While the exact cause is unknown, possible causes may include rough teeth

smokeless tobacco market Health Effects of Smokeless Tobacco Addictive Not a safe alternative to cigarette smoking Most smokeless tobacco products contain carcinogens (at least 28 identified, and nitrosamine levels are higher in smokeless tobacco than in cigarettes) Most smokeless tobacco products cause oral, esophageal, and pancreatic cancer Use of these products causes precancerous lesions of the mouth (leukoplakia), as well as gum recession, gum disease, and tooth decay Use also associated with greater risk of fatal heart attacks and stroke Cigarette Smoking and Use of Smokeless Tobacco: A Complex Relationship An individual, non-smoking smokeless tobacco user experiences lower overall disease and mortality risks than a smoker, but the health effects depend on the properties of the specific product (they vary considerably) and how the product is used In 2010, almost 60 percent of young adults who used smokeless tobacco in the past month also smoked cigarettes during the same period Many smokers who begin using smokeless tobacco products neither successfully quit tobacco use nor transition to exclusive use of smokeless tobacco Many users remain stuck in a pattern of dual use of smoked and non-smoked tobacco products, instead of turning to FDA-approved nicotine replacement therapy (NRT) options This behavior effectively increases the users health risks Marketing of Smokeless Tobacco Tobacco industry promotes dual use Ads promote use of smokeless tobacco products not to replace cigarettes but as a way for smokers to satisfy addiction wherever they cannot smoke There is a need to clearly position the [smokeless tobacco] product as a situational substitute for cigarettes rather than a replacement. - R.J

life insurance companies that view chewing tobacco the same as smoking cigarettes
It is clear that the trend of most governments is to choose health and well-being over tobacco industry thuggery, but too many politicians, especially in the U.S., still fight hard for the wrong side