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therefore, this negates the assumption that nicotine sachets are less harmful yet are very addictive [69]

It also predisposes individuals who chew tobacco to start smoking which further increase their risk of developing other cancers

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In addition, EC use altered oral microbiota, increasing Porphyromonas and Veillonella abundance and elevating IL-6 and IL-1 levels, suggesting heightened inflammatory responses

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