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.
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52% of snus users reported gingival recession.
“52% of snus users reported gingival recession (Daneshian et al. 2026)”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Daneshian et al. 2026
89% of snus users reported oral lesions.
“89% of snus users reported oral lesions (Daneshian et al. 2026)”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Daneshian et al. 2026
ONP users have a lower frequency of gingival recession compared to snus users, and a higher frequency of mucosal erythema, oedema, etch damage, and mucosal ulcers compared to snus users.
“Lower frequency of gingival recession in ONPs users compared to snus users (Daneshian et al. 2026) Higher frequency of mucosal erythema, oedema, etch damage and mucosal ulcers in ONPs users compared to snus users”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Daneshian et al. 2026
Among snus users, oral lesion was found in 89%, mucosal erythema in 32%, and gingival recession in 52%; hyperkeratosis was found in 79%, and odds of hyperkeratosis increased with the number of snus use.
“oral lesion, mucosal erythema and gingival recession in 89%, 32% and 52% of snus users, respectively.Moreover, users of such products showed hyperkeratosis (79%), and odds of hyperkeratosis increased with the number of snus use (OR = 18.5 for 5-10 snus per day; OR = 2.95 for 11-15 snus per day; OR = 5.21 for 16-20 snus per day; p = 0.0007) (Daneshian et al. 2026).”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Daneshian et al. 2026
Hyperkeratosis thickness increases with >20 pouches per day (OR = 6.59; p < 0.0001).
“Hyperkeratosis thickness increases with the number of pouch per day (OR = 2.3 for 11-15 pouches per day; OR = 2.56 for 16-20 pouches per day; OR = 6.59 for > 20 pouches per day; p < 0.0001)”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Daneshian et al. 2026
79% of ONPs users reported oral lesions.
“79% of ONPs users reported oral lesions (Daneshian et al. 2026)”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Daneshian et al. 2026
Hyperkeratosis thickness increases with 11-15 pouches per day (OR = 2.3).
“Hyperkeratosis thickness increases with the number of pouch per day (OR = 2.3 for 11-15 pouches per day; OR = 2.56 for 16-20 pouches per day; OR = 6.59 for > 20 pouches per day; p < 0.0001)”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Daneshian et al. 2026
Hyperkeratosis thickness increases with 16-20 pouches per day (OR = 2.56).
“Hyperkeratosis thickness increases with the number of pouch per day (OR = 2.3 for 11-15 pouches per day; OR = 2.56 for 16-20 pouches per day; OR = 6.59 for > 20 pouches per day; p < 0.0001)”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Daneshian et al. 2026
65% of ONPs users reported hyperkeratosis.
“65% of ONPs users reported hyperkeratosis”
From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Daneshian et al. 2026
Cites
Lunell, E., Fagerström, K., Hughes, J., & Pendrill, R. (2020) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntaa068 · Cited by 121 · see citing works
Liu, J., Rensch, J., Wang, J., Jin, X., Vansickel, A., Edmiston, J., & Sarkar, M. (2022) · Psychopharmacology · doi:10.1007/s00213-022-06172-y · Cited by 37 · see citing works
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Kopa-Stojak, P. N., & Pawliczak, R. (2026) · Exposure and Health · doi:10.1007/s12403-026-00812-w
- Authors
- Daneshian, M., Fredriksson, L., Skott, P., & Garming Legert, K.
- Venue
- Oral Diseases
- Publisher
- Wiley
- Published
- 2026-07-01
- ISSN
- 1354-523X
- 1601-0825
- Cited by
- 5
- References
- 2
- Language
- en
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