ORAL AND SYSTEMIC HEALTH EFFECTS OF NICOTINE POUCHES: A NARRATIVE REVIEW WITH PUBLIC HEALTH IMPLICATIONS

Sylwia Wit; Monika Błądek; Natalia Bębenek; Karolina Drygała; Gabriela Barszcz; Justyna Bogdan; Benedykt Baljon; Izabela Harpula; Radosław Ramotowski; Paulina Frączkiewicz; Patryk Brzezicki

doi:10.31435/ijitss.2(50).2026.5890

Authors

Sylwia Wit College of Medical Sciences, University of Rzeszów, al. Tadeusza Rejtana 16C, 35-310 Rzeszów, Poland https://orcid.org/0009-0004-9866-2092
Monika Błądek College of Medical Sciences, University of Rzeszów, al. Tadeusza Rejtana 16C, 35-310 Rzeszów, Poland https://orcid.org/0009-0005-1939-0891
Natalia Bębenek College of Medical Sciences, University of Rzeszów, al. Tadeusza Rejtana 16C, 35-310 Rzeszów, Poland https://orcid.org/0009-0006-6976-6698
Karolina Drygała College of Medical Sciences, University of Rzeszów, al. Tadeusza Rejtana 16C, 35-310 Rzeszów, Poland https://orcid.org/0009-0002-0049-3856
Gabriela Barszcz College of Medical Sciences, University of Rzeszów, al. Tadeusza Rejtana 16C, 35-310 Rzeszów, Poland https://orcid.org/0009-0004-0127-6225
Justyna Bogdan CM Łańcut Sp. z o.o., St. Michael the Archangel Hospital, 5 I. Paderewski St., 37-100 Łańcut, Poland https://orcid.org/0009-0002-8599-3656
Benedykt Baljon CM Łańcut Sp. z o.o., St. Michael the Archangel Hospital, 5 I. Paderewski St., 37-100 Łańcut, Poland https://orcid.org/0009-0008-0843-4627
Izabela Harpula Clinical Provincial Hospital No. 2 in Rzeszów, Lwowska 60, 35-301 Rzeszów, Poland https://orcid.org/0009-0005-3167-159X
Radosław Ramotowski Clinical Provincial Hospital No. 2 in Rzeszów, Lwowska 60, 35-301 Rzeszów, Poland https://orcid.org/0009-0007-2880-7788
Paulina Frączkiewicz Military Clinical Hospital SPZOZ in Cracow, Wrocławska 1-3 Street, 30-901 Cracow, Poland https://orcid.org/0000-0002-4163-2843
Patryk Brzezicki Infant Jesus Clinical Hospital UCC MUW (University Clinical Centre, Medical University of Warsaw), 4 Lindleya Street, 02-005 Warsaw, Poland https://orcid.org/0000-0003-1788-807X

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5890

Keywords:

Nicotine Pouches; Health; Nicotine Exposure; Oral Health; Systemic Health; Smokeless Nicotine Products

Abstract

Background and Aim: Oral nicotine pouches (ONPs) have rapidly emerged as popular, non-combustible, tobacco-free nicotine delivery systems. While marketed as reduced-risk alternatives, their health impacts and epidemiological trends raise significant concerns. This narrative review critically synthesizes current evidence, regarding the localized oral and systemic health effects of ONPs and also their broader public health implications.

Findings: Locally, prolonged ONP use induces mucosal inflammation, cytotoxicity and clinically observable lesions such as gingival recession and leukoplakia, which can be exacerbated by different kind of flavors and pH adjusters. Systemically, ONPs deliver high plasma nicotine concentrations comparable to or exceeding combustible cigarettes, triggering acute cardiovascular strain, gastrointestinal distress, also posing severe acute toxicity and neurodevelopmental risks to youth. From a public health perspective, while ONPs may offer a theoretical harm-reduction pathway for established adult smokers, real-world data indicate a troubling prevalence of poly-tobacco use and a rapid surge in youth uptake. Driven by aggressive marketing and regulatory loopholes - including the use of synthetic nicotine analogs - the current trajectory of ONPs closely mirrors the early e-cigarette epidemic.

Conclusion: ONPs are not risk-free. A comprehensive, evidence-based regulatory approach, including strict product standards, flavor bans, and digital marketing restrictions, is urgently required. Independent prolonged research is essential to ensure that adult harm reduction strategies do not inadvertently catalyze a new generation of youth nicotine addiction.

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