The Impact of Smokeless Tobacco, Nicotine Pouches, and Electronic Cigarettes on Oral Health. Summary of the Doctoral Thesis
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Date
2025
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Rīga Stradiņš University
Abstract
In recent years, new tobacco and nicotine-containing products have emerged that offer colourful designs and a variety of flavours. These products are becoming increasingly popular, not only with traditional tobacco users, but also with new smokers. One of these new nicotine products are nicotine pouches, which resemble smokeless tobacco in appearance and use. Although the sale of smokeless tobacco is prohibited in Latvia, it is widely used, especially among athletes. Nicotine pouches, or smokeless tobacco sachets, are placed under the upper or lower lip and allow the absorption of tobacco, nicotine and other substances through the oral mucosa. As these products do not produce smoke, they are easy to use without disturbing others. Meanwhile, electronic cigarettes are attracting not only current tobacco users, ostensibly to help them to quit smoking, but also individuals who have never used tobacco products before. Unfortunately, disposable electronic cigarettes are widely used by children, leading not only to serious addiction problems but also to health problems requiring hospitalisation. At present, the public and the authorities are under the impression, largely created by these manufacturers, that these new tobacco and nicotine products are a much better alternative to cigarettes and therefore their sale should not be banned. Moreover, such claims are supported by research funded by or associated with these manufacturers. As these products have only recently entered the market, studies on their effects on oral and general health are urgently needed. The aim of this study is to determine the effects of smokeless tobacco products, nicotine pouches and electronic smoking devices on oral microbiota, salivary inflammatory biomarkers and overall oral health. Five scientific articles have been published based on the results of the research and the Thesis will be defended as a series of publications. The research design includes four sections. The first section includes a survey of respondents about general health, oral health habits, diet, lifestyle and use of tobacco and nicotine products. Respondents were selected based on inclusion criteria, followed by oral examinations and the collection of saliva and biofilm samples. The second section includes a histopathological and visual examination of clinical changes in the oral cavity. In the third section, inflammatory biomarkers (IL-1, IL-6, IL-8, TNF-alpha) and LRG-1 in saliva samples are examined. In the fourth section periodontal pathogens and other microorganisms (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Fusobacterium nucleatum, Fusobacterium periodonticum, Porphyromonas endodontalis, Rothia mucilaginosa) in saliva, subgingival and supragingival biofilm samples are investigated. The results show that users of smokeless tobacco and nicotine pouches report dry mouth and tingling of the mucous membranes. Users of electronic cigarettes and pouches are prone to bleeding gums, increased plaque build-up, gum recession, altered taste and bad breath. In addition, in areas where pouches are placed, mucosal changes can be seen, clinically characterised as white keratoses of varying roughness and shape. Histological examination of these mucosal samples shows parakeratosis with marked acanthotic mucosal thickening, intraepithelial and connective tissue oedema and a chronic inflammatory infiltrate with lymphocytes and macrophages. Such changes can be defined as mild dysplasia, which is a precancerous condition. In addition, smokeless tobacco and nicotine pouch users who were clinically diagnosed with oral mucosal changes had elevated levels of IL-6 in saliva. Periodontal pathogenic microorganisms are found in the saliva and periodontal pockets of users of electronic cigarettes, smokeless tobacco and nicotine pouches, suggesting that the use of these products may lead to periodontitis. The study data suggest that these products negatively impact oral health and are a serious risk factor for the development of periodontitis and mucosal disease. Furthermore, as these products have only recently entered the market, the long-term effects on oral health are not yet known.
Description
The Doctoral Thesis was developed at Rīga Stradiņš University, Department of Biology and microbiology. Defence: at the public session of the Promotion Council of Basic Medicine on 9 April 2025 at 15.00 in the Hippocrates Lecture Theatre, 16 Dzirciema Street, Rīgas Stradiņš University and remotely via online platform Zoom.
Keywords
Summary of the Doctoral Thesis, oral health, oral microbiota, salivary inflammatory biomarkers, smokeless tobacco, tobacco substitutes, nicotine pouches, oral mucosal changes
Citation
Miļuna-Meldere, S. 2025. The Impact of Smokeless Tobacco, Nicotine Pouches, and Electronic Cigarettes on Oral Health: Summary of the Doctoral Thesis: Sub-Sector – Stomatology. Rīga: Rīga Stradiņš University. https://doi.org/10.25143/prom-rsu_2025-06_dts