title: The prevalence of oral lesions in smokeless tobacco users and an evaluation of risk factors.
abstract: BACKGROUND
  The widespread use of smokeless tobacco (ST) has prompted concern in regard to the development of oral lesions in long-term users.
  
  
  METHODS
  For inclusion in the current study, a subject must have used an ST product, either snuff or chewing tobacco, for at least 6 months. The subjects were recruited by advertising, and none was referred for the evaluation of an oral lesion. The following were performed on all subjects: assessment of exposure to ST, cigarettes, and alcohol; examination of the oral cavity; a biopsy, if an oral lesion was found; and analysis of a blood sample for beta-carotene. The dietary intake of most of the subjects was analyzed.
  
  
  RESULTS
  Of the 347 ST users, all of whom were white male subjects, 45 (13.0%) had an oral lesion. Thirty-five of the lesions were hyperkeratosis and 10 were epithelial dysplasia.
  
  
  CONCLUSIONS
  Snuff exposure was associated significantly with the presence of an oral lesion (P < 0.0001). A decreased vitamin C intake also was found among the ST users with oral lesions (P < 0.01). The ST users with epithelial dysplasia, as compared with those with hyperkeratotic lesions, were slightly older, had a lower intake of vitamin C (P < 0.05), and were more likely to have used chewing tobacco than snuff.
authors.affiliation: Department of Oral Pathology, Medical College of Virginia, Richmond 23298.
authors.forename: G E
authors.initials: GE
authors.lastname: Kaugars
authors.forename: W T
authors.initials: WT
authors.lastname: Riley
authors.forename: R B
authors.initials: RB
authors.lastname: Brandt
authors.forename: J C
authors.initials: JC
authors.lastname: Burns
authors.forename: J A
authors.initials: JA
authors.lastname: Svirsky
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking; D001205:Ascorbic Acid; D002338:Carotenoids / Q000097:blood; D004032:Diet; D006801:Humans; D008297:Male; D009059:Mouth Diseases / Q000139:chemically induced*; D009061:Mouth Mucosa / Q000187:drug effects* / Q000473:pathology; D010947:Plants, Toxic; D012307:Risk Factors; D012907:Smoking; D013997:Time Factors; D014030:Tobacco, Smokeless / Q000009:adverse effects*; D019207:beta Carotene
chemical_list: D019207:beta Carotene; D002338:Carotenoids; D001205:Ascorbic Acid