The prevalence of oral lesions in smokeless tobacco users and an evaluation of risk factors.
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.
Kaugars
G E
GE
Department of Oral Pathology, Medical College of Virginia, Richmond 23298.
Riley
W T
WT
Brandt
R B
RB
Burns
J C
JC
Svirsky
J A
JA
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
D019207:beta Carotene; D002338:Carotenoids; D001205:Ascorbic Acid