Snus linked to gum damage but tooth decay risk unclear

Snus is clearly linked to damage to the gums. The connection to tooth decay, however, remains unclear, according to a systematic review. When it comes to white snus, more studies are needed.

The researchers reviewed 26 European studies on Swedish smokeless tobacco (snus) and oral health. The overall picture that emerges is nuanced. There is consistent evidence that snus can cause the gums to recede, particularly at the site where the snus is placed. Several older studies also report more gum inflammation among users of traditional snus, even after accounting for plaque levels. The risk of gum recession is lower with portion snus than with loose snus. Newer types of portion products may reduce the risk further.

No clear evidence for periodontal disease

One of the researchers behind the study is Mats Jontell, professor emeritus of oral medicine and pathology at Sahlgrenska Academy, University of Gothenburg:

"When we weigh the evidence together, we see that snus affects the gums locally. It is not only a matter of the portion pressing against the tissue; there also appears to be an inflammatory reaction that leads to bone resorption, which over time causes the gums to recede. However, we see no clear evidence that it leads to destructive periodontal disease—the type of condition in which teeth gradually lose their attachment to the jawbone," says Mats Jontell.

When it comes to tooth decay, the results are contradictory. Some studies report more filled or decayed teeth among users of traditional snus, while others find no difference. Taken together, it is therefore not possible to conclude that traditional snus itself increases the risk of tooth decay.

Risk during pregnancy

One of the larger studies included in the review shows that children born to women who used traditional snus during pregnancy tended to have a higher risk of being born with a cleft palate compared with children of non-users. The risk was not elevated among women who had stopped using snus before their first antenatal care visit.

Maria Bankvall is a senior lecturer in dentistry at the School of Health and Welfare, Jönköping University, and a co-author of the study:

"Although this represents an increased risk rather than proof of causation, it is an important signal from a public health perspective. The use of nicotine products during pregnancy cannot be considered risk-free, especially as snus use is increasing among young women," says Maria Bankvall.

Major knowledge gap regarding white snus

The main knowledge gap identified by the researchers concerns the new tobacco-free nicotine pouches, often referred to as white snus. Tobacco-free nicotine pouches have recently overtaken traditional snus, and their use is increasing rapidly, particularly among young people and women. However, there are virtually no studies on how these products affect oral health over the long term. Preliminary studies suggest that white snus may cause oral mucosal changes that differ from those previously observed.

Because the majority of the studies in the review are observational, it is not possible to establish cause and effect. Lifestyle, oral hygiene, and socioeconomic factors may influence the results. By compiling the available research, however, the review provides an updated picture of what is supported by evidence and where the greatest uncertainties remain.

The review is based on a systematic analysis of published studies in several scientific databases, in which the researchers assessed the quality of the material before including it. The study was funded with independent research funding with no links to tobacco products or white snus and has been published in the scientific journal Acta Odontologica Scandinavica.