The Swedish Snus and the Sudanese Toombak: are they different?

Abstract

In Sweden, snu (locally known as snus), was introduced since the year 1637. Presently, Sweden has the highest per capita consumption and sale ®gures of snu in the world, and the habit is becoming increasingly popular. Snus is manufactured into a dry form used in the nasal cavity and a moist form used in the oral cavity. Snus manufactured for oral use is a moist ground tobacco of Dark Kentucky or Virginia species mixed with an aqueous solution of water and other blending ingredients. This form of snu is found in two types: (1) loose and (2) portion-bag-packed. These are the most widely used. The loose moist form (1±2 g a quid) is the most popular type consumed by 73% of the males, followed by the portion-bag-packed form (0.5±1 g a quid), consumed by 13% of the males, while 14% of the males are mixed users. The majority of snus users place the quid in the vestibular area of the upper lip, and the prevalence among persons 15 years of age or older is 15.9% among males and 0.2% among females. The pH of snus has declined from a previous range of 8±9 to a range of 7.8±8.5, moisture content ranges 35±60% and nicotine content is in the order of 5±11 mg/g dry wt tobacco-speci®c N-nitrosamines (TSNAs) in micrograms (N H -nitrosonornicotine: NNN 5±9; 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone: NNK 1±2; N H -nitrosoanatabine: NAT 2±5). In the Sudan, snu, locally known as toombak, was introduced approximately 400 years ago. It is always processed into a loose moist form, and its use is widespread in the country. Tobacco used for manufacture of toombak is of the species Nicotiana rustica, and the fermented ground powder is mixed with an aqueous solution of sodium bicarbonate. The resultant product is moist, with a strong aroma, highly addictive and its use is widespread particularly among males. Its pH range is 8±11, moisture content ranges 6±60% and nicotine content is from 8 to 102 mg/g dry wt, and TSNAs contents in micrograms (NNN 420±1 550; NNK 620±7 870; NAT 20±290). Snus and toombak dippers develop a clinically and histologically characteristic lesion at the site of dipping. Probably due to control of the TSNAs in snus, this type of snu is associated with a lower risk of cancer of the oral cavity (relative risk: RR 5±6-fold), whereas the risk for cancer of the oral cavity among toombak users was high (RR 7.3±73.0-fold). In conclusion, the two snu products signi®cantly dier in many aspects. Most notable dierences are tobacco species, fermentation and ageing, nicotine and TSNAs content, pH, expression of the p53 tumour supressor gene, and keratin types 13, 14, and 19. It was, therefore, the object of the present study to highlight the oral health hazards of toombak, and to compare it with snus regarding the aforementioned dierences. #

Smokeless Tobacco (Shammah) in Saudi Arabia: A Review of its Pattern of Use, Prevalence, and Potential Role in Oral Cancer

“…Approximately 23% of Swedish men are reported to use snus (Foulds 2003). In Sudan, about 40% of males and 10% of females use toombak (local name of ST) (Idris et al, 1996;Idris et al, 1998). Today, the trade of certain types of ST, such as moist snuff, is also illegal in several countries, e.g., in Saudi Arabia, Japan, Hong Kong, Singapore, Australia and New Zealand (Klus et al, 2009).…”

Oral Submucous Fibrosis Turning Malignant. A case report and review of literature.

“…A number of studies have characterized smokeless tobacco as an etiological factor in the development of cancer of the oral cavity 31,32 and the esophagus. One study from Sweden showed that snus dipping (snuff dipping) increased the risk of oral cancer by 5-to 6-fold 33 . As said before OSMF has a malignant transformation rate of 7-30%.…”

Review: Smoking During Pregnancy Menacing to Baby.

“…Some of the ingredients are tar, carbon monoxide, nicotine and other chemicals and additives such as ammonia, arsenic (a poison used in insecticides and weed killers), benzene, hydrogen cyanide and many others. Millions of pregnant women use smokeless tobacco, predominantly in Africa and Asia [14] but also in Scandinavia [15]. These women are not exposed to the combustion products in tobacco smoke (e.g.…”

“…The baby also might be considerably light in weight. If certain genetic susceptibilities are present, the harmful effects of smoking during pregnancy are multiplied [40,41,42].…”