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    Addicted to Dipping

    Chewing tobacco's grip on addicted users.


    More adults are also taking up the habit. Severson says firemen, policemen, airport workers, and even white-collar workers are resorting to smokeless tobacco to satisfy their nicotine addictions. "Historically, the prevalence of use was higher in rural areas, and while that is still true, the demographics are changing," he says.

    Dentists are seeing signs of increased use among people who can no longer smoke on the job. Badly discolored teeth, receding gums, bad breath, and chronic sores are common among users.

    But the real worry is cancer. Smokeless tobacco contains at least three known carcinogenic agents: N-nitrosamines, polycyclic aromatic hydrocarbons, and polonium 210. There are about 28,000 new cases of oral cancer a year, "and very, very few of the people who get it haven't used chew," Severson says. "And one-third of those diagnosed with oral cancer will die of it. It is a very deadly disease." As Garagiola tells baseball players, "You lose your face one piece at a time until you are dead." Users who swallow chewing tobacco increase their risk of esophageal damage and stomach ulcers.

    According to Greene, between half and three-quarters of daily smokeless tobacco users have noncancerous and precancerous oral lesions. Called leukoplakia, these lesions are white, leathery ridges in the tissues of the mouth. They often resolve in about six weeks after stopping smokeless tobacco use.

    That?s why the American Dental Association urges dentists and hygienists to counsel patients who use smokeless tobacco to quit. Severson says the success rate for quitting has been about the same as for cigarettes -- about 10% or 12% -- for many years. Quitting smokeless tobacco is as difficult as quitting cigarettes, and the approaches are similar. He notes that smokeless tobacco users are sometimes easier to convince to quit than cigarette smokers if they can be shown lesions inside their mouths. "Fear is a good motivator," he says.

    Most experts agree that until people understand that smokeless tobacco isn't a safe alternative to cigarettes, efforts to get people to stop smoking may actually push many smokers to smokeless tobacco. Severson also worries that the number of smokeless tobacco users might be higher than surveys indicate. "You're dealing with a silent epidemic," he says, "because people can do this without others knowing."

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