Oral manifestations of smokeless tobacco use.

Smokeless tobacco (SLT) has been smoked, chewed, and inhaled in various forms for hundreds of years. The primary oral, mucosal, and hard tissue changes associated with SLT use include SLT keratosis (STK); gingival inflammation, periodontal inflammation, and alveolar bone damage; and dental caries, tooth abrasion, and dysplasia and oral squamous cell carcinoma (SCC). Some high-risk STKs are human papillomavirus associated, and the highest level of transition of STK to dysplasia or oral SCC appears to be in those lesions that have a diffuse velvety or papillary texture clinically. There is minimal risk for oral cancer associated with SLT use.