Smokeless tobacco, paan and your mouth

If you chew paan, betel quid or chewing tobacco, or use gutkha, khaini, naswar or something similar, you may wonder what it means for your mouth. The same goes if someone close to you does. This page sets out what the NHS and other health bodies say, without judgement.

What counts as smokeless tobacco?

Smokeless tobacco is tobacco that is not burned: it is chewed, placed in the mouth or inhaled. Action on Smoking and Health (ASH) groups the products by what they contain.

What it contains	Names you may know
Tobacco, with or without added flavours and sweeteners	mishri, qiwam
Tobacco with an alkaline ingredient	khaini, naswar, gul
Tobacco with areca nut and slaked lime	gutkha, zarda, mawa

Paan, also called betel quid, is a mix wrapped in a betel leaf. The NHS describes the mix as betel nut (also called areca nut), herbs, spices and often tobacco. So a paan may or may not contain tobacco. Areca nut, also known as supari, is an ingredient in several tobacco products, and ASH describes it as a stimulant and a recognised carcinogen in its own right.

Names vary a lot. NICE guidance asks dentists, GPs and pharmacists to ask about these products using the name a person knows them by. It also says to use pictures if that helps. You can use whatever name you know yours by.

What do we know about the risks?

Mouth cancer

The NHS says that using smokeless tobacco raises the risk of mouth cancer and oesophageal (food pipe) cancer. It also says chewing betel quid without tobacco is still harmful, because studies have found that betel can raise the risk of cancer. The NHS page does not separate the leaf from the other ingredients, but two other sources do.

A Leicester NHS leaflet says the betel leaf on its own is not known to be harmful. It says the leaf is used to wrap harmful ingredients, including the betel nut (areca nut), tobacco and lime. The International Agency for Research on Cancer (IARC), part of the World Health Organization, found evidence suggesting that betel leaf does not cause cancer in experimental animals. Taken together, these sources point to the areca nut and the mixture it is chewed in, rather than the leaf.

IARC’s review, published in 2012, puts areca nut, betel quid with tobacco and betel quid without tobacco in Group 1. This is its category for agents that are carcinogenic to humans. It found sufficient evidence that betel quid with tobacco causes cancers of the mouth, the pharynx (throat) and the oesophagus. For betel quid without tobacco it found sufficient evidence for cancers of the mouth and the oesophagus.

Tobacco you do not smoke is not a safe way to use tobacco, the NHS says, and it can be as addictive as smoking.

Gums and teeth

NICE lists gum (periodontal) disease, alongside heart and circulation problems and cancers of the mouth and throat, among the health risks of smokeless tobacco. Government guidance for dentists says tobacco use, smoked or smokeless, seriously affects oral health and is the most common risk factor for gum disease. ASH adds that smokeless tobacco has been linked to tooth staining and wear, bad breath and tooth loss.

ASH points out that little research looks at individual products, so much of the evidence covers smokeless tobacco as a group. If you also use a vape, our guide to vaping and your mouth sets out what the evidence says.

Oral submucous fibrosis

Paan and similar products are linked to a condition called oral submucous fibrosis, in which the soft tissues inside the mouth harden. A 2025 leaflet from University Hospitals of Leicester NHS Trust says it can make the mouth hard to open fully, which can affect eating, brushing and dental treatment. It says the condition can start at any age and at any stage of using betel nut or paan. It says the condition cannot be reversed and may lead to oral cancer. IARC lists it, with white and red patches, among the mouth disorders of concern in people who chew betel quid.

Does stopping help?

Stopping can help. The IARC review describes studies of betel quid with added tobacco. People who cut down developed fewer precancerous lesions (changes that can turn into cancer), and people who stopped developed no new ones. The NHS says something similar about one kind of patch.

A white patch called leukoplakia carries a small chance of developing into mouth cancer. The NHS says the patch may get smaller or go away if you do not chew tobacco, paan or betel nuts. It lists not chewing them among the steps that may lower the chance of leukoplakia and of mouth cancer. It also lists regular dental check-ups among those steps.

Not every change can be undone, as the section on oral submucous fibrosis explains. Stopping still matters. The Leicester leaflet says the hospital team may refer people to a stop smoking service and offer follow-up appointments. It also advises contacting a dentist or GP about problems opening the mouth, or if you want help to quit.

Where can I get support to stop?

For stopping smoking or tobacco use, the NHS names expert help from a stop smoking adviser as the most effective route. Your free local NHS stop smoking service can provide medication and support, and many services also help people stop smokeless tobacco such as paan. You can read the NHS advice on paan and how to get support to stop.

NICE guidance says GPs, dentists, pharmacists and other health professionals should make sure people who use smokeless tobacco know the health risks. They should offer brief advice and refer anyone who wants to stop to a local specialist service. It also says advisers should help with the effects of stopping, such as withdrawal symptoms or mouth pain. They should check whether you also smoke, so you can get help with both.

Smoking has its own evidence and its own NHS support. Our guide to how smoking affects your mouth covers it.

When to see a dentist

The NHS lists the signs below as possible symptoms of mouth cancer and says to see a GP about them. It adds that a dentist can also help with ulcers, lumps, patches or pain in the mouth.

The Leicester leaflet also lists problems opening the mouth, unexplained loose teeth and ear pain that does not ease within a few days. For a white patch, the NHS says to get it checked by a dentist or GP if it does not go away. Other causes of white patches on the tongue are covered in our guide to bad taste and changes to your tongue.

The NHS says these symptoms are very common and can have other causes. Having them does not definitely mean you have mouth cancer, but it is important to get checked. If cancer is the cause, finding it early may make it easier to treat.

What we would do

If you use smokeless tobacco or paan, begin with a new patient exam. We examine your teeth, gums and soft tissues, carry out an oral cancer screening, take small X-rays where needed and explain what we find in plain language. You are welcome to tell us what you use, by whatever name you know it.

If your gums need attention, a dental hygiene appointment removes plaque and tartar, picks up early signs of gum disease and includes advice on brushing and flossing. For support to stop, the free NHS stop smoking services above are the place to start.

Whatever you use, and whatever it is called, you can book an appointment to have your mouth checked.

Want us to take a look?

Book an appointment at whichever of our five practices suits you. We will check what is going on and talk you through your options.

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