Karin Garming-Legert researches mucosal changes in the mouth. She explains that those who use white snus nicotine pouches sometimes exhibit a different type of oral alteration not previously seen.
Text: Annika Lund, first published in Medicinsk Vetenskap no 2 2024 / Spotlight on new nicotine products
“We are accustomed to seeing mucosal lesions in users of brown snus. These localised effects on the mucosa occur precisely where the snus is typically placed. If the patient does not want to quit, our advice is to regularly change the placement of the nicotine pouch”, says Karin Garming-Legert, a dentist and specialist in orofacial medicine and researcher at the Department of Dental Medicine at Karolinska Institutet.
What have you observed in white snus users?
“Some of them have more extensive lesions that cover larger portions of the mucosa, not just where the snus lies. The lesions can extend across the entire side above the dental arch, sometimes affecting both sides. Symptoms may include pronounced redness with signs of inflammation, occasionally accompanied by sores and blisters. Interestingly, patients seek dental care for these issues, which is not typically the case with snus lesions caused by brown snus”.
What do you know about the causes?
“Honestly, very little. We do not even know how common it is. However, in some cases, biopsies have revealed signs of hypersensitivity reactions in patients. Mint-flavoured snus seems to be particularly implicated. While we have previously seen mint sensitivity spread to the point where regular toothpaste becomes unusable, we have not yet observed such cases specifically related to nicotine pouch use”.
How will you continue to explore this?
“I am supervising a study within Folktandvården, (Public Dental Service). It involves 300 individuals who use brown snus, white snus or no tobacco or nicotine products at all. Initially, we will describe the occurance and appearance of lesions in these three groups”.
What is known about brown snus and oral health?
“Brown snus can lead to exposed tooth necks, causing sensitivity and reduced protection against cavities. It may also result in discoloured teeth and bad breath. As mentioned, snus lesions are common. Research on whether they pose a a risk for more serious conditions, such as oral cancer, remains inconclusive when it comes to brown snus”.
The magazine Medical Science
The magazine Medical Science (Medicinsk Vetenskap) is published by Karolinska Institutet and targets the general public interested in medical science.
