Nicotine pouches may cause receding gums

Nicotine pouches probably cause receding gums, as well as discomfort and redness. That’s according to the first study investigating their effects on the lining of the mouth relative to snus, which is generally considered more harmful because it contains tobacco. Tobacco-free nicotine pouches have surged in popularity in recent years. In 2020, just 0.1 per cent of adults in Britain reported being users, rising tenfold to 1 per cent in 2025. The small sachets fit under the top lip, similar to snus, a powdered tobacco that is sometimes administered in a pouch. Snus has been linked to mouth irritation and heart-related deaths, but less is known about nicotine pouches, which were first produced in Scandinavia in the early 2000s and became widely available in the US and the UK in 2020. Now, Karin Legert at the Karolinska Institute in Sweden and her colleagues have studied 272 adults, aged 18 to 30, of whom 126 used nicotine pouches and 63 used snus. This was defined as using the product five or more times a day for at least three months, but not using any other nicotine or tobacco products. The researchers also looked at 83 people who didn’t use nicotine pouches, snus or any related products. Advertisement They observed gingival recession – when the gums recede from the teeth, exposing the sensitive roots – in 45 per cent of those using nicotine pouches, 52 per cent of the snus users and just 6 per cent of the non-users. This recession often occurred around the area where users typically placed their pouches or snus. The researchers also found that nicotine pouches seem to cause more gum irritation, such as redness and discomfort, than snus. This could be because they are often flavoured, which “may contribute to irritation, epithelial damage and inflammatory responses, especially in sensitive oral tissues”, says Legert. The users’ favourite flavours were minty, which often consist of “complex mixtures of chemical constituents, as well as synthetic cooling agents”, says Legert. The team didn’t investigate whether nicotine pouches are linked to other health concerns, but Legert says this warrants further investigation. “Although the absence of tobacco [in these nicotine pouches] eliminates exposure to many well-established tobacco-specific carcinogens, this should not be interpreted as evidence of long-term safety,” she says. Gita Gale at the University of Gothenburg, Sweden, says people shouldn’t assume that nicotine pouches are harmless, even though they are likely to be safer than smoking. “Almost all tobacco-free pouches that are sold in Sweden derive from tobacco leaves.” But it may not be easy for people to give them up. “Even when [people] grade their discomfort quite high, they still can’t stop themselves from putting the [pouches] in their mouth,” she says.