Sir, with current smoking patterns about 500 million people alive today will eventually be killed by tobacco use, so that by 2030 tobacco is expected to be the single biggest cause of death worldwide accounting for about 10 million deaths per year. One half of these deaths will occur among people 35 to 69 years of age, losing an average of 20-25 years of life.

The effect of tobacco use on oral health is also alarming. All forms of tobacco have been established as causes for oral and pharyngeal cancer. Smokeless tobacco commonly comes in two basic forms, snuff and chewing tobacco. Snuff is finely ground tobacco packaged in cans or pouches and is of two types, namely dry and moist. Moist snuff is used by placing the pinch, dip, lipper or quid between the lower lip or cheek and gum. Nicotine is absorbed through the tissues of the mouth. Dry snuff is sold in the powdered form and is used by sniffing or inhaling up the nose.

Snuff in both forms is not a safe substitute for tobacco smoking leading to harmful health effects such as oral cancer, alveolar bone loss, pancreatic cancer and leukoplakia.

As well as containing the highly addictive nicotine, snuff also contains very high levels of tobacco specific nitrosamines. Nicotine replacements such as nicotine gums, patches and lozenges provide nicotine without the other harmful ingredients in tobacco and these should be considered when advising patients to quit tobacco use. Dental practice in the twenty-first century will increasingly move towards promotion of health and wellbeing and in terms of snuff, which is often adopted by young people as a lifestyle choice, we should advise our patients to quit.