The Swedish snus and the sudanese toombak: are they different?

In Sweden, snuff(locally known as snus), was introduced since the year 1637 . Presently, Sweden has the highest per capita consumption and sale figures of snuff in the world, and the habit is becoming increasingly popular. Snu s 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 snuff is found in tw o types: (1) loose and (2) portion-bag-packed. These are the most widely us ed. The loose moist form (1-2 g a quid) is the most popular type consumed b y 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. Th e 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 15.90/0 among males and 0.2% among females. The pH of snus has declined from a prev ious 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-specific N-ni trosamines (TSNAs) in micrograms (N "-nitrosonornicotine: NNN 5-9; 4-(methy lnitrosamino)-1-(3-pyridyl)-1-butanone:NNK 1-2; N'-nitrosoanatabine: NAT 2- 5). In the Sudan, snuff, locally known as toombak, was introduced approxima tely 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 mix ed with an aqueous solution of sodium bicarbonate. The resultant product is moist, with a strong aroma, highly addictive and its use is widespread par ticularly 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 mi crograms (NNN 420-1 550; NNK 620-7 870; NAT 20-290). Snus and toombak dippe rs develop a clinically and histologically characteristic lesion at the sit e of dipping. Probably due to control of the TSNAs in snus, this type of sn uff 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 to ombak users was high (RR 7.3-73.0-fold). In conclusion, the two snuff produ cts significantly differ in many aspects. Most notable differences are toba cco species, fermentation and ageing, nicotine and TSNAs content, pH, expre ssion of the p53 tumour supressor gene, and keratin types 13, 14, and 19. I t was, therefore, the object of the present study to highlight the oral hea lth hazards of toombak, and to compare it with snus regarding the aforement ioned differences. (C) 1998 Published by Elsevier Science Ltd. All rights r eserved.