ORAL HEALTH EFFECTS OF NICOTINE POUCHES: A SYSTEMATIC NARRATIVE REVIEW WITH CONTEXTUALIZATION AGAINST CONVENTIONAL TOBACCO PRODUCTS
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5569Keywords:
Nicotine Pouches, Oral Health, Oral Mucosa, Periodontal Disease, Tobacco Harm Reduction, Oral Carcinogenesis, Narrative SynthesisAbstract
Background: Nicotine pouches are tobacco-free oral nicotine delivery products placed in the oral vestibule without combustion or tobacco leaf contact. Despite accelerating global market expansion and the 2025 U.S. Food and Drug Administration (FDA) marketing authorization, their oral health consequences remain poorly characterized.
Objective: This systematic narrative review synthesizes available clinical and mechanistic evidence on the oral health effects of nicotine pouches across four domains: oral mucosal changes, periodontal status, dental caries, and oral cancer risk.
Methods: A systematic search of PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, Embase, and Google Scholar was conducted (last updated March 2026). Ten eligible studies published between 2021 and 2026 were identified and appraised using design-appropriate quality tools. Evidence was synthesized narratively across four clinical and mechanistic domains.
Results: Evidence consistently documents localized gingival recession and leukoplakia at vestibular pouch-placement sites, with severity appearing lower than traditional snus. Periodontal clinical data are absent, though mechanistic evidence for nicotine-driven periodontal injury is robust. Nicotine promotes Streptococcus mutans virulence, induces oral microbiome dysbiosis, and impairs salivary function. No epidemiological data on oral cancer incidence in nicotine pouch users exist; however, mechanistic evidence demonstrates multi-pathway oncogenic potential of nicotine independently of tobacco-specific nitrosamines.
Conclusions: Nicotine pouches are not orally safe. Available evidence suggests a tentative harm-reduction gradient relative to cigarettes for mucosal outcomes when data are contextualized indirectly, but direct clinical comparisons between nicotine pouch users and cigarette smokers are virtually absent, and critical evidence gaps persist across all four domains. Long-term independent prospective studies are urgently required.
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Copyright (c) 2026 Jacek Kowalski, Dominika Julia Kozdroń, Michalina Weronika Nieścioruk, Paulina Szczepańska, Dominika Dutkiewicz, Alia Echtay Yarbou, Rami Mallah, Adrian Mikołajuk
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