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J Negat Results Biomed (2006) 5:17.10.1186/1477-5751-5-17 48 JacobPAbu RaddahaAHDempseyDHavelCPengMYuLet alComparison of nicotine and carcinogen exposure with water pipe and cigarette smoking

Chewing tobacco is processed to food-grade standards for oral contact, while pipe tobacco is not

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Specific oral health consequences include: Gum recession and periodontal disease Tooth decay and tooth loss Leukoplakia (white patches that can become cancerous) Bone loss in the jaw Tooth staining and bad breath According to research on nicotine and periodontal tissues, smokeless tobacco users show significantly greater risk for attachment loss, with studies reporting odds ratios as high as 5.4 for periodontal disease development