Wednesday, December 2, 2015

Another Smokeless Tobacco Myth: The Dangerous White Patch

If you use smokeless tobacco for a long time and hold it in the same place in your mouth, the surface of your lip or cheek, called the mucosa, where the tobacco sits might thicken and turn white. A layer of white keratin is reacting to the irritating effect of the tobacco.  The reaction is similar to the development of calluses on a worker’s hand.  White patches in the mouth related to smokeless tobacco are nearly always benign.

Physicians and dentists refer to these spots as “leukoplakia” – “leuko” meaning white and “plakia” meaning plaque or patch.  Regrettably, many health professionals don’t know that smokeless use is far safer than smoking and that a wealth of research shows that smokeless tobacco-related callouses hardly ever turn into anything more serious. 

As an oral pathologist, I have decades of experience examining these patches and I have researched this issue extensively.  A 1990 study (abstract here) is typical; it showed that white patches were common in baseball players who chewed and dipped.  Upon biopsy, all were benign.  The link between white patches and cancer is virtually zero for dippers and chewers. 

On the other hand, white patches in smokers are matters of concern.  Smoke permeates the lining of the mouth, throat, airway and lungs, delivering thousands of toxic agents.  As I discussed in a 1995 journal article, studies show that white patches in smokers are much more likely to be associated with mouth cancer (abstract here). 

Too many doctors have blindly included smokeless tobacco in their anti-tobacco crusade without learning the facts. You ought to share this blog entry with your physician and dentist, and tell them that more information is available in my book (here and here).


Unknown said...

Thanks Dr. Rodu. I had a mild case of leukoplakia and my dentist insisted that I return weekly to check it's status. During that time I placed the snuff in a different place and the irritation cleared up within a few weeks. The dentist then threatened me with the words, "You were lucky. Next time I'll have you referred to an oral pathologist." Scaremongering. I have since changed dentists.

CarolAST said...

Here are the grammar police to kick down your door:

"Callus is a noun meaning a localized thickening of the skin, and a verb meaning to form a localized thickening of the skin. Callused means having many calluses. Callous is closely related to callus, but it’s figurative—that is, it doesn’t describe actual skin—and it is never a noun. As an adjective, it means toughened or unfeeling. As a verb, it means to make or become callous."

CarolAST said...

According to your 1990 abstract, people who don't use smokeless tobacco are extremely unlikely to get those white patches: "Of the 423 current smokeless tobacco users, 196 had leukoplakia compared to seven of the 493 nonusers (OR = 60.0, 95% CI = 40.5-88.8)."

More recent work shows that smoking is not as much a concern as you claim. If you analyze the supplemental material in this prospective, 6/56 = 10.7% current smokers; 20/65 = 30.8% former smokers (or 26/121 = 21.5% of current plus former smokers), versus 9/41 = 22.0% never smokers developed oral cancer. (Gene expression profiling predicts the development of oral cancer. Saintigny P, Zhang L, Fan YH, El-Naggar AK, Papadimitrakopoulou VA, Feng L, Lee JJ, Kim ES, Ki Hong W, Mao L. Cancer Prev Res (Phila) 2011 Feb;4(2):218-29.)

Brad Rodu said...

Callus typo corrected.
Brad Rodu