SMOKELESS TOBACCO USE IN INDIA: IMPLICATIONS FOR ORAL HEALTH AND PUBLIC HEALTH DENTISTRY

Smokeless tobacco use remains an important preventable cause of oral morbidity in India. Unlike smoked tobacco, these products are placed in the oral cavity, chewed, sucked, or applied to the teeth and gingiva. Common Indian preparations include khaini, gutka, tobacco-containing pan masala, zarda, mawa, mishri, gul, gudakhu, and tobacco used with betel quid. Many products also contain areca nut, slaked lime, catechu, flavouring agents, and other additives. Their use is influenced by affordability, easy availability, social acceptance, cultural practices, peer influence, and aggressive or indirect marketing. Evidence summarized in the source literature shows substantial use among Indian adults and adolescents, with higher use in several rural and socioeconomically disadvantaged populations. Oral consequences include mucosal irritation, periodontal disease, tooth loss, staining, oral potentially malignant disorders, oral submucous fibrosis, and oral cancer. Areca nut-containing products are particularly relevant because areca nut is carcinogenic even in the absence of tobacco. Dentists and dental teams are strategically positioned to identify users, detect early mucosal changes, provide brief cessation counselling, and refer patients for comprehensive treatment. Effective control requires surveillance, health education, regulation of products and marketing, accessible cessation services, and coordinated action involving dental professionals, primary healthcare workers, schools, communities, and government agencies.