Snus linked to gingival damage but not periodontitis

Dental Tribune International

Tue. 31 March 2026

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GOTHENBURG, Sweden: As the popularity of snus continues to grow, so too does the diversity of products available, which now include portion-packed snus and tobacco-free nicotine pouches, commonly referred to as white snus. Given the marked changes in snus products in recent years and the absence of a systematic review on their effects on oral health since 2008, a recent systematic review has sought to assess the current evidence on the oral health risks of traditional and newer snus products and found that snus use is associated with a range of dental conditions.

The review analysed 26 European studies investigating the relationship between Swedish smokeless tobacco and oral health. Overall, the findings indicated that snus use is associated with gingival recession, particularly among users of loose snus. Several studies also reported higher levels of gingivitis among users of traditional snus even after adjusting for plaque levels, although findings were not entirely consistent. Snus use was also linked to increased tooth wear and a higher prevalence of self-reported temporomandibular disorder symptoms.

Co-author Dr Mats Jontell, professor emeritus of oral medicine and pathology at Sahlgrenska Academy at the University of Gothenburg, said in a press release: “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.”

One of the most important findings of the study was that maternal snus use during pregnancy was associated with a 48% increased risk of oral cleft malformations in offspring. Notably, this elevated risk was not observed among women who had discontinued use before their first antenatal care visit. Co-author Dr Maria Bankvall, a lecturer and researcher at the Centre for Odontology and Oral Health at Jönköping University in Sweden, commented: “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.”

Findings related to caries were inconsistent. Some studies reported a higher number of decayed or filled teeth among snus users, whereas others found no association. Overall, the evidence was considered insufficient to support a link between traditional snus use and an increased risk of caries. Additionally, the review did not identify a significant association between snus use and periodontitis.

Finally, the researchers identified notable knowledge gaps regarding the effects of white snus on oral health, particularly the lack of long-term data. Previous reporting by Dental Tribune International has indicated that users of white snus may develop oral lesions that differ from those associated with use of traditional products and may experience painful inflammation, which in some cases can take up to 12 months to resolve.

According to the Public Health Agency of Sweden, there has been a continued rise in daily use of snus in recent years among men and women aged 16–84. The increase is particularly pronounced among women aged 16–29. Overall, the review’s findings strengthen the case for targeted public health measures to regulate snus use, especially among populations in which its use is increasing, including enforcement of age restrictions and curbs on youth-targeted marketing.

The study, titled “Swedish smokeless tobacco and its impact on oral health: A systematic review”, was published online on 6 February 2026 in Acta Odontologica Scandinavica.

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Tags:

Dental research Gingival recession Gingivitis Nicotine Oral mucosal lesions Pregnancy Smokeless Tobacco Snus Women's oral health

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