as nicotine patches or gum, and support to help you cope with how you feel. A local stop-smoking centre can also give you support.

Can my dentist help?

Your dental team will carry out a regular check-up to make sure that your teeth, gums and mouth are healthy. They will also check your cheeks, tongue and throat for any signs of other conditions. Using smokeless tobacco may cause white, red or white-and-red patches, and these can be found at a dental examination. Your dental team may also be able to refer you to organisations and self-help groups who will have the latest information to help you stop using smokeless tobacco.

It is important that you visit your dental team regularly for a normal check-up and a full mouth examination so that any other problems can be spotted early.

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