Nicotine Pouches and Oral Health: What Dentists Need to Know Abstract Oral nicotine pouches are an emerging nicotine delivery product increasingly encountered in dental practice. Marketed as tobacco-free and smoke-free, they are often perceived as low risk. However, they deliver nicotine through prolonged contact with the gingival mucosa and contain multiple chemical constituents, including tobacco-specific nitrosamines. Early evidence suggests localized effects such as gingival recession and mucosal changes, along with the potential to mask periodontal disease due to nicotine-induced vasoconstriction. Usage is rising, particularly among younger individuals, raising concerns about new nicotine dependence in previously tobacco-naive patients. Although long-term data are limited, dentists are well-positioned to identify early signs and intervene. Routine screening, targeted examination of placement sites, and initiation of evidence-based cessation strategies, including pharmacotherapy, can be integrated into routine care. Incorporating tobacco cessation and nicotine dependence education into dental practice is essential to addressing this evolving clinical and public health concern. Many patients already use oral nicotine pouches, and uptake is increasing rapidly. These small, tobacco-leaf-free products (e.g., Zyn, Velo, Rogue) are placed between the lip and gingiva and are now widely available in retail settings across Canada. Some patients (and some clinicians) assume that nicotine pouches are essentially harmless because they contain no tobacco leaf and involve no combustion. This assumption is incorrect. Their chemical profile, oral health effects, and regulatory status warrant the same clinical attention as smoking and vaping. This article outlines key considerations for chairside conversations and care. Not Tobacco, but Not Safe Oral nicotine pouches remain in direct, sustained contact with the gingival mucosa and deliver nicotine transorally. Unlike approved nicotine replacement therapies (NRT), they are recreational products regulated under the Deborah P. Saunders, BSc, DMD; Peter C. Fritz, BSc, DDS, PhD, FRCD(C) 26 | 2026 | Issue 3
RkJQdWJsaXNoZXIy OTE5MTI=