gum recession – Tooth Be Told

As a dental hygienist, it is a part of my job to discuss with my patients about smoking and the different nicotine products, such as smokeless tobacco and nicotine pouches and explain the effects they have on the mouth. And as newer products emerge onto the market, I need to be up to date and current with the information about them. Nicotine pouches, including ZYN, are bad for the gum tissue. Nicotine reduces blood flow and oxygen levels and impairs healing in the gums, leading to cell death. Using nicotine pouches increases the user's odds of gum disease, gum recession, leukoplakia, decay, bad breath, dry mouth, and bruxism. Below I go into more detail on how nicotine patches affect not only the gums but the whole mouth and body and what you should be looking out for in your mouth if you are using nicotine pouches. I also touch on the relationship between gingivitis, periodontitis (gum disease) and nicotine pouches, if the pouches stain your teeth, how to prevent some of the gum issues caused by nicotine pouches and a few other interesting tidbits of information that you need to know. Why nicotine pouches are bad for the gums The majority of issues caused by nicotine pouches (including ZYN) are from the effects the pouches have on the gums, mostly on a microscopic level, and we can't see the changes happening with the naked eye. Out of sight, out of mind? Unfortunately not, in this case, the issues should very much be in your mind. Read Now: Do ZYNS Cause Gum Cancer? Dental Hygienist Explains Where the nicotine pouch comes in contact with the soft tissues in the mouth, the nicotine will cause vasoconstriction (tightening of the blood vessels, which restricts blood flow). Restricting the blood flow in the gums reduces the oxygen supply to the tissues, reducing healing and ultimately causing cell death. In the Dental Chair Because of the effect of nicotine on the blood flow in the mouth, often my patients who are smokers, or oral nicotine users, their gums actually look healthy at first glance. The gums are pink in colour and do not bleed easily, giving the illusion of a healthy mouth. But what's going on underneath the gumline and on a microscopic level is a whole other story. I discuss with my patients who are either thinking about quitting or in the process, that their gums will start to bleed more as they reduce the smoking and cut it out completely because the nicotine masks gum disease symptoms! The left side of the photo indicates gum and bone health. The right side of the photo indicates gum disease (gum inflammation and bone loss). Th17 immune cells are specialized cells of our immune system that cause inflammation and destroy cells, causing bone loss around the teeth. Can nicotine gum cause gum recession? I wrote an article all about it linked here; Read Now: Does Nicotine Gum Cause Gum Recession? Hygienist Explains! Are ZYN pouches with nicotine bad? No current studies show that nicotine pouches are safe and effective, and nicotine pouches are not FDA-approved for nicotine replacement therapy as nicotine gum or lozenges are. Nicotine usage is related to increased gum disease, tooth decay, bad breath, and oral cancer. I go into more depth about these issues below. Can nicotine pouches cause gingivitis? Because of the microscopic effects of the nicotine pouches on the tissues surrounding the teeth, the gum tissue becomes much more susceptible to developing both gingivitis and periodontitis (types of gum disease). When blood flow is restricted in the gums due to the constriction of the blood vessels when nicotine is used, our bodies cannot fight infection or heal as easily. Using nicotine pouches leaves the gums vulnerable to the bacteria in our mouths, resulting in inflammation of the tissues. Both chronic inflammation and the restriction of blood from the cells contribute to cell death, which can lead to gum recession. Gingivitis is inflammation in the gum tissue surrounding the teeth. Periodontitis is when inflammation is present in the bone and gum tissues surrounding the teeth, resulting in bone loss and soft tissue loss. Gingivitis can progress to periodontitis. Once the inflammation reaches the bone, you can never get rid of it. You can slow and stop the progression of tissue loss with dental hygiene therapies, at-home oral hygiene and possibly surgery. When speaking to my patients about gum disease, I often get the question if the bone loss can be reversed. You can find all the information about it in this post I linked here; Read now: Can Bone Loss in the Jaw Be Reversed? Hygienist Explains. Localized gum inflammation and recession. Can receding gums happen from using nicotine pouches? Receding gums can be caused by the death of gum tissue