The use of smokeless tobacco products is increasing among teenagers and young adults in the United States. Community health professionals play a vital role in educating the public about these products, and in this regard the dental hygienist is of critical importance. This study evaluated the knowledge and attitudes towards smokeless tobacco among a representative sample of dental hygiene students in the United States. The dental hygiene schools were divided into six geographical regions and a total of 34 schools and 722 students participated. Seniors were found to score significantly higher than non-seniors both in knowledge and attitude. Furthermore, some significant differences in attitude were discovered between regions. In general, students scored poorly on both knowledge and attitude despite reporting having received classroom instruction on smokeless tobacco.