Snus has clear adverse effects on oral health, according to a new review published in Acta Odontologica Scandinavia.
The tobacco pouches, though illegal to sell or import in the UK and much of the EU, is a popular item in Sweden. In the UK, nicotine pouches (sometimes called white snus) are an addictive product found behind the counter of many convenience stores – these have a notable lack of tobacco.
The review looked at Swedish snus, which contains tobacco, and found an association with gingival recession, with mechanical pressure and cytotoxic effects contributing to the issue.
Rates of gingivitis also increased for snus users, but no significant relationship with periodontitis was observed. Caries incidences varied between studies.
It also found that snus can affect more than just the user; maternal use saw a 48% increased risk of oral cleft malformations in children.
Snus’ long-standing ban across the EU, which the UK then continued after leaving in 2016, began in the early 1990s as concerns around its health effects were raised. Personal possession is, however, allowed.
It has been reported that snus use is popular amongst professional footballers, potentially due to its limited impact on lung capacity whilst still delivering nicotine and tobacco through the gingivae.
Nicotine pouches that do not contain tobacco are popular in the UK, with the BBC previously reporting its use amongst teenagers still in school. They note that in 2024, an estimated 3.4% of 16 to 24-year-olds used the pouches. An even more recent survey found 13% of 14 to 17-year-olds in England, Scotland and Wales have used a nicotine pouch, and 30% of these did so at least once a week, according to the Guardian.
The effect of these tobacco-free alternatives is less clear. The aforementioned review finds virtually no studies on their long-term oral health effects, but preliminary findings suggest oral mucosal changes that are different from those that clinicians have previously seen. These are anecdotal reports, and thus may be impacted by a myriad of lifestyle and oral hygiene factors.
It seems the UK is one step ahead with the pre-existing ban for tobacco-containing snus, but a greater understanding of white pouches is needed before more changes can be recommended.
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