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It happens when smoking tobacco that is too moist

This is unacceptable, given the state of the science documented in this report

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Javed F, Al-Kheraif AA, and Al Amri MD, et al (2015) Periodontal parameters and whole salivary cytokine profiles among habitual gutka chewers and non-chewers J Periodontol 86 689695 PMID: 25612632 41

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This is despite the fact that, until the early 1920s, tobacco grown in Cuba was a collection of random, poorly selected, varietal cultivars