The Correlation of Swedish Snus, Nicotine Pouches and Other Tobacco Products with Oral Mucosal Health and Salivary Biomarkers

Abstract

In society, tobacco products, such as e-cigarettes, and smokeless tobacco products, such as snus and nicotine pouches, are becoming more attractive. There is still a lack of information regarding the effects of these products on the oral mucosa and oral saliva biomarkers. The aim of this study is to evaluate oral mucosa and the presence of inflammatory biomarkers IL-6, IL-1, IL-8, TNF alpha and LRG-1 in saliva. Respondents were divided in four groups based on their tobacco product usage. Oral examination was carried out, saliva samples were taken, and the detection of IL-6, IL-8, IL-1, TNF alpha and LRG-1 levels in saliva was carried out. Out of the tobacco users, 30.8% were snus users, 48.7% were cigarette users and 20.5% were e-cigarette users. The control group was composed of respondents who did not use any tobacco products. E-cigarettes were used more by women, but snus was used more by men. Mucosal changes were seen in the group of snus users, and mucosal changes were only seen in men who had used 5–10 tobacco units per day for 5–10 years. Increased IL-6 levels in saliva were detected in respondents who also experienced mucosal changes. Mucosal changes were white, leathery and localized at the site where snus sachets were placed. Saliva, as an easily available biofluid, could be used as a first tool to detect potentially precancerous signs, but the LRG1 marker cannot be used as a prognostic marker.

Effect of conventional cigarettes and e-cigarettes on salivary biomarkers: A systematic review

“…In three studies, 12 - 14 it was higher in conventional smokers, and in others, 15 - 17 e-cigarette users had higher levels of IL-1β. IL-6 biomarker was assessed in four studies, and all of them except one, 16 reported higher levels in conventional smokers. Also, three studies evaluated IL-8 and 15 - 17 showed higher IL-8 biomarker levels in conventional smokers, and in one study, 16 it was vice versa.…”

Oral nicotine pouches with an aftertaste? Part 1: screening and initial toxicological assessment of flavorings and other ingredients

“…Local concentrations might be significantly higher than after ingestion and adverse effects at the site of use are thus most likely. In fact, mucosal changes have been reported in users of snus and nicotine pouches (Miluna et al 2022 ). Shao et al ( 2022 ) analyzed posts related to nicotine pouches on the platform Reddit and found that many users experienced gum problems upon usage of nicotine pouches.…”

Snus Use in Adolescents: A Threat to Oral Health

“…Miluna et al confirmed in their study that there is a statistically significant correlation between how many years tobacco products were used and mucosal changes that could be seen in patients using tobacco products for 5-10 years. [39] It would be essential to educate teenagers at in early age about the negative effects of snus, as the duration of regular usage is crucial in developing irreversible changes.…”