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Lipton RB, Stewart WF, Celentano DD, Reed ML

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Appearance and Medical Issues with smokeless tobacco: 50 times more likely to suffer from oral cancers Leukoplakia (white mouth lesions that are precancerous) Tooth decay (due to high levels of sugar in chew) Stained and discolored teeth Bad breath Gum disease, recession (and eventually tooth loss) Increased heart rate, blood pressure and epinephrine levels (Two times the risk of dying from cardiovascular disease compared to non-users.) Other Cancers: kidney, pancreas, digestive system Death Smokeless tobacco use is often initiated and established during adolescence

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This suggests that, in combination with nicotine, they could affect the safety profile of e-cigarette refills