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Control 29 (4), 432446 (2020)

The same factsheet also mentions that it is "often used to clean teeth"

Our findings highlight a need for policy makers, researchers, and communities at risk to devote greater attention to chewing tobacco by both advancing tobacco control efforts and investing in strengthening the existing evidence base

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Omoike OE, Paul TK, Ridner SL, Awasthi M, Harirforoosh S, Mamudu HM (2020) Association between smoking status and homocysteine levels and possible effect modification by cholesterol and oestradiol

However, the use of SLT is substantial [4] with the main types of SLT products including mishri, gutkha, pan with tobacco and chewing tobacco mixed with Jaggery