Skip to main content

Table 6 Prevalence of oral mucosal lesions in relation to ST use – evidence from the USA

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

    % prevalence (n)a  
Study Endpointb Exposurec Exposed Unexposed Statistical tests and other results and commentsd
Experimental studies
Grasser 1977 [21] Oral leukoplakia ST ever 13.3 (4) 0.5 (1) OR 28.2 (3.03–262)
      Lesions in users resolved after 10 days quit
Payne 1988 [22] Greer 1–3 Snuff current 100.0 (16)e - After switching site of snuff placement and to reference snuff, all 16 subjects had new lesions after 7 days of use, evident in 15 subjects by day 2. After 7 days, the original lesions at the habitual sites had resolved by 1 degree
Martin 1999 [23] Oral leukoplakia ST current 39.4 (119) 1.5 (42)f OR 41.9 (28.6–61.4)
   Snuff current 41.8 (118) 1.5 (42)f OR 46.4 (31.5–68.2)
   CT current 5.0 (1) 1.5 (42)f OR 3.39 (0.44–25.9)
      Lesion had completely resolved in 97.2% (106/109) of ST users 6 weeks after tobacco use was prohibited
Case-control studies
    Cases Controls  
Fisher 2005 [26] Oral leukoplakia ST current 22.5 7.2 OR 9.21 (1.49–57.0)g
   ST former 25.7 12.3 OR 2.73 (0.69–10.8)g
   Snuff current 19.0 2.7 OR 30.1 (2.67–338)g
   Snuff former 11.1 6.6 OR 0.98 (0.17–5.61)g
   CT current 4.2 4.3 OR 0.97 (0.19–4.98)
   CT former 20.0 12.0 OR 1.83 (0.76–4.40)
Cross-sectional studies of populations unselected by ST use
    Exposed Unexposed  
Greer 1983 [27] Greer 1–3 ST use 42.7 (50) - Only ST users examined
Poulson 1984 [28] Greer 1–3 ST use 58.9 (33) - Only ST users examined
Offenbacher 1985 [29] Oral mucosal pathology ST use 22.7 (17) 4.7 (23) OR 5.95 (3.00–11.8)
Wolfe 1987 [30] Greer 1–3 ST currenth 25.5 (37) 3.7 (3)f OR 8.91 (2.65–29.9)
Creath 1988 [32] Oral leukoplakia Snuff ever 5.2 (15) 0.1 (1) OR 38.6 (5.07–294)
Cummings 1989 [31] Soft tissue lesion ST current 17.6 (3) 0.0 (0) Only 6 never users of ST No differences significant
   ST former 100.0 (2) 0.0 (0)  
   Snuff current 21.4 (3) 0.0 (0)  
   CT current 11.1 (1) 0.0 (0)  
Stewart 1989 [33] Greer 1–3 ST current 29.0 (9) - Prevalence only reported for male current users
Ernster 1990 [34] Oral leukoplakia ST current 46.3 (196) 1.4 (7) OR 59.9 (27.8–129)
   ST formerj 1.7 (3) 1.4 (7) OR 1.19 (0.30–4.65)
   Snuff currentk 58.3 (165) 1.4 (7) OR 97.1 (44.4–212)
   CT currentk 17.7 (14) 1.4 (7) OR 15.0 (5.82–38.4)
Greene 1992 [35] Oral leukoplakia ST current 51.7 (167) 2.9 OR 35.8i
   ST formerj 3.5 2.9 OR 1.21i
   Snuff currentk 61.3 (157) 2.9 OR 53.0i
   CT currentk 14.8 (8) 2.9 OR 5.82i
Sinusas 1992 [36] Greer 1–3 ST current 37.1 (23) 6.0 (5) OR 9.32 (3.29–26.4)
   ST formerl 6.7 (4) 6.0 (5) OR 1.13 (0.29–4.39)
   Snuff currentk 34.2 (13) 6.0 (5) OR 8.22 (2.67–25.3)
   CT currentk 16.7 (4) 6.0 (5) OR 3.16 (0.78–12.9)
Daughety 1994 [37] Oral lesions at placement site ST current 33.0 (45) - Only ST users asked about oral lesions
   Snuff current 43.9 (25) -  
Robertson 1997 [38] Oral leukoplakia ST current ≈50 < 2 Approximate estimates based on 1846 baseball players in various studies
   ST former < 2 < 2  
Tomar 1997 [39] ST lesions Snuff current 34.9 (107)m 1.9 (102)m OR 18.4 (8.5–39.8)n
   Snuff former 5.6 (18)m 1.9 (102)m OR 2.4 (1.0–6.1)n
   CT current 19.6 (54)m 3.0 (156)m OR 2.5 (1.3–5.0)o
   CT former 6.0 (32)m 3.0 (156)m OR 1.3 (0.7–2.2)o
Shulman 2004 [42] Oral mucosal lesions ST currentp 60.3 (224) 23.8 (1939) OR 3.90 (2.75–5.55)q
   ST formerp 12.8 (23) 23.8 (1939) OR 0.53 (0.25–1.13)q
Sinusas 2006 [44] Greer 1–3 ST current 27.9–46.3r 4.0 p < 0.001
   ST former 9.5 4.0 p < 0.001
Cross-sectional studies of populations selected by ST use and/or presence of oral lesions
Smith 1970 [45] Oral mucous membrane change Snuff current 11.7 (1751) - Only snuff users examined
Christen 1979 [46] Clinical leukoplakia ST current 64.3 (9) - Only ST users examined
   Snuff current 69.2 (9) -  
   CT current 57.1 (4) -  
Kaugars 1992 [47] Oral lesions ST currents 13.0 (45) - Only ST users examined
   Snuff currents 14.4 (34) -  
   CT currents 8.4 (18) -  
Little 1992 [48] Greer 1–3 ST current 78.8 (193) 6.3 (14)t OR 55.4 (29.8–103)
Roberts 1997 [49] Oral lesion Snuff current 31.8 (7) - Only snuff users examined
  1. a n = number of subjects with endpoint
  2. b See Table 5 for further definition of endpoint
  3. c Where possible exposure is classified as "current" or "former" with exposure given as "use" only where the source paper did not clearly distinguish how former users were considered. The corresponding non-exposure is "never" or "non-use" to the same type of ST, except where indicated
  4. d ORs are unadjusted for potential confounding variables, except where stated. Where necessary ORs and 95% CIs are calculated from the data provided in the source paper
  5. e Subjects selected to have a lesion at site of snuff placement
  6. f Unexposed group is non-current ST
  7. g Adjusted for age, sex, smoking, alcohol, dental prostheses
  8. h Within the last 7 months
  9. i Numbers of never and former users not available so CI cannot be calculated
  10. j Former includes current in last month but not in last week
  11. k Product usually used
  12. l Former includes those who only used ST in baseball season (study conducted out of season)
  13. m Percentages are based on weighted data; numbers of cases are approximate, calculated by multiplying sample size by weighted percentage
  14. n Adjusted for age, cigarettes, alcohol and CT
  15. o Adjusted for age, cigarettes, alcohol and snuff
  16. p Analyses compare ST users who do not smoke with never users of any tobacco
  17. q Adjusted for age, sex, race and denture use
  18. r Prevalence in current users given only as range over the course of the 10 year study
  19. s Within the past 12 months
  20. t Comparison is with non ST users