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The major ingredients and carcinogens found in tobacco-based products such as gutkha and pan masala are tobacco-specific nitrosamines (TSNAs) including NNK [4(methylnitrosamino)1(3pyridyl)1butanone], NNN (Nnitrosonornicotine), and MNPN [3(methylnitrosamino) propionitrile], and ROS (reactive oxygen species, O, H 2 O 2 , OH) (Nair et al., 2004) Chewing of tobacco with betel quid results in high exposure to carcinogenic TSNAs and has also been associated with dysbiosis in the oral microflora of tobacco-consuming individuals compared to non-consuming individuals (Reichart, 2001
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