from gum disease or by constant wearing on the gums from the nicotine pouch. Excessive wearing on the gums will damage the gums and, over time, can wear away some of the tooth structure too! When gums recede, it exposes the soft root surface of the tooth. When the root of the tooth is exposed, there is an increased risk for tooth sensitivity, cavities, tooth abrasion and abfractions! When this happens, taking care of the root surfaces and the gums is even MORE important, and it all starts with proper brushing and using the right tool for the job; an electric toothbrush with a pressure sensor! Most Oral-B electric toothbrushes have both a visible (flashing light) and physical pressure sensor. The brush will actually lower the power when it senses that you are brushing too hard, preventing damage to the gums and tooth surface. I linked an article below to go over all the Oral-B electric toothbrushes I recommend to my patients and use myself. Read Now: Receding Gums? Best Electric Toothbrush and Head to Use! I linked the toothbrush that I used for a long time below, which is such a great brush and includes a pressure sensor! If you want a bit more knowledge on the different electric toothbrushes to use, you can read my post linked above for more insight! What to look for when observing your gum tissue for damage from nicotine pouches Leukoplakia on the underside of the tongue. The border is irregular in shape, and it cannot be wiped off. On top of receding gums and gum disease, leukoplakia is a condition brought on by tobacco products, including non-smoking ones. Leukoplakia is a white lesion commonly found on the gums, is irregular in shape and cannot be wiped off. If you notice a white lesion similar to the one in the picture above that does not go away within 2 weeks, have it checked by your medical and dental practitioner! Because nicotine pouches are fairly new, there haven't been many studies or information on the possible carcinogenic properties of nicotine itself. However, changes have been observed in the mouth tissue caused by nicotine, so I would not discount it! Leukoplakia can become cancerous so checking for these lesions is so so so important! All I am asking is for you to be aware of what leukoplakia looks like, so you can keep an eye out because your oral health and overall health matter to me. :) Read Now: Can You Swallow ZYN Nicotine Pouches Spit? I wrote this post to give you more information about nicotine pouch use! You can read more about this study here. A quote from the study is below. NRT stands for nicotine replacement therapy, replacing tobacco use with nicotine in the form of gums, patches, vaping, sprays, lozenges and nicotine pouches. "The role of nicotine as a potential carcinogen is unknown. Use of NRT is associated with development of oral disorders, although it is rarely published." Check your mouth for lesions/changes in the tissue once a month As a dental hygienist, I have seen and sent many people to have biopsies done of tissue that doesn't look right and is most often related to nicotine and tobacco use. Please, check your oral tissues once a month using a bright light and a mirror. For any lesion that does not go away within 2 weeks or looks off and uneven, please book an appointment with your dental professional and bring it up to them. TIP: If you do notice any lesions or white areas that cannot be wiped off, take note of them and write down where in the mouth they appear, and when you first noticed it. You can make comments on how large it is and what colour it is as well. This will give your medical/dental professional good insight. Other oral health effects of ZYN/nicotine pouches The oral health effects of using nicotine pouches don't stop at gum issues but extend to the whole mouth, and some will surprise you! These changes don't happen all at once or immediately after starting to use nicotine pouches. Things could start to change 1 week after using them for 2 years. It really depends from person to person, the amount of usage, and oral health status. Using nicotine pouches can contribute to the following conditions; Cavities (decay) Irritation to the throat (from the different ingredients within the pouches) Bad breath Dry mouth Clenching and grinding (bruxism) (leading to tooth wear, cracked and broking teeth, and gum recession, tooth sensitivity) As a dental hygienist, I know that not everyone will change their habits and immediately quit using nicotine products. It's an extremely addictive chemical. My way of approaching patients who use nicotine products is not to preach about quitting and giving it up but to give them information and knowledge for what to look out for and beyond. We all have vices in life and small pleasures that we do