Oral leukoplakia status six weeks after cessation of smokeless tobacco use

Background. This study evaluated the prevalence and risk of developing oral leukoplakia in smokeless tobacco, or ST, users and the response of these l eukoplakic lesions after six weeks of involuntary tobacco cessation. U.S. A ir Force basic military training provided an environment of a mandatorily t obacco-free setting. Methods. The authors designed their investigation as a case control study w ith a nested cohort study. The principal investigator (G.C.M.) conducted or al examinations of 3,051 male U.S. Air Force basic military trainees. Using a questionnaire, he obtained detailed information concerning subjects' ST use patterns before basic training. Clinical photos were taken of all leuko plakic lesions identified in ST users at the initial examination and again six weeks later. Results, Of the 3,051 male trainees examined (mean age = 19.5 years), 9.9 p ercent (302/3,051) were identified as current ST users. Among current ST us ers, 39.4 percent (119/302) had leukoplakia vs. 1.5 percent (42/2,749) of n onusers of ST (odds ratio = 41.9, 95 percent confidence interval = 28.1-62. 6). At the end of the involuntary cessation of tobacco use, 97.5 percent of these leukoplakic lesions had complete clinical resolution. The type of ST used (snuff vs. chewing tobacco), amount used (cans or pouches per day), l ength of use (months), number of days since last use and brand of snuff use d were significantly associated with the risk of developing leukoplakic les ions among ST users. Conclusions. The important new finding from this investigation is that if a young, otherwise healthy man with leukoplakic lesions stops using tobacco for six weeks, most of his leukoplakic lesions will resolve clinically. Use of ST, specifically snuff, is strongly associated with development of oral leukoplakia in young adult men. Clinical Implications. The clinician can use these findings in deciding whe n to perform biopsies on leukoplakic lesions associated with ST use. This i nformation also should be used to assist ST users in quitting this addictiv e behavior.