CoChat
Sign Up
Cited by 57

What is the impact of nicotine pouches on oral health: a systematic review

Rungraungrayabkul, Dulyapong, Gaewkhiew, Piyada, Vichayanrat, Tippanart, Shrestha, Binit, Buajeeb, Waranun·2024·BMC Oral Health
DOI 10.1186/s12903-024-04598-8PMC PMC11297755
Open this paper in CoChat — free account

Abstract

Background: Increase in nicotine pouch (NP) users, particularly among the young, is a matter of concern requiring a comprehensive understanding of its short- and long-term oral health implications. The objective of this research was to systematically review potential oral side-effects associated with NP usage. Methods: This systematic review was conducted following the PRISMA guidelines. Databases (Medline via PubMed, Scopus, Cochrane Trial, and Google Scholar) were searched for relevant studies up to February 2024. Modified Newcastle-Ottawa Scale (NOS) and the Risk Of Bias In Non-randomized Studies - of Exposure (ROBINS-E) tool were used to assess the quality and bias of the included studies. Results: Three studies were included for this review, two from Europe and one from USA, and considered of a total of 190 participants. All studies were deemed to have a high risk of bias. Participants used NP for periods ranging from 1 month to 10 years. Among these studies, only one study provided information on the usage pattern between 1 and 5 units for an average of 11 ± 7 min per session. Oral mucosal changes at the site of placement were common among NP users. Oral lesions varied from slight wrinkling to various white lesions, seemingly related to the NP units consumed per day and their duration of usage. Other oral side effects included dry mouth, soreness, gingival blisters, and a strange jaw sensation. Conclusions: Research on the use of NP and its effect on oral health are currently limited. The use of NP should take into consideration the short-and-long-term effects, especially on oral health. Further studies are crucial to understand oral health implications associated with NP usage. Systematic review registration: PROSPERO Registration number CRD 42,024,500,711.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/s12903-024-04598-8

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • There is only a limited number of data on the long-term effect of snus and TF-ONPs on users' health.

    “Furthermore, there is only a limited number of data on their long-term effect on their user's health (Rungraungrayabkul et al. 2024).”

    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 Rungraungrayabkul et al. 2024

    The Background says evidence on nicotine pouches is insufficient and calls for research into their short- and long-term oral-health effects. The Discussion says the three included studies could not definitively determine their oral-health impact. This supports limited evidence for tobacco-free nicotine pouches, but the review does not establish the same claim about snus or users’ overall long-term health. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

No references could be resolved yet.

