Sir, a patient aged 20 years reported to the Department of Periodontology with the chief complaint of sensitivity to hot and cold food. On examination, abrasion was noted on the facial surfaces of the canines and premolars of all four quadrants of the mouth being more pronounced on the incisal third and middle third of the crowns (Fig. 1), a few of which were tender to percussion due to pulpal involvement.

Figure 1
figure 1

Abrasion due to tobacco based tooth powder

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The patient gave a history of brushing twice daily using a tooth powder (Nirala, a tobacco-based dentifrice) for two years. He was advised to stop using the dentifrice, instructed in tooth brushing technique and referred for endodontic and restorative treatment.

Nirala manjan (Nirala tooth powder) (Fig. 2) is available in some parts of northern India. The dentifrice (which also smells like tobacco) claims to contain tobacco dust, clove, black spice, geru powder (a red brown powder used for topical application in ayurvedic medicines), dried ginger powder and salt. Use of tobacco in toothpastes and tooth powder was banned by the Indian government in 1992 and the ban upheld by the highest court of the land.1 However, use of these dentifrices (under different trade names) still continues, especially among rural and uneducated populations.2 Ill-effects caused include oral cancer, oral mucosal lesions, caries, periodontal disease, impaired healing after periodontal treatment and gingival recession.3 Usually, abrasives make up approximately 50% of any toothpaste but the abrasiveness of Nirala must be far higher than required resulting in severe destruction of the hard tissues in the short span of two years.

Figure 2
figure 2

Tobacco-based toothpowder (Nirala Manjan)

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We feel that the war against tobacco-based dentifrices could be won more by creating awareness among masses and educating patients, rather than by fighting for stricter legislation or by requesting its more stringent implementation. Patient education and oral hygiene instruction should include the devastating effects of using dentifrices containing tobacco.