The effect of a non‐tobacco‐based nicotine pouch on mucosal lesions caused by Swedish smokeless tobacco (snus)

Oral mucosal lesions are commonly found in Swedish smokeless tobacco (snus) users where the pouch is placed. These lesions are reversible, that is, clinical and histological tissue changes return to normal following cessation. However, the exact mechanisms behind these changes are unknown. The main aim of this study was to investigate how snus‐like non‐tobacco‐based nicotine pouches affect the oral mucosa and the severity of pre‐existing lesions. Sixty regular users of Swedish smokeless tobacco were encouraged to substitute their snus with non‐tobacco‐based nicotine pouch products during a 6‐week period. Meanwhile, oral mucosal lesions were assessed using a four‐degree scale. Over time, a reduction of pre‐existing mucosal lesions was observed between baseline and the final visit. In a second part, the effect of exposure to regular snus on the production of 48 different cytokines in peripheral blood mononuclear cells was compared in vitro with that resulting from exposure to the non‐tobacco‐based nicotine products. Results showed significantly increased production of proinflammatory cytokines in cells exposed to regular snus compared to untreated or cells exposed to the non‐tobacco‐based nicotine products. This may be related to the improved clinical appearance of the oral mucosa in the participants that used the non‐tobacco‐based nicotine test pouches.