Oral Mucosa

Recent studies indicated alterations in the oral mucosa occurred at the placement of the ONP, as well as the sulcus of the site. Oral mucosal tissues become granular, corrugated, and/or hyperkeratotic with leather like appearances, associated with circular or linear white or yellowish lesions in the presence of ONPs.²⁵ Keratinized tissues could lead to oral squamous cell carcinoma, when combined with risk factors such as nicotine and tobacco.²⁶ Unlike oral lesions associated with smoking, these oral lesions are localized mostly in the sulcus or vestibule and are considered less severe, resolving at an increased pace, after relocation of ONP placement.²⁷ It is imperative to continuously change the placement of the oral nicotine pouch in the oral cavity to minimize caries, pathology and recession.

However, its direct contact on gingival tissues can initiate irritation and lead to mechanical injury, increasing the occurrence of periodontal disease, along with localized gingival recession.⁵ Microbes in the oral cavity are susceptible and at risk for oral soft tissue lesions from penetration of toxic chemicals presented in nicotine flavoring, such as menthol.¹ Additional findings include, gingival blisters, jaw sensations, soreness, and xerostomia.²⁶ Further continued research is needed to investigate oral pathology involvement, and although it is considered a lower risk, with lesions healing faster than traditional tobacco products because non-combustible agents, more evidenced based research is needed for further analysis.²⁶