Research works printed but not linked: 39

  1. [3]Robichaud MO, Seidenberg AB, Byron MJ. Tobacco companies introduce ‘tobacco-free’ nicotine pouches. Tob Control. 2020;29(e1):e145–6. 31753961 PMC7239723
  2. [4]Hrywna M, Gonsalves NJ, Delnevo CD, Wackowski OA. Nicotine pouch product awareness, interest and ever use among US adults who smoke, 2021. Tob Control. 2023;32(6):782–5. 35217596 10.1136/tobaccocontrol-2021-057156 PMC9402802 · DOI
  3. [5]IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Smokeless tobacco and some tobacco-specific N-nitrosamines [Internet]. IARC. 2007. PMC4781254 18335640
  4. [6]Mallock N, Schulz T, Malke S, Dreiack N, Laux P, Luch A. Levels of nicotine and tobacco-specific nitrosamines in oral nicotine pouches. Tob Control. 2024;33(2):193–9. 38378209 10.1136/tc-2022-057280 · DOI
  5. [7]Andersson G, Axell T, Larsson A. Histologic changes associated with the use of loose and portion-bag packed Swedish moist snuff: a comparative study. J Oral Pathol Med. 1989;18(9):491–7. 2481736 10.1111/j.1600-0714.1989.tb01349.x · DOI
  6. [8]Axell T, Mornstad H, Sundstrom B. The relation of the clinical picture to the histopathology of snuff dippers lesions in a Swedish population. J Oral Pathol. 1976;5(4):229–36. 820845 10.1111/j.1600-0714.1976.tb01769.x · DOI
  7. [9]Dowd AN, Thrul J, Czaplicki L, Kennedy RD, Moran MB, Spindle TR. A cross-sectional survey on oral nicotine pouches: characterizing Use-Motives, Topography, dependence levels, and adverse events. Nicotine Tob Res. 2024;26(2):245–9. 37712111 10.1093/ntr/ntad179 PMC10803111 · DOI
  8. [10]Kang SW, Park HJ, Ban JY, Chung JH, Chun GS, Cho JO. Effects of nicotine on apoptosis in human gingival fibroblasts. Arch Oral Biol. 2011;56(10):1091–7. 21497792 10.1016/j.archoralbio.2011.03.016 · DOI
  9. [11]Kim SY, Kang KL, Lee JC, Heo JS. Nicotinic acetylcholine receptor alpha7 and beta4 subunits contribute nicotine-induced apoptosis in periodontal ligament stem cells. Mol Cells. 2012;33(4):343–50. 22382680 10.1007/s10059-012-2172-x PMC3887805 · DOI
  10. [12]Wang XJ, Liu YF, Wang QY, Tsuruoka M, Ohta K, Wu SX, et al. Functional expression of alpha 7 nicotinic acetylcholine receptors in human periodontal ligament fibroblasts and rat periodontal tissues. Cell Tissue Res. 2010;340(2):347–55. 20309583 10.1007/s00441-010-0949-9 · DOI
  11. [13]Du A, Cheng Y, Zhao S, Wei X, Zhou Y. MicroRNA expression profiling of nicotine-treated human periodontal ligament cells. J Oral Sci. 2019;61(2):206–12. 31118359 10.2334/josnusd.17-0403 · DOI
  12. [14]Back S, Masser AE, Rutqvist LE, Lindholm J. Harmful and potentially harmful constituents (HPHCs) in two novel nicotine pouch products in comparison with regular smokeless tobacco products and pharmaceutical nicotine replacement therapy products (NRTs). BMC Chem. 2023;17(1):9. 36869349 10.1186/s13065-023-00918-1 PMC9985244 · DOI
  13. [15]Miluna S, Melderis R, Briuka L, Skadins I, Broks R, Kroica J et al. The correlation of Swedish snus, nicotine pouches and other Tobacco products with oral Mucosal Health and salivary biomarkers. Dent J (Basel). 2022;10(8). PMC9406994 36005252
  14. [16]Alizadehgharib S, Lehrkinder A, Alshabeeb A, Östberg AK, Lingström P. The effect of a non-tobacco-based nicotine pouch on mucosal lesions caused by Swedish smokeless tobacco (snus). Eur J Oral Sci. 2022;130(4):e12885. 35853092 10.1111/eos.12885 PMC9540014 · DOI
  15. [18]Sahibzada HA, Khurshid Z, Khan RS, Naseem M, Siddique KM, Mali M et al. Salivary IL-8, IL-6 and TNF-α as potential diagnostic biomarkers for oral Cancer. Diagnostics (Basel). 2017;7(2). PMC5489941 28397778
  16. [19]Chiamulera MMA, Zancan CB, Remor AP, Cordeiro MF, Gleber-Netto FO, Baptistella AR. Salivary cytokines as biomarkers of oral cancer: a systematic review and meta-analysis. BMC Cancer. 2021;21(1):205. 33639868 10.1186/s12885-021-07932-3 PMC7912500 · DOI
  17. [20]Nijakowski K, Gruszczynski D, Kopala D, Surdacka A. Salivary metabolomics for oral squamous cell carcinoma diagnosis: a systematic review. Metabolites. 2022;12(4). PMC9029144 35448481
  18. [21]Azzopardi D, Liu C, Murphy J. Chemical characterization of tobacco-free modern oral nicotine pouches and their position on the toxicant and risk continuums. Drug Chem Toxicol. 2022;45(5):2246–54. 34034614 10.1080/01480545.2021.1925691 · DOI · Paper page
  19. [22]Yu F, Rudd K, Pour SJ, Trelles Sticken E, Dethloff O, Wieczorek R, et al. Preclinical Assessment of Tobacco-Free Nicotine Pouches demonstrates reduced in Vitro Toxicity compared with Tobacco Snus and combustible cigarette smoke. Appl Vitro Toxicol. 2022;8(1):24–35. 10.1089/aivt.2021.0020 · DOI
  20. [23]Nadja M, Thomas S, Sebastian M, Nadine D, Peter L, Andreas L. Levels of nicotine and tobacco-specific nitrosamines in oral nicotine pouches. Tob Control. 2024;33(2):193. 38378209 10.1136/tc-2022-057280 · DOI
  21. [24]Gould TJ. Epigenetic and long-term effects of nicotine on biology, behavior, and health. Pharmacol Res. 2023;192:106741. 37149116 10.1016/j.phrs.2023.106741 · DOI
