Oral Lesions and Dental Status in Individuals Using Oral Tobacco-Free Nicotine Pouches

Abstract

Objectives: Users of Swedish nicotine pouches and traditional oral tobacco-derived pouches were compared to non-users for clinical tissue responses and oral health status. In addition, the habits associated with snus use were also evaluated. Material and Methods: In this cross-sectional study, participants aged 18–30 were recruited from nine dental clinics: 126 nicotine pouch users, 63 oral tobacco-derived pouch users, and 83 non-users. Clinical examinations assessed mucosal changes and dental status, including erythema, ulceration, oedema, hyperkeratosis, etching, bone defects, and gingival recession. Participants completed a questionnaire on snus use, oral hygiene, and education. Tissue responses were graded and intergroup differences analysed. The study followed the STROBE checklist. Results: Oral lesions were identified in 79% of nicotine pouch users and 89% of oral tobacco-derived pouch users. Nicotine pouch users more frequently exhibited erythema and reported more oral symptoms, while hyperkeratosis predominated among oral tobacco-derived pouch users. A non-significant trend suggested mint-flavoured nicotine pouches may be associated with more pronounced lesions. No increased risk of caries or periodontal disease was observed for ≤ 6 years of use. Conclusions: Nicotine pouches appear to induce broader mucosal responses than tobacco-containing snus. Further research is needed to clarify local and systemic effects.