All included subjects completed a questionnaire to gather critical information prior to clinical examination. The questionnaire included information to be completed by patients self-reporting on their age, gender, abuse history (duration of snuff use and the site of snuff placement), and medical history, including drug use. Furthermore, an experienced senior clinical consultant (W.M.) undertook an oral examination, including assessment of oral hygiene and periodontal screening using the community periodontal index (CPI) (WHO standard) to assess the presence or absence of gingival bleeding, calculus, or deep pockets [19]. The oral cavity is divided into sextants and using a CPITN probe, an index was determined.: Code 0—healthy periodontium, Code 1—bleeding on gentle probing, Code 2—calculus deposits on probing, Code 3—pocket 4-5 mm, Code 4—pocket 6mm or more. The teeth examined were 17, 16, 11, 26, 27, 37, 36, 31, 46, and 47. Each patient was provided with oral hygiene instructions at clinical evaluation.

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