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Cited by 12

Self-reported oral health outcomes after switching to a novel nicotine pouch technology: a pilot study

La Rosa, Giusy Rita Maria, Fagerström, Karl, Pacino, Sebastiano Antonio, Kowalski, Jan, Górska, Renata, Gospodaru, Stefan, Bordeniuc, Gheorghe, Fala, Valeriu +3 more·2025·Acta Odontologica Scandinavica
DOI 10.2340/aos.v84.43805PMC PMC12138386
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Abstract

Objective: Nicotine pouch use has been linked to oral health concerns, including oral lesions and gingival irritation. This pilot study examines self-reported oral health outcomes following the use of a novel nicotine pouch (Stingfree Strong Blue Mint), with an impermeable barrier on the interior side designed to reduce mucosal irritation. Materials and methods: A total of 23 Swedish dentists who were current snus or nicotine pouch users participated in a 5-week observational study. Baseline and follow-up assessments included self-reported oral health status and photographic documentation of mucosal conditions, reviewed by an independent blinded dental expert. Primary outcomes included changes in self-reported snus lesions, gingival recession, gingival irritation, and gingivitis. Results: The prevalence of self-reported snus lesions decreased from 95.7% (n = 22) to 69.6% (n = 16). Median Axell-scale lesion severity declined from 2 (interquartile range [IQR]: 1–3) to 1 (IQR: 0–2) (z = 3.756, p = 0.0002). Moderate-to-severe lesions (Axell score ≥ 3) dropped from 39.1% (n = 9) to 0% (n = 0). Self-reported gingivitis cases (n = 3) were eliminated, and gingival irritation decreased by 90.0%. Conclusions: Preliminary findings suggest that the use of the Stingfree Strong Blue Mint nicotine pouch may reduce mucosal irritation. While promising, these findings warrant validation through large randomised controlled trials to establish long-term effectiveness and safety.

