Oral Nicotine Pouch Use and Associations with Periodontal Status and Salivary Microbiome Dysbiosis

Oral nicotine pouches (ONPs) are increasing in use, yet data on potential oral health effects are scarce. We evaluated whether ONP use is associated with clinical periodontal measures and salivary microbiome dysbiosis in a field-based regional sample. We recruited firefighters, as this population has historically featured an elevated prevalence of oral tobacco use.

In this preliminary, cross-sectional study, 26 eligible participants (100% male; ages 26-53 y) were enrolled from fire stations near Sacramento, California (USA), in April-May 2025. Clinical measures from full-mouth periodontal examinations (probing depth, gingival margin position, clinical attachment loss, bleeding on probing) were compared between ONP use (≥15 in the past 30 d, no more than minimal use of other tobacco, n = 12) and tobacco nonuse (n = 14) groups. We conducted 16S rRNA gene amplicon sequencing of saliva samples to determine genus-level profiles using differential abundance testing and Bray-Curtis beta diversity analyses.

Clinical periodontal measures were numerically worse with ONP use, including a higher percentage of sites with ≥3 mm clinical attachment loss (P = 0.009). Across all samples, approximately 130 genera were detected (Streptococcus most abundant). ONP use (vs. tobacco nonuse) was associated with higher abundance of Comamonas, Alloscardovia, F0058, and Dialister and lower abundance of the [Eubacterium] sulci group, Aminipila, Mannheimia, and Peptostreptococcus. Principal coordinates analysis showed substantial overlap between groups, whereas beta dispersion was lower in the ONP group (P = 0.035).

In this hypothesis-generating study, ONP use was associated with worse periodontal status and salivary microbiome shifts. While these results await confirmation in future studies and additional populations, they suggest plausible oral health risks that should be incorporated into any comprehensive assessment of potential ONP harms.Knowledge Transfer Statement:Although preliminary, these findings provide some of the first evidence that use of oral nicotine pouches is associated with indicators of worse periodontal health. These results should encourage further research to confirm these signals and clarify potential mechanisms. Patients, providers, and product regulators should include oral health when evaluating the risk profile of this product.