From Babe Ruth to John Wayne, Americans have seen chewing tobacco in popular culture for over a century. Spitting chew has been a trademark of cowboys and professional athletes alike and chewing tobacco use continues at high rates in the United States. In 2018, a survey showed 2.4% of American adults used smokeless tobacco, with snuff or snus pouch use on the rise and chewing tobacco on the decline.

Though smokeless tobacco use is not associated with lung cancer like smoking is, it has its own set of potential dangers. First, smokeless tobacco does contain nicotine, causes nicotine addiction, and thus, can be very difficult to quit.

Chewing tobacco can wreak havoc on a person’s teeth and gums. It causes tooth discoloration, dental cavities, tooth loss and recession of the gums, sometimes requiring oral surgery.

Smokeless tobacco is a major risk factor for cancer of the oral cavity and throat. Smoking cigarettes also increases the risk of this type of cancer. Cancer of this region can be devastating, partly because its treatment may result in the inability for a patient to use their mouth, throat and vocal cords.

A person who uses or has used smokeless tobacco, as well as current and former smokers, should discuss that with their primary care provider, as well as their dentist and dental hygienist, as those professionals can perform thorough oral and neck exams as part of their regular care. Any abnormality found should be investigated thoroughly.

Another crucial note is that many oral, head and neck cancers are also associated with human papilloma virus, or HPV, infection. If you are on the fence about getting your children or yourself, if eligible, vaccinated for HPV, this disease is another excellent reason to do so.

The iconic Babe Ruth, who chewed tobacco and smoked cigarettes, died prematurely of throat cancer at age 53. Major League Baseball finally prohibited the use of smokeless tobacco in 2016.

If you use smokeless tobacco and are ready to quit, the advice is similar to that for quitting smoking. First, make a plan and talk to people who can help hold you accountable. Get rid of all stashes of tobacco at your home, workplace and vehicle. Consider use of nicotine replacement therapy, such as patches and/or gum, or prescription medication, which may make kicking your nicotine addiction a little easier. Finally, if you aren’t successful this time, re-gear your plan and try again. It will absolutely be worth it.

Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc® at http://www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its 20th season of truthful, tested, and timely medical information streaming live on Facebook most Thursdays at 7 p.m. central.