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Methods: An electronic search in six databases (PubMed, Scopus, Embase, Web of Science, ProQuest, and Cochrane Library) was conducted using keywords equivalent to oral cancer and smokeless tobacco. After selecting the articles according to the inclusion and exclusion criteria, a total of 30 prospective cohort and case-control studies from 2010 to 2020, which investigated the association of smokeless tobacco with oral cancer, were examined. The articles were qualitatively assessed using the Newcastle Ottawa Quality Assessment scale checklist. Then, study design (study type, setting, and duration of data collection), sample population (number, gender, and age), cancer type, smokeless tobacco type, effect size, and confounder adjustment were extracted from the studies. Findings: Five studies examined smokeless tobacco and chewing tobacco, and 25 studies reported and evaluated the type of smokeless tobacco, most of which were related to betel quid and supari. While the results of 21 studies revealed a positive and significant relationship between oral cancer and smokeless tobacco use (OR: 0.67\u2013149.5), seven studies did not find a significant correlation. Conclusion: This systematic review confirms the positive and significant association between non-smoking tobacco use and the risk of oral cancer.<\/jats:p>","DOI":"10.34172\/ahj.1522","type":"journal-article","created":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T16:11:43Z","timestamp":1765037503000},"page":"1522","update-policy":"https:\/\/doi.org\/10.34172\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Relationship Between Smokeless Tobacco and the Incidence of Oral Cancer: A Systematic Review Study"],"prefix":"10.34172","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5898-3180","authenticated-orcid":true,"given":"Zohreh","family":"Dalirsani","sequence":"first","affiliation":[{"name":"Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0064-1233","authenticated-orcid":true,"given":"Ala","family":"Ghazi","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0480-6442","authenticated-orcid":true,"given":"Atessa","family":"Pakfetrat","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9681-8231","authenticated-orcid":true,"given":"Jamshid","family":"Jamali","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8168-547X","authenticated-orcid":true,"given":"Zeinab","family":"Foroughi","sequence":"additional","affiliation":[{"name":"General dentist, Bajestan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7679-2305","authenticated-orcid":true,"given":"Mohammad","family":"Mirzaei","sequence":"additional","affiliation":[{"name":"Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"20123","published-online":{"date-parts":[[2025,5,10]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.20107"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.18231\/j.ijpo.2020.048"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.29210"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.7314\/apjcp.2013.14.3.1957"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21332"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1186\/1758-3284-1-8"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1016\/0964-1955(95)00031-3"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2008.06.002"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1159\/000398801"},{"key":"R11","doi-asserted-by":"crossref","unstructured":"Johnson NW, Amarasinghe HK. 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