Investigating the oral and dental effects of nicotine pouches: findings from a patient and professional survey with in-person assessment.
- 1Newcastle University
Abstract
BackgroundNicotine pouches (NPs) are increasingly popular tobacco-free nicotine products, particularly among young people. Despite growing use, evidence regarding their oral health effects remains limited.
MethodsWe employed a mixed-methods approach comprising: (1) a national cross-sectional survey of NP users, (2) a survey of UK dental professionals, and (3) in-person clinical assessments of NP users. Survey data explored patterns of NP use, oral and dental side effects, and perceptions of risk. Clinical assessments included comprehensive oral examinations, periodontal assessments, and histopathological investigation of lesions where indicated.
ResultsA total of 3,659 NP users completed the public survey. Participants were predominantly male (89%) and aged 16-22 years (78%). Overall, 45% reported at least one oral or dental side effect. The most commonly reported effects were gingival recession (60%), burning sensations (41%), white patches (30%), and dry mouth (29%). Higher nicotine exposure was associated with increasing numbers of reported side effects. Among 126 dental professionals, oral lesions associated with NP use were commonly observed clinically, while only 17% reported seeing no oral or dental effects. Thirty-three NP users underwent in-person assessment. Ten lesions were biopsied; six demonstrated hyperkeratosis and four showed oral epithelial dysplasia (three mild, one moderate). All dysplastic lesions occurred at pouch placement sites. In two cases, clinical follow-up demonstrated partial or complete resolution of lesions following cessation of NP use. Periodontal assessments demonstrated generally low levels of periodontal disease and gingival recession across the cohort.
ConclusionsOral and dental side effects associated with NP use were commonly reported by users and observed by dental professionals. Histopathological assessment identified biopsy-confirmed oral epithelial dysplasia in lesions occurring at pouch placement sites, representing, to our knowledge, the first such report associated with NP use. Evidence of lesion improvement following discontinuation of use suggests that at least some NP-associated oral changes may be reversible.
Although causality cannot be established, these findings highlight the need for vigilance among dental professionals and urgent longitudinal research to determine the incidence, progression, and reversibility of NP-associated oral lesions.
Related
- Scientific assessment of oral nicotine pouches and associated risk reduction in comparison to combustible cigarettes
- The Physicochemical Principles Governing Nicotine Delivery from Oral Nicotine Pouches.
- Acute Cardiovascular and Electrocardiographic Effects of Nicotine Pouches: A study protocle for a Randomized, Double-Blind, Placebo-Controlled Crossover Trial (NICOTUNE STUDY)
- Exploring possible point-of-sale restrictions for vapes and nicotine pouches: cross-sectional surveys with adults and adolescents in the UK
- Nicotine and heavy metal exposure in recent exclusive cigar users: Insights from the U.S. population assessment of tobacco and health study wave 7 (2022−2023)
BibTeX
@misc{holliday2026investigating,
title = {{Investigating the oral and dental effects of nicotine pouches: findings from a patient and professional survey with in-person assessment.}},
author = {R. Holliday and C. Currie and J. Jackson and J. Allison and E. Ash and N. Lansdowne and P. Basta and R. Tapon and N. Atkinson and A. Fucile and E. Padgett and S. Warner and S. Miluna-Meldere and L. Crombie and Z. Toma and C. Nile and N. Jakubovics and R. Kist and M. Robinson},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.29.26364219},
url = {https://www.medrxiv.org/content/10.64898/2026.09.29.26364219v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Investigating the oral and dental effects of nicotine pouches: findings from a patient and professional survey with in-person assessment.
AU - R. Holliday
AU - C. Currie
AU - J. Jackson
AU - J. Allison
AU - E. Ash
AU - N. Lansdowne
AU - P. Basta
AU - R. Tapon
AU - N. Atkinson
AU - A. Fucile
AU - E. Padgett
AU - S. Warner
AU - S. Miluna-Meldere
AU - L. Crombie
AU - Z. Toma
AU - C. Nile
AU - N. Jakubovics
AU - R. Kist
AU - M. Robinson
PY - 2026
DA - 2026/09/29
PB - medRxiv
DO - 10.64898/2026.09.29.26364219
UR - https://www.medrxiv.org/content/10.64898/2026.09.29.26364219v1
AB - BackgroundNicotine pouches (NPs) are increasingly popular tobacco-free nicotine products, particularly among young people. Despite growing use, evidence regarding their oral health effects remains limited. MethodsWe employed a mixed-methods approach comprising: (1) a national cross-sectional survey of NP users, (2) a survey of UK dental professionals, and (3) in-person clinical assessments of NP users. Survey data explored patterns of NP use, oral and dental side effects, and perceptions of risk. Clinical assessments included comprehensive oral examinations, periodontal assessments, and histopathological investigation of lesions where indicated. ResultsA total of 3,659 NP users completed the public survey. Participants were predominantly male (89%) and aged 16-22 years (78%). Overall, 45% reported at least one oral or dental side effect. The most commonly reported effects were gingival recession (60%), burning sensations (41%), white patches (30%), and dry mouth (29%). Higher nicotine exposure was associated with increasing numbers of reported side effects. Among 126 dental professionals, oral lesions associated with NP use were commonly observed clinically, while only 17% reported seeing no oral or dental effects. Thirty-three NP users underwent in-person assessment. Ten lesions were biopsied; six demonstrated hyperkeratosis and four showed oral epithelial dysplasia (three mild, one moderate). All dysplastic lesions occurred at pouch placement sites. In two cases, clinical follow-up demonstrated partial or complete resolution of lesions following cessation of NP use. Periodontal assessments demonstrated generally low levels of periodontal disease and gingival recession across the cohort. ConclusionsOral and dental side effects associated with NP use were commonly reported by users and observed by dental professionals. Histopathological assessment identified biopsy-confirmed oral epithelial dysplasia in lesions occurring at pouch placement sites, representing, to our knowledge, the first such report associated with NP use. Evidence of lesion improvement following discontinuation of use suggests that at least some NP-associated oral changes may be reversible. Although causality cannot be established, these findings highlight the need for vigilance among dental professionals and urgent longitudinal research to determine the incidence, progression, and reversibility of NP-associated oral lesions.
ER -