Questions about the oral health effects of nicotine pouches have become increasingly important as their use expands. The evidence remains limited, particularly when it comes to longer-term outcomes, but a newly published Swedish clinical study adds useful data to the discussion.
Published in Clinical Oral Investigations on 22 August 2026, researchers from the University of Gothenburg examined what happened when 45 daily snus users with existing snus-induced oral lesions completely replaced their usual snus with tobacco-free nicotine pouches for four weeks. Participants were randomised to either a dry or moist ZYN nicotine pouch formulation.
The results are relevant. They also need careful interpretation.
Oral Lesions Improved After Switching
The study’s clearest finding was a significant reduction in the severity of existing snus-induced lesions after participants switched to nicotine pouches. Improvement occurred with both the dry and moist formulations.
Researchers also examined tissue samples and inflammatory markers in saliva. They found no significant changes in epithelial thickness, inflammatory cell infiltration, total protein levels, IL-1β, TNF-α or MCP-1 during the four-week study. One marker, IL-8, increased significantly among participants using the dry pouch formulation.
These findings suggest that replacing tobacco-containing snus with the nicotine pouches tested was associated with clinical improvement in pre-existing oral lesions over the short study period.
That is useful evidence. It does not establish that nicotine pouches have no oral health effects.
What the Study Does and Does Not Show
The distinction is important because the study examined a specific population and a specific switching behaviour.
Participants were healthy adults aged 21–55 who had used tobacco-based snus for at least a year. They were already experiencing snus-related lesions and switched completely to one of two nicotine pouch formulations for 28 days. They were not people who had never previously used oral nicotine products.
The study therefore provides evidence about substitution from snus to particular nicotine pouches, rather than the long-term effects of initiating nicotine pouch use.
Four weeks is also far too short to answer questions about chronic oral health outcomes. The authors themselves conclude that their findings apply “within the limitations of this short-term study.”
This is why claims that the study proves nicotine pouches are harmless would go beyond the evidence.
Equally, the observed improvement in lesions should not be ignored simply because longer-term evidence is still needed.
Product Differences Matter
The results also reinforce a wider point about nicotine regulation.
Snus and nicotine pouches are both placed between the lip and gum, but their composition differs. Snus contains tobacco. Nicotine pouches do not contain tobacco leaf and consequently lack several tobacco-specific constituents associated with conventional smokeless tobacco, including certain nitrosamines and polycyclic aromatic hydrocarbons.
Products that appear similar in how they are used may therefore produce different exposures.
That does not mean every nicotine pouch has the same composition or risk profile. Nicotine strength, pH, moisture, ingredients and patterns of use can vary considerably between products. The present study itself compared only two formulations from a single manufacturer.
This makes product-specific evidence and appropriate standards important.
More Independent and Longer-Term Research Is Needed
There are significant limitations that policymakers should keep in view.
The study involved only 45 participants and lasted four weeks. It was open-label, so participants and researchers knew which products were being used. It examined two ZYN formulations and was funded by Swedish Match North Europe AB, which also supplied study materials. The authors state that the sponsor had no role in study design, data collection, analysis, interpretation or manuscript preparation.
Industry funding does not invalidate a study, but it makes independent replication particularly valuable.
Future research should follow nicotine pouch users for longer periods, include products from different manufacturers and examine people with different histories of nicotine use. Clinical findings should also be considered alongside emerging evidence on oral tissue changes, periodontal health and other relevant outcomes.
What This Means for GINN
For GINN, this study illustrates why nicotine policy should be guided by the totality of evidence and by careful comparisons between products.
The finding that pre-existing snus lesions improved after switching to the nicotine pouches tested is relevant to assessing relative effects. It should be communicated accurately without turning a short-term clinical result into a broad claim about long-term safety.
Regulators need both caution and perspective.
Nicotine pouches should be subject to credible product standards, ingredient requirements and ongoing health surveillance. At the same time, differences between tobacco-containing products and tobacco-free alternatives should be recognised where scientific evidence demonstrates them.
As research develops, the key question is not whether nicotine pouches can be labelled simply “safe” or “unsafe.” Regulation needs a more useful evidence base: how their risks compare with the products people are replacing, how those risks vary between formulations, and what happens with sustained use over time.
This new Swedish study contributes one piece to that evidence base. More evidence is still needed before the longer-term oral health picture becomes clear.