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  1. [1]Rodgman A, Perfetti TA. The chemical components of tobacco and tobacco smoke. Boca Raton, FL: CRC Press, Taylor & Francis Group; 2009.
  2. [3]U.S. Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the surgeon general. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2010. 21452462
  3. [4]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 Sep; 45(5): 2246– 54. 10.1080/01480545.2021.1925691 34034614 · DOI · Paper page
  4. [5]Azzopardi D, Haswell LE, Frosina J, McEwan M, Gale N, Thissen J, et al. Assessment of biomarkers of exposure and potential harm, and physiological and subjective health measures in exclusive users of nicotine pouches and current, former and never smokers. Biomarkers. 2023 Feb; 28(1): 118– 29. 10.1080/1354750X.2022.2148747 36484137 · DOI
  5. [6]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 Mar 3; 17(1): 9. 10.1186/s13065-023-00918-1 36869349 PMC9985244 · DOI
  6. [7]Rensch J, Edmiston J, Wang J, Jin X, Sarkar M. A randomized, controlled study to assess changes in biomarkers of exposures among adults who smoke that switch to oral nicotine pouch products relative to continuing smoking or stopping all tobacco use. J Clin Pharmacol. 2023 Oct; 63(10): 1108– 18. 10.1002/jcph.2293 37322571 · DOI
  7. [8]Sjödin E, Andersson J, Nordendahl M, Wennberg M, Heldorsson Fjellström L, Lundholm C, et al. Thirty-six-year trends (1986–2022) in cigarette smoking and snus use in northern Sweden: a cross-sectional study. BMJ Open. 2024 Dec 20; 14(12): e088162. 10.1136/bmjopen-2024-088162 PMC11667336 39806602 · DOI
  8. [9]Ramstrom LM. If there had been no snus in Sweden: the impact of snus on mortality attributable to smoking. Harm Reduct J. 2024 Sep 26; 21(1): 176. 10.1186/s12954-024-01095-7 39327580 PMC11426055 · DOI
  9. [10]Hajat C, Stein E, Ramstrom L, Shantikumar S, Polosa R. The health impact of smokeless tobacco products: a systematic review. Harm Reduct J. 2021 Dec 4; 18(1): 123. 10.1186/s12954-021-00557-6. 34863207 PMC8643012 · DOI
  10. [12]Renard K, Nishihara D, Nilsson J, Larroque S, Martinez J, Giles L. Characterization of the nicotine uptake and safety of Nordic spirit tobacco-free oral nicotine pouches: a randomized cross-over study. Psychopharmacology (Berl). 2025 Apr; 242(4): 855– 65. 10.1007/s00213-024-06721-7 39578274 PMC11890228 · DOI · Paper page
  11. [13]Kopperud SE, Ansteinsson V, Mdala I, Becher R, Valen H. Oral lesions associated with daily use of snus, a moist smokeless tobacco product. A cross-sectional study among Norwegian adolescents. Acta Odontol Scand. 2023 Aug; 81(6): 473– 8. 10.1080/00016357.2023.2178502 36799465 · DOI · Paper page
  12. [14]Modéer T, Lavstedt S, Xhlund C. Relation between tobacco consumption and oral health in Swedish schoolchildren. Acta Odontol Scand. 1980; 38: 233– 7. 10.3109/00016358009003493 6937088 · DOI
  13. [15]Rusiecka AW, Szymacha K, Lewkowicz N. The safety of using oral nicotine pouches-consideration of their effects on general health, oral mucosa and periodontal diseases, comparing them to snus and other nicotine containing products. J Pre Clin Clin Res. 2024 Jul 1; 18(3): 224- 230
  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 Aug; 130(4): e12885. 10.1111/eos.12885 35853092 PMC9540014 · DOI
  15. [17]Rungraungrayabkul D, Gaewkhiew P, Vichayanrat T, Shrestha B, Buajeeb W. What is the impact of nicotine pouches on oral health: a systematic review. BMC Oral Health. 2024 Aug 3; 24(1): 889. 10.1186/s12903-024-04598-8 39097712 PMC11297755 · DOI · Paper page
  16. [18]Miluna-Meldere S, Vanka SA, Skadins I, Kroica J, Sperga M, Rostoka D. Correction: oral mucosal changes caused by nicotine pouches: case series. Diagn Pathol. 2025 Jan 28; 20(1): 12. https://doi.org/10.1186/s13000-025-01606-5. Erratum for: Diagn Pathol. 2024 Sep 19;19(1):127. https://doi.org/10.1186/s13000-024-01549-3 39871358 PMC11773900 · DOI
  17. [20]Axéll T, Mörnstad H, Sundström B. The relation of the clinical picture to the histopathology of snuff dipper’s lesions in a Swedish population. J Oral Pathol. 1976 Jul; 5(4): 229– 36. 820845
  18. [21]Andersson G, Axéll T, Curvall M. Reduction in nicotine intake and oral mucosal changes among users of Swedish oral moist snuff after switching to a low-nicotine product. J Oral Pathol Med. 1995 Jul; 24(6): 244– 50. 10.1111/j.1600-0714.1995.tb01176.x 7562659 · DOI
  19. [22]Andersson G, Axéll T, Larsson A. Clinical classification of Swedish snuff dippers’ lesions supported by histology. J Oral Pathol Med. 1991 Jul; 20(6): 253– 7. 10.1111/j.1600-0714.1991.tb00923.x 1716317 · DOI
  20. [23]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 Aug 17; 10(8): 154. 10.3390/dj10080154 36005252 PMC9406994 · DOI · Paper page
  21. [24]Cairo F, Nieri M, Pagliaro U. Efficacy of periodontal plastic surgery procedures in the treatment of localized facial gingival recessions. A systematic review. J Clin Periodontol. 2014 Apr; 41 Suppl 15: S44– 62. 10.1111/jcpe.12182 24641000 · DOI
  22. [25]Imber JC, Kasaj A. Treatment of gingival recession: when and how? Int Dent J. 2021 Jun; 71(3): 178– 87. 10.1111/idj.12617 34024328 PMC9275303 · DOI
  23. [26]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 Jan 22; 26(2): 245– 9. 10.1093/ntr/ntad179 37712111 PMC10803111 · DOI
  24. [27]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 Sep; 97(9): 2357– 69. 10.1007/s00204-023-03538-9 37389646 PMC10404176 · DOI
  25. [28]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 Oct 31; 10(11): 660. 10.3390/toxics10110660 36355951 PMC9696007 · DOI
  26. [29]Jackson MJ, Weke A, Holliday R. Nicotine pouches: a review for the dental team. Br Dent J. 2023 Oct; 235(8): 643– 6. 10.1038/s41415-023-6383-7 37891304 PMC10611559 · DOI
  27. [30]Liu J, Edmiston JS, Wang J, Milleman KR, Milleman JL, Yoder AL, et al. Oral health effects among adults switching from cigarettes to on!® Nicotine Pouches compared to those who continue smoking. Oral Health Prev Dent. 2025 Mar 25; 23: 189– 201. 10.3290/j.ohpd.c_1925 40130808 PMC11966149 · DOI
  28. [31]Kowalski J, La Rosa GRM, Di Stefano A, Gangi D, Sahni V, Yilmaz HG, et al. Navigating the dual burden of dental and periodontal care in individuals who also smoke: an expert review. J Dent. 2025 Apr 10; 157: 105744. 10.1016/j.jdent.2025.105744 40216069 · DOI

Cited by

Sorted by citations

Authors
La Rosa, G. R. M., Fagerström, K., Pacino, S. A., Kowalski, J., Górska, R., Gospodaru, S., Bordeniuc, G., Fala, V., Amaliya, A., Chapple, I., & Polosa, R.
Venue
Acta Odontologica Scandinavica
Publisher
MJS Publishing, Medical Journals Sweden AB
Published
2025-05-27
Volume
84
Pages
292-298
ISSN
  • 1502-3850
  • 0001-6357
DOI
10.2340/aos.v84.43805
PMC
PMC12138386
Cited by
12
References
1
Licence
creativecommons.org/licenses/by/4.0 (unspecified)

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