Oral Nicotine Pouches: Histology of Oral Mucosa with Chronic Use
Document Type
Poster
Abstract
Objective: Oral Nicotine Pouches (ONP’s) are a new generation of tobacco-free nicotine pouches, which are used recreationally. Unlike snus and smokeless tobacco, ONP’s contain pharmaceutical-grade nicotine as their major ingredient, along with flavorings, buffers, and preservatives. Limited research has examined the impact of ONP use on oral tissues. The purpose of this case-series study was to perform histologic evaluation of oral mucosa in chronic ONP users. Diagnostic status of oral mucosa in chronic users is critical for assessing overall risk for adverse outcomes from recreational ONP use.
Methods: Individuals who self-reported ONP use were recruited for the study. Chronic ONP use was defined as more than 100 days of continuous usage. Data collected included self-reported ONP use, duration/frequency of use, and concurrent alcohol use. Subjects received an oral examination and a 4mm punch biopsy using local anesthesia. Biopsy locations were dependent on either presence of clinically affected tissue or site of most common use. Selected sites were photographed prior to the procedure. Biopsies underwent standard histologic analysis and were given a diagnosis from a board-certified pathologist.
Results: Ten male participants, ages 22-29 years, used an average of 7.1 pouches/day with an average duration of 4 years of use. The majority of the cases (n=9, 90%) demonstrated epithelial hyperplasia, hyperkeratosis, and chronic mucosal inflammation. A single case showed reactive atypia, which warrants long term clinical follow up. A second case captured a minor salivary gland which showed atrophy and the deposition of amorphous eosinophilic material, similar to what is seen in tobacco pouch keratosis. All cases were negative for epithelial dysplasia and carcinoma. Seven participants reported an average increase of 4.71 pouches when consuming alcohol.
Conclusion: Chronic ONP use produces an inflammatory response at the site of pouch placement.
Publication Date
2-2025
Recommended Citation
McSweeny, Christian; Canterbury, Carleigh; Shackelford, Austin; and Spolarich, A. E., "Oral Nicotine Pouches: Histology of Oral Mucosa with Chronic Use" (2025). ASDOH Student Publications. 6.
https://scholarworks.atsu.edu/asdoh-student/6
Comments
Poster presented at ASDOH Research Week - March 2025.
This is a Cubify based presentation hosted at https://my.ltb.io/#/showcase/atsu-asdoh. It includes a video presentation, references, a PowerPoint presentation, and summary poster.