What are the oral health implications of using snus? A systematic review.

Many consider the consumption of smokeless tobacco (SLT) a risk to oral health. Snus is being increasingly used, and the aim of this systematic review was to determine the oral health effects of this. Medline, Web of Science, and Scopus were searched using oral health related terms and the term snus. Studies concerning SLT products other than snus were excluded. The literature search identified 47 studies suitable for inclusion. Five out of six epidemiological studies did not report an elevated risk of oral cancer in users of snus. However, three observational studies presented cases of oral cancer at the site of snus placement. Snus was consistently associated with the development of oral mucosal lesions, or snuff dipper's lesions (SDLs). Studies indicate that quitting the habit leads to rapid SDL regression, and that taking up the habit leads to its rapid initiation. Evidence in this review suggests that snus may not increase the risk of oral cancer. Further research is required to supplement the current evidence in this area, and to investigate the range of snus products now available.