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Dermatologists are particularly qualified to identify these signs and distinguish them from other conditions that can mimic abuse

They can smell the nicotine on you, notice the yellowing teeth, spot the dry mouth and diagnose the early (or advanced, depending on your last visit) stages of tooth decay and gum disease

Consumption of combustible and smokeless tobacco - United States, 2000-2015

But even among the rich, we are still facing the problem of a few laggards notably the United States which is on a slightly rising trend (from 515,412 deaths in 1990 to 527,736 in 2019) and Germany, as noted by the German news outlet DW