Oral mucosal changes related to smokeless tobacco usage: research findings in Scandinavia.

Smokeless tobacco is used in all Scandinavian countries. By far the highest consumption is recorded in Sweden, where the highest sales figures in the world can be found. Moist non-fermented snuff with a pH value of 8-9 comprises over 99% of the products. Only a few tons per year of chewing tobacco are sold. Moist snuff as it is used in Scandinavia today gives rise to oral mucosal changes which are reversible after cessation of the habit. The use of portion-bags, and even more so the use of chewing tobacco, seems to be associated with less pronounced changes than the use of loose snuff. The daily amount of snuff used and hours of daily use seem to have a greater impact on the risk for development of more pronounced changes as recorded clinically and histologically than the number of years with the habit and/or age of the subject. Gingival recessions are much more frequently found among users of loose snuff than among users of portion-bag-packed snuff and they seem to be irreversible.