Implications of smokeless tobacco use in athletes.

After almost falling into obscurity, smokeless tobacco use began to increase almost simultaneously with the reduction in cigarette smoking that was influenced by the Surgeon General's first Report on Smoking and Health in 1964. Consumption of smokeless tobacco was stimulated by media promotion using professional athletes; and large numbers of impressionable male teenagers, assuming that it was a safe alternative to smoking, began to use this product, particularly snuff. The nicotine content of smokeless tobacco is equivalent to that of cigarettes and, therefore, will produce habituation and addiction. It may also expose the long-term user to a number of adverse physiologic effects on the cardiovascular system that are similar to those attributed to smoking. Smokeless tobacco contains N-nitrosamines that have a potential carcinogenic effect on the tissues with which they come into contact in the oral cavity. A hazard of short-term use is irreversible gingival recession. The contact of snuff with the oral mucosa can produce leukoplakia that is readily visible and will alert the dentist. The dental professional team must actively strive to prevent initiation of smokeless tobacco use and assist with cessation of this habit.