Toomback is local Nicotiana rustica, a tobacco species with high level of nicotine and nornicotine. Toomback is finely ground tobacco leaves, mixed with sodium bicarbonate, water is added, and a paste is made. The resulting saffa is placed in the oral vestibule where it remains up to several hours. In general saffa is replaced 5 -15 times per day. Moreover, a study by Ahmed and Mahjoob suggested that, toombak dipping and cigarette smoking might be considered as important risk factors in induction of oral epithelial atypia as seen in oral smears.