Joseph Hart 10 January 2024

 

There are many outrageous claims made about nicotine replacement therapy (NRT) products. Some of the classics, like pouches are a gateway to smoking, there is a nicotine pouch epidemic, or pouches target children are easily dismantled by a bit of research or even some plain old common sense.

However, other claims require a bit more digging. For example, what about the question, “Are nicotine pouches bad for oral health?”

An abstract image showcasing a transition from harmful effects of smoking (depicted as a dark, damaged tooth and smoke) to the less harmful effects of nicotine pouches (depicted as a partly healed tooth and a nicotine pouch), illustrating the concept of harm reduction in oral health

Some context

Before we get into the research, we must establish some sort of baseline. Firstly, what do we mean when we say something is bad?

I can’t believe this needs to be said, but it seems that some people expect that placing a nicotine pouch between your mouth should be no more harmful than drinking a glass of water for it to be considered a “safe” product. That is, frankly, a perverse way to judge a harm-reduction product.

The alternative here is smoking. That should be our baseline, alongside the various harms it causes the body. Poor oral health is probably among the least of your worries if you smoke cigarettes, but let’s have a look at what dentists have to say.

The dentists view

Research released late last year by the British Dental Journal takes a pleasantly sensible view of nicotine pouches. The paper titled Nicotine pouches: a review for the dental team, looks at nicotine pouches from a UK perspective and includes some interesting links to other research, including:

  • Nicotine pouches generally contain artificial sweeteners rather than sugars, and so pose little direct risk of the development of dental caries. [link]
  • Chemical analysis of nicotine pouches has shown that they contain much lower toxic compounds than Swedish snus and tobacco smoking [link]
  • Nicotine pouches are likely to be a substantially ‘lower-risk product’ relative to tobacco smoking [link]

But what else about oral health, you ask? Well, the authors suggest there is not a lot of existing research on the matter because pouches are a relatively new nicotine product.

Here are the images of a dentist in a newspaper comic style, capturing the essence of mid-20th century comic art.

However, they note that they can take a stab at the question based on knowledge of:

  • The ingredients
  • Similar products

I like that the authors have stuck their necks out a bit here because it’s easy to play it safe and say, “we don’t have the data,” as if medical professionals really expect there is some plausible world we wake up in where it turns out nicotine pouches are more harmful than smoking.

That world does not exist, no matter how legally cautious health professionals think they should be.

Anyway, the authors cite a few interesting points.

We’ve had oral nicotine products for years

The “we just can’t know” crowd always seems to ignore the fact that we’ve had oral nicotine products for many years. It’s not just Swedes using snus since the 18th century; it’s also 40 years’ worth of products like nicotine gum.

We’re not lumbering about in the dark dealing with some utterly unknown quantity here. We know the damage that smoking does, and we have very clear ideas about the relative harm of alternative smoking products. It’s worth noting that some of the same bodies spreading misinformation about nicotine pouches endorse nicotine gum, which is a little confusing.

The paper cites a 2019 literature review titled Effect of nicotine on human gingival, periodontal ligament and oral epithelial cells. A systematic review of the literature. It found that “nicotine is unlikely to be cytotoxic to human gingival and periodontal cells.” The authors go on to state, “There is no reported evidence of increased oral disease (cancer, caries, periodontal disease) with orally administered NRT.”

Another pooled analysis of nine studies, not cited by the British Dental Journal, concludes that “Swedish snus use does not appear to be implicated in the development of oral cancer in men.”

If snus doesn’t cause oral cancer, it’s hard to imagine a mechanism where nicotine pouches somehow do. So that blows a lot of the nonsense out of the water.

The downsides

Another important part of the British Dental Journal paper talks about localised gingival recession, aka receding gums. According to this study from 2016, this problem occurs in around 1 in 4 snus users and involves roots becoming exposed. The British Dental Journal hypothesised that “we might anticipate that we will see similar effects in nicotine pouch users due to their similar methods of administration.”

Again, it’s essential to put this in the context of the damage that smoking does to your mouth, which includes plaque buildup, gum disease, tooth decay, and, in the worst cases, oral cancer.

Final thoughts

There is a lot of misinformation about the adverse effects of nicotine pouches on oral health. Claims that nicotine pouches cause cancer are laughable, unsupported by evidence, and the fanciful concoction of liars. However, research suggests that receding gums may affect some users. If you smoke, that is one of the milder oral health outcomes you’ll need to worry about.

In short, for people who smoke and want better oral health, nicotine pouches are a step in the right direction.