[Health hazards when using snuff].

Snuff taking produces a white to yellowish, wrinkled lesion of the oral mucosa at the site where the quid is placed. The lesion is reversible, and only rarely exhibits dysplasia. Gingival recession and loss of attachment may occur in conjunction with the mucosal lesion. The risk of oral cancer varies greatly among the different published studies, from a relative risk of 48 to no increase in risk at all. Case control studies have found no association between oral tobacco and bladder cancer, whereas cigarette smoking carries a relative risk of about two. There appears to be no evidence for an association between oral snuff and cancer in general when the analysis takes into account confounders such as occupation, smoking and alcohol. The epidemiological evidence for an association with cardiovascular disease is contradictory. Snuff may probably cause hypertension, and one large study has reported a relative risk of 2 for dying of ischaemic heart disease. Biochemical evidence disfavors the hypothesis that snuff is atherogenic. In conclusion, the health hazards of oral moist snuff seem modest, and very much smaller than those of cigarette smoking.