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Table 3 Definitions of oral mucosal lesions used in studies in Scandinavia

From: Systematic review of the relation between smokeless tobacco and non-neoplastic oral diseases in Europe and the United States

Definition of Axéll 1976 [15]
Snuff dipper's lesion is a lesion of the oral mucosa at the exact site of the regular placing of snuff. The clinical appearance is graded as follows:
Degree 1. A superficial lesion with a colour similar to the surrounding mucosa, and with slight wrinkling. No obvious mucosal thickening.
Degree 2. A superficial, whitish or yellowish lesion with wrinkling. No obvious thickening.
Degree 3. A whitish-yellowish to brown, wrinkled lesion with intervening furrows of normal mucosal colour. Obvious thickening.
Degree 4. A marked, white-yellowish to brown and heavily wrinkled lesion with intervening, deep and reddened furrows and/or a heavy thickening.
Studies using the Axéll 1976 definition
Larsson 1991 [1], Andersson 1995 [2], Andersson 2003 [3], Roosaar 2006 [4], Rosenquist 2005 [5], Axéll 1976 [15], Hirsch 1982 [16], Salonen 1990 [8]a, Andersson 1989 [18], Andersson 1994 [19] and Rolandsson 2005 [20]
Studies using other definitions
Jungell 1985 [7] – "snuff-induced lesion", not further defined
Pindborg 1963 [13] – "snuff-induced leukoplakia", characterised by a mucous membrane with "a slightly whitish, sometimes yellowish-brown dry appearance with a very delicately folded or finely grooved appearance"
Roed-Peterson 1973 [14] – "oral leukoplakia", defined as "a white patch not less than 5 mm in diameter which cannot be removed by rubbing, and which cannot be ascribed to any other diagnosable disease"
Frithiof 1983 [17] – "snuff-induced lesion", with "a characteristic whitish appearance frequently with a brown discolouration which clearly contrasted with the neighbouring mucosa"
  1. a 32 other types of oral mucosal lesion were also considered, but results were incompletely presented and their incidence (not shown in Table 4) did not appear to be clearly snuff related