not want to give up (mine is coffee). Will nicotine pouches stain your teeth? Nicotine pouches can stain your teeth. Over time, the nicotine salts within the pouch will be oxidized and will go from a pale colour to a dark amber colour. The darker the colour of the nicotine, the more it will cause yellow/brown stains on the teeth. However, nicotine pouches will stain less than traditional tobacco products such as smoking and smokeless tobacco. If you are worried about the staining on your teeth, don't jump to using whitening toothpastes as they are extremely abrasive and can cause irreversible damage to the gums and teeth. In the post linked below, I go into detail about everything you NEED to know about stained teeth and whitening! Read Now: Why Teeth Become Yellow and Whitening Tricks That Worsen It Periodontitis. Generalized gum recession due to bone loss from gum disease. What happens if you use ZYN/nicotine pouches with gum disease? If you know you already have gum disease, using nicotine products can worsen and expedite the destruction of the bone and gum tissue surrounding the teeth. With gum disease, most often, there will be gum recession, which leaves the tooth's root vulnerable to wear away, forming cavities and tooth sensitivity. Because the root surfaces are so much softer than the crown of the tooth, taking care to prevent wear is crucial. Rubbing on gum tissue as you speak and swallow can cause even more irritation. Over time, Irritation can cause inflammation, and the tissue will start to change to protect itself. Rubbing can lead to even more gum recession. Tips to prevent gum issues while using ZYN and other nicotine pouches Realistically, there will always be some people who will continue to use nicotine pouches because they enjoy them or are using them to ween off other tobacco and/or nicotine products. We all have a vice and small things we enjoy! If you use nicotine pouches, here are 7 tips to help prevent gum issues from nicotine pouches; Change the location of the nicotine pouch, so it is not always rubbing on the same spot. Try not to speak or move your mouth as much while the nicotine pouch is in your mouth; this will prevent the pouches from moving/rubbing along the gum tissue and teeth. Keep your mouth hydrated. Either by drinking water more frequently or by using a saliva substitute. Introduce xylitol mints/gums into your daily routine. Keep up with your at-home oral hygiene routine. Flossing at least 4-5 times a week (every day is best) and brushing 2 times a day, and for extra effectiveness, use an electric toothbrush with a pressure sensor. You can find the electric toothbrush that I recommend to my patients and that I use myself here on my adult dental resources page! Maintain dental hygiene and dental appointments, and be honest with your dental professional about your usage of nicotine pouches and/or tobacco products. Your dental professional will give you tailored advice and direction, which is 100% for you. Reduce the number of times a day you use the pouches. You can find the products that I recommend to my own patients on my Dry Mouth Dental Must-Haves page :) Always talk with your doctor and dental professional Everyone is so unique, and your personal situation will not be the same as the next person's. Having a full medical history and an in-person experience is superior to most of the information you can find online. The best advice that I can give is to speak to multiple health care practitioners, including your dentist and dental hygienist, so the information given to you is unique to you and your situation. Are nicotine pouches regulated by the FDA? Why does it matter? The FDA does not classify nicotine pouches as smokeless tobacco products (because there is no tobacco in them). Nicotine pouches don't have the same regulations and rules that manufacturers need to follow for tobacco products and their packaging. This allows them to make different flavours, make the packaging more appealing to buy, and don't have to put the same warnings and labels on the packaging that would normally help deter buyers from purchasing and educate them on possible health risks. And people are used to seeing the warnings on tobacco products, so when there are no major warnings on the packaging of nicotine pouches, it can lead to a false sense of security that they are okay to use and don't pose risks. The flavours that they come in can make us think that they are not harmful and more of a treat/candy. I was writing this in 2022, so the rules and regulations may change in the coming years as there is a growing demand for changes. I hope that this information in this post has given you some insight and knowledge about nicotine pouches. Have a wonderful day, Holly :)