New tobacco products, such as smokeless tobacco, are becoming more popular every year. In talking with our patients, we determined several reasons for that trend. The sale of these products is prohibited in many countries; hence, people obtain the product illegally. This is important, since when these products are stored under inappropriate conditions and temperatures, the quality and properties of the product change, including their carcinogenic properties. Sometimes people use a lot of this product or more than one tobacco product daily. It is challenging for dental practitioners to question their patients about tobacco consumption and more challenging to visually detect oral mucosal changes, because patients usually do not have concerns or they do not pay attention.


In the two cases presented here, the patients did not have any pain, nor did they notice when the lesions appeared. These patients used conventional cigarettes for some time and then switched to smokeless tobacco due to relocation to Latvia. Soft tissue excision was performed and sent for histopathological examination.


The findings were proliferation of oral epithelial cells from buccal region, their overgrowth, an excessive amount of fibroblasts, cell destruction and necrosis, and a large amount of inflammatory cells, eosinophil leukocytes, and plasma cells.


We can conclude that these intraoral findings are important risk factors for possibly developing precancerous lesions. Such mucosal changes can occur with different forms of tobacco, including Swedish snus and betel leaves. Dental practitioners should always question patients about tobacco use and regularly check for mucosal changes for early detection.

Keywords: Smokeless tobacco, Oral lesions, Histopathology, Swedish snus, Cigarettes, Mucosal changes.
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