Evidence-based options remain the standard of care. Dentists in Canada are prescribers and can initiate treatment directly. Varenicline has the strongest RCT evidence as a first-line therapy. Combination NRT (patch plus lozenge or gum) and bupropion are effective alternatives. Dentists are well-positioned to prescribe these therapies at the point of care. A 6-Step Framework for Practice Dental visits are among the most consistent points of contact in the health care system. Brief, non-judgmental interventions using Ask–Advise–Act improve cessation outcomes. The following framework can be integrated into a standard recall visit: Closing Comments Oral nicotine pouches represent a rapidly evolving category of nicotine delivery that is already present in our operatories. While long-term data are still emerging, the existing evidence is sufficient to warrant clinical attention. Dentists do not need to wait for definitive outcomes to act. Routine screening, careful examination of placement sites, and initiation of evidence-based cessation strategies can be integrated into everyday practice now. Incorporating tobacco cessation and nicotine dependence education and intervention into routine dental care is essential to this approach. As one of the most consistent points of contact in the health care system, the dental setting is uniquely positioned to identify early harm, correct misconceptions, and prevent the progression of nicotine dependence. Oral Health 1. Screen: Ask every patient about oral nicotine pouch use. 2. Document: Record placement site, laterality, and duration of daily use. 3. Examine: Assess the placement site for recession, blanching, and mucosal change. 4. Photograph: Capture baseline images and monitor over time. Cessation 5. Act: As a prescriber, consider initiating varenicline or combination NRT when appropriate to support timely care. 6. Monitor: Assess for dual use and persistent lesions; maintain a low threshold for biopsy referral. Dr. Peter Fritz is a periodontist in Fonthill, Ontario, and Chair of the Royal College of Dentists of Canada’s Committee on AI and Emerging Digital Technology. He holds adjunct professorships at the University of Toronto, Western University, McMaster University, Brock University, and the University of Rochester, and is currently completing a Master’s in AI and Digital Business Transformation at IMD Business School in Switzerland. References 1.Mallock-Ohnesorg N, Rabenstein A, Juhász J, et al. Chemical characterization of oral nicotine pouches. Arch Toxicol. 2023;97(3):723–36. 2. Sparrock LSM, Wang TW, Roeseler A, et al. Susceptibility to oral nicotine pouch use among adults—United States, 2021. Int J Environ Res Public Health. 2023;20(4):3064. Dr. Deborah Saunders is an associate professor at Northern Ontario School of Medicine University and medical director of the Department of Dental Oncology and Regional Lead for Clinical Tobacco Interventions at the Northeast Cancer Centre in Sudbury, Ontario. She holds a faculty appointment at the Centre for Addiction and Mental Health, with a focus on tobacco intervention in oncology and dental settings. She is a member of the Ontario Health Tobacco Initiative Research Committee, with research interests in epigenomics in head and neck cancer patients who smoke. Bottom Line Oral nicotine pouches are not without risk. They are associated with identifiable oral health effects, and dentists are well-positioned to detect them. Screening, targeted examination, and evidencebased cessation support can be incorporated into routine care. Each recall appointment provides an opportunity for intervention. Clinical Pearl Do not rely on bleeding scores alone in oral nicotine pouch users. Probe carefully and examine the placement site directly at each visit. See Dr. Saunders discuss oral nicotine pouches on CDA Oasis at: bit.ly/4e5VeNE 28 | 2026 | Issue 3 Issues and People
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