The contradictory results of earlier studies on the role of snuff in the aetiology of oral cancer may be due to the heterogeneous composition of snuff and to regional and cultural differences in its use. The aim of this study was to determine the prevalence and pattern of use of oral snuff in a rural South African adult population, and to report on associated oral lesions. A structured questionnaire was administered by means of face-to-face interviews with a population of 30 randomly selected households (125 adults over the age of 30 years). Of the respondents, 20.8% were active oral snuff-dippers and 80.8% of them had never visited a dentist before. There was no significant difference between the genders of the dippers (P > 0.05). The mean age of dippers was 62.7 years. None of the snuff-dippers chewed or smoked tobacco, but 38.5% used alcohol. Mean dipping period was 21.5 years, for about 2 hours per day and an average of 35 minutes per dip. Of the snuff-dippers, 84.6% place their snuff in the lower labial sulcus and 15.4% in the lower buccal sulcus, 80.8% of the dippers demonstrated keratotic lesions at the site of placement. The clinical severity of the lesions was significantly associated with the brand of snuff used (P < 0.01). The high prevalence of snuff dipping and associated lesion in many of the elderly that had never visited a dentist before highlights the importance of regular screening of this group at risk.