  22. [25]Marynak KL, Wang X, Borowiecki M, Kim Y, Tynan MA, Emery S, et al. Nicotine pouch unit sales in the US, 2016–2020. JAMA. 2021;326(6):566–8. 34374729 10.1001/jama.2021.10366 PMC8356066 · DOI
  23. [26]Duren M, Atella L, Welding K, Kennedy RD. Nicotine pouches: a summary of regulatory approaches across 67 countries. Tob Control. 2023. 36750358
  24. [27]Fisher MA, Taylor GW, Tilashalski KR. Smokeless Tobacco and severe active Periodontal Disease, NHANES III. J Dent Res. 2005;84(8):705–10. 16040726 10.1177/154405910508400804 · DOI
  25. [28]Tomar SL, Hecht SS, Jaspers I, Gregory RL, Stepanov I. Oral Health effects of Combusted and Smokeless Tobacco products. Adv Dent Res. 2019;30(1):4–10. 31538806 10.1177/0022034519872480 PMC7577287 · DOI
  26. [29]Yaragani A, Sushuma K, Guduri V, Thirumalasetty SMK, Vishnubhotla G, Kandikatla P, et al. The influence of tobacco consumption on periodontal health: a stratified analysis based on type of tobacco use. J Family Med Prim Care. 2020;9(4):2061. 32670966 10.4103/jfmpc.jfmpc_1071_19 PMC7346959 · DOI
  27. [30]Holliday RS, Campbell J, Preshaw PM. Effect of nicotine on human gingival, periodontal ligament and oral epithelial cells. A systematic review of the literature. J Dent. 2019;86:81–8. 31136818 10.1016/j.jdent.2019.05.030 · DOI
  28. [31]Johnson GK, Guthmiller JM, Joly S, Organ CC, Dawson DV. Interleukin-1 and interleukin-8 in nicotine- and lipopolysaccharide-exposed gingival keratinocyte cultures. J Periodontal Res. 2010;45(4):583–8. 20337880
  29. [32]Kubota M, Yanagita M, Mori K, Hasegawa S, Yamashita M, Yamada S, et al. The effects of cigarette smoke condensate and nicotine on periodontal tissue in a periodontitis model mouse. PLoS ONE. 2016;11(5):e0155594. 27203240 10.1371/journal.pone.0155594 PMC4874667 · DOI
  30. [33]Bosco AF, Bonfante S, de Almeida JM, Luize DS, Nagata MJH, Garcia VG. A histologic and histometric assessment of the influence of nicotine on alveolar bone loss in rats. J Periodontol. 2007;78(3):527–32. 17335377 10.1902/jop.2007.060149 · DOI
  31. [34]Zhang W, Lin H, Zou M, Yuan Q, Huang Z, Pan X, et al. Nicotine in Inflammatory Diseases: anti-inflammatory and pro-inflammatory effects. Front Immunol. 2022;13:826889. 35251010 10.3389/fimmu.2022.826889 PMC8895249 · DOI
  32. [35]Liu S, Wu T, Zhou X, Zhang B, Huo S, Yang Y, et al. Nicotine is a risk factor for dental caries: an in vivo study. J Dent Sci. 2018;13(1):30–6. 30895091 10.1016/j.jds.2017.09.006 PMC6388820 · DOI
  33. [36]Mary H, Nishi JG, Cristine DD, Olivia AW. Nicotine pouch product awareness, interest and ever use among US adults who smoke, 2021. Tob Control. 2023;32(6):782. 35217596 10.1136/tobaccocontrol-2021-057156 PMC9402802 · DOI
  34. [37]Speciale Z, Rao S, Yang S, Nugent K. An analysis of Nicotine Pouch Use by Middle School and High School Students surveyed by the National Youth Tobacco Survey in 2021 and a review of the literature. J Prim Care Community Health. 2023;14:21501319231169994. 37128171 10.1177/21501319231169994 PMC10159243 · DOI
  35. [38]Odani S, Armour B, Agaku IT. Flavored Tobacco Product Use and its Association with indicators of Tobacco Dependence among US adults, 2014–2015. Nicotine Tob Res. 2020;22(6):1004–15. 31180498 10.1093/ntr/ntz092 · DOI
  36. [39]Xu K, Lee T, Reyes-Guzman CM, Davis Lynn BC, Kofie JN, Rostron BL, et al. Use patterns of flavored non-cigarette tobacco products among US adults, 2010–2019. Prev Med. 2024;180:107870. 38272271 10.1016/j.ypmed.2024.107870 PMC10923177 · DOI
  37. [40]Keller-Hamilton B, Alalwan MA, Curran H, Hinton A, Long L, Chrzan K, et al. Evaluating the effects of nicotine concentration on the appeal and nicotine delivery of oral nicotine pouches among rural and Appalachian adults who smoke cigarettes: a randomized cross-over study. Addiction. 2024;119(3):464–75. 37964431 10.1111/add.16355 PMC10872395 · DOI · Paper page
  38. [41]Mallock-Ohnesorg N, Rinaldi S, Malke S, Dreiack N, Pieper E, Laux P, et al. Oral nicotine pouches with an aftertaste? Part 1: screening and initial toxicological assessment of flavorings and other ingredients. Arch Toxicol. 2023;97(9):2357–69. 37389646 10.1007/s00204-023-03538-9 PMC10404176 · DOI
  39. [42]Shaikh SB, Tung WC, Pang C, Lucas J, Li D, Rahman I. Flavor Classification/Categorization and Differential toxicity of oral nicotine pouches (ONPs) in oral gingival epithelial cells and bronchial epithelial cells. Toxics. 2022;10(11). PMC9696007 36355951

Cited by

Sorted by citations

Authors
Rungraungrayabkul, D., Gaewkhiew, P., Vichayanrat, T., Shrestha, B., & Buajeeb, W.
Venue
BMC Oral Health
Publisher
Springer Science and Business Media LLC
Published
2024-08-03
Volume
24
Issue
1
ISSN
1472-6831
DOI
10.1186/s12903-024-04598-8
PMC
PMC11297755
Cited by
57
References
0
Language
en
Licence
Funders
Mahidol University

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review