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Toxicokinetic and genotoxicity study of NNK in male Sprague-Dawley rats following nose-only inhalation exposure, intraperitoneal injection, and oral gavage

Overall when compared with smoking chewing tobacco is probably a slightly better option than smoking for both overall health and acid reflux though both clearly have a negative effect that ideally you want to stop or avoid

Chewing tobacco also contains grit and sand, which will scratch your teeth and wear off the enamel over time

Part 2: in vitro toxicity in human gingival fibroblasts

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So, coming back to the question: Does nicotine gum cause cancer