The latest oral health threat: Nicotine pouches

Adverse effects of nicotine pouches

Though nicotine pouches are marketed as a safer alternative to smoking or chewing tobacco, they still carry significant risks for oral health.⁷ One study, which compared Zyn nicotine pouches to traditional Swedish and smokeless tobacco products, found that even the lower amounts of nicotine in Zyn pouches could deliver nicotine to the bloodstream as effectively as other smokeless products. Participants in the study reported mild side effects, such as dry mouth, after using the pouches. These effects are concerning, as dry mouth can increase the risk of tooth decay, periodontal disease, and other oral health issues.

A case series investigating the effects of nicotine pouches on oral health highlighted the potential for adverse outcomes.⁸ The study examined five users, focusing on oral health and conducting histopathological analyses. In each case, users developed white lesions in their mouths, usually near the upper lip and frenum where the pouches were placed.

Histopathological analysis revealed inflammation, tissue thickening, changes in the oral mucosa, and parakeratosis, a condition in abnormal growth of cells in tissue. These findings suggested that nicotine pouch use can directly impact oral tissues, potentially leading to long-term damage.

A systematic review of the potential oral health risks of nicotine pouches, especially among young users, analyzed three studies involving 190 participants.⁹ The researchers discovered that frequent use of nicotine pouches was linked to several oral health issues, including mucosal changes (white lesions), dry mouth, soreness, and gum blisters.

These problems were commonly observed among regular and long-term users. The review noted concerns that nicotine pouch use might contribute to inflammation and increase the risk of oral cancer, although the evidence was limited and the studies involved had a high risk of bias.

Our call to action

As nicotine pouches rise in popularity, particularly among adolescents and young adults, there is a pressing need for robust, long-term research. While current studies highlight oral mucosal changes, inflammation, and dry mouth, the full extent of systemic and long-term oral health effects remain unclear, especially regarding potential links to oral cancer and chronic tissue damage.

As key players in oral health, dental hygienists are essential in identifying early signs of damage caused by new nicotine products. We must stay up to date, ask the right questions during patient assessments, and include nicotine pouches in our patient education and tobacco cessation conversations. By doing this, we can empower patients to make more informed choices and potentially prevent long-term damage.

References

1. Robichaud MO, Seidenberg AB, Byron MJ. Tobacco companies introduce ‘tobacco-free’ nicotine pouches. Tob Control. 2020;29:145-146. doi:10.1136/tobaccocontrol-2019-055321

2. Ingredients, how to use, freshness, and more. ZYN. https://us.zyn.com/questions/

3. Patwardhan S, Fagerstrom K. The new nicotine pouch category: a tobacco harm reduction tool? Nicotine Tob Res. 2022;24: 623-625. doi:10.1093/ntr/ntab198

4. Liu J, Rensch J, Wang J, Jin ., Vansickel A, Edmiston J, Sarkar M. Nicotine pharmacokinetics and subjective responses after using nicotine pouches with different nicotine levels compared to combustible cigarettes and moist smokeless tobacco in adult tobacco users. Psychopharmacology Berl. 2022;239(9):2863-2873. doi:10.1007/s00213-022-06172-y

5. On! nicotine pouches. On nicotine. https://www.onnicotine.com/

6. Lucy US nicotine pouches. https://lucy.co/products/pouchesf?variant=41980094742714&selling_plan=711688378#

7. Lunell E, Fagerström K, Hughes J, Pendrill R. Pharmacokinetic comparison of a novel non-tobacco-based nicotine pouch (Zyn) with conventional, tobacco-based Swedish snus and American moist snuff. Nicotine Tob Res. 2020;22(10):1757-1763. doi:10.1093/ntr/ntaa068

8. Miluna-Meldere S, Vanka SA, Skadins I, Kroica J, Sperga M, Rostoka D. Correction: oral mucosal changes caused by nicotine pouches: case series. Diagnos Path. 2025;20(1):12. doi:10.1186/s13000-025-01606-5

9. Rungraungrayabkul, D., Gaewkhiew, P., Vichayanrat, T., Shrestha, B., & Buajeeb, W. (2024). What is the impact of nicotine pouches on oral health: a systematic review. BMC Oral Health, 24(1), 1–10.