When my patients come to see me for their dental hygiene appointments, I discuss their oral habits, including the use of nicotine pouches and how they can affect oral health and potentially increase oral cancers. It is my professional duty to keep informed and practice current evidence-based healthcare.
Using nicotine pouches, including ZYNS, Rogue and ON, can increase the risk of oral cancer because they can cause increased proliferation of tissue cells and microscopic histological changes such as hyperplasia and hyperkeratosis.
We dental professionals need to check oral cancer in all of our patients and educate our patients on the risks and what to look for to prevent and catch changes in the mouth quickly to ensure early diagnosis.
In this post, I expand on what the scientific evidence is saying about nicotine’s correlation to oral cancer, what we need to be cautious of, and what to do if you are concerned about a lesion in your mouth.
What the science is saying about nicotine correlation to oral cancer
The below quote from Cancer Research UK has been under fire for giving people a false sense of security. As I mentioned, just because something does not have specific scientific proof does not mean it does not exist.
“However, the best evidence available shows that nicotine does not cause mouth cancer, or any type of cancer. People have used nicotine replacement therapy safely for many years.”
Cancer Research UK
This quote was also written in 2009, and things can change quickly in science as new studies and research is conducted.
And as the quote itself says, “the best evidence available.” Saying in 2009 that there was not enough evidence leaves room that there could be evidence one day.
My main concern is someone choosing to use nicotine pouches because they think they are 100% safe.
If I had a family member or a patient using them, I would kindly inform them that they need to keep an eye on the tissue in their mouth.
Scientific evidence shows that nicotine is absorbed easily through the oral mucosa and causes increased cell proliferation, angiogenesis and apoptotic pathways, which promotes tumorigenesis.
Tumorigenesis is the initial formation of a tumour when normal cells begin to have malignant properties.
Nicotine has been shown to promote tumour formation and is linked to cancer in other body parts.
“Nicotine has also been found to be carcinogenic in several studies. It promotes tumorigenesis by affecting cell proliferation, angiogenesis and apoptotic pathways. It causes resistance to the chemotherapeutic agents.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363846/
Please, to learn more about the effects of nicotine on the body, the study link above dives deep into the science. I encourage you to read into it if you want a more scientific read.
I want to add that nicotine replacement therapy is of great help to those trying to quit smoking. Tobacco and nicotine products are highly addictive, and tools like nicotine pouches or gum can help people quit.
Always speak to your doctor and get your dental professional to check out the tissues in your mouth and do an oral cancer screening.
But nicotine pouches can cause other issues in the mouth that can be irreversible and cause pain.
I wrote a post about the effects of nicotine pouches on gums which is linked below!
Read Now: Hygienist Explains: ZYN Nicotine Pouches Bad For Your Gums?
There is not a lot of research on oral cancer and nicotine pouches for an excellent reason. Below I explain why.
Unethical studies cannot be conducted regarding oral cancer and nicotine pouches
We must understand that we do not know everything and that it is unethical to test nicotine pouches on humans to see if they develop cancer. This makes it challenging to obtain information to prove that nicotine pouches cause oral cancer in humans because we cannot conduct these studies.
But we can test the changes in cells and look for histological changes in vitro or other ways, such as by applying nicotine to the inside hamsters’ cheeks. The study I am referring to is linked here. 
In the study linked above, the following quote is from;
“These results suggest that in mucosal tissues nicotine may enhance the effect of weak carcinogens such as the nitrosamines.”
https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0714.1994.tb00054.x
It is just one more piece of evidence that nicotine can increase the risk of changes in the mouth’s tissues.
Even though these changes have been seen, the evidence that oral nicotine pouches directly cause cancer is not concrete.
But because the studies that do exist show changes in tissue that could increase the chance of tumour formation, a link can be made from what we already know about cancer formation.
Read Now: Can You Swallow ZYN Nicotine Pouches Spit?
Nicotine pouches have not existed long enough for long-term research to be conducted. And I do not like how they can be marketed and perceived as a “safe alternative.”
“Low concentrations of nicotine stimulate cell proliferation, while high concentrations are cytotoxic”
Source
I feel like there is so much pressure on people to quit smoking and to find other ways to quit by using nicotine replacement therapy by using gums, patches, vaping, etc., but there is a lack of emphasis that they are short-term solutions.
All of my patients who smoke or use tobacco products will never be lectured by me to quit smoking or using these products. Everyone who uses them knows they are unhealthy, but addiction is real, and habits are hard to overcome.
I think we need to be more compassionate, educate people on how these products can affect the mouth, and motivate patients to keep checking their tissues for changes and to maintain regular dental appointments!
Be cautious of being told nicotine pouches are 100% safe
I think outdated information should be edited, as in the quote I included at the top of the page. I believe it can provide a false sense of safety for users.
I only wish that people understand the risks of using such products and not be swayed that they are safe to use.
Read Now: Does Nicotine Gum Cause Gum Recession? Hygienist Explains!
The mouth is highly vascular, and the tissue proliferates quickly and is why we must be observant of oral cancer and note any changes we see in the mouth.
Speak with your healthcare provider, including dental professionals, about using nicotine products.
What to do if you have a suspicious area where you place the nicotine pouch?
The tissue that comes in contact with the nicotine pouch can become irritated, and you may start to see changes in the appearance of the tissue. You may see a white layer or wrinkling.
If you see something abnormal, please do not leave it.
Any lesion in the mouth that doesn’t heal within two weeks definitely needs to be looked at in more depth.
I really hope that I have given you some insight into nicotine use and the potential risk it poses to our health.
Holly 🙂
