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Complications that can arise from oral cancer include: changes in the appearance of the mouth, speech problems, difficulty eating and swallowing, depression and anxiety

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Compositional variations likely explain these differences: the high pH/additive contents of black shammah may accelerate oxidative darkening, whereas the fine particulates of DZRT could enable deep staining followed by leaching 18

Also, they say they use some form of pasteurization with their products: " The tobacco leaves are heated with steam so that when the stems are removed the leaf is not damaged "

However, in regions like southern Africa and Southeast Asia, women surpass men in smokeless tobacco and areca nut consumption, leading to a reversal of this trend, with a higher prevalence of oral cancer among women in these areas (2)