Mathias Ahl, dentist
The results of the Stingfree study indicate that built-in gingival protection is beneficial for oral health. Therefore, I encourage dental colleagues to inform their snus-using patients according to the following recommendations:
- Snus-using patients with snus lesions should be discouraged from continuing to use snus.
- Inform patients that receding gums cannot regenerate
- Inform patients who are unwilling or unable to stop using snus that there are tablets available to protect against snuff lesions and gum irritation
- Advise patients who do not want to quit snus or use gum protection pills to regularly rotate the snus placement site.
The study is available for download at:
Acta Odontologica Scandinavica & National Library of Medicine (PubMed®).
Methodology
In May 2025, a study was published in which the participants were 23 Swedish dentists, who were themselves snus users. The study evaluated the effect of Stingfree Strong Blue Mint on oral health.
Each participant:
- filled in a form about their oral health & photographed their gums.
- swapped his regular snus for Stingfree for 5 weeks
- filled in a form about their oral health & photographed their gums.
The photographs were reviewed by independent dentists for assessment of snuff lesion according to the Axéll scale (0-4).
Outcome
The results of the 5-week use of Stingfree showed a clear improvement in gum health.
Before the test, four dentists had grade 4 snuff lesions on the Axéll scale and five dentists had grade 3.
After the test, no dentist had grade 4 or 3 snuff lesions. All had moved down the Axéll scale.
The Axell scale
To assess the severity of snuff lesions, Professor Tony Axell, a Swedish specialist dentist and researcher, has developed a four-step scale called the Axell scale. The scale is based on clinical and histological criteria, and divides snuff lesions into the following categories:
Grade 1: Slight change. The mucosa is smooth and whitish, without folds or wrinkles. Histologically, a thickening of the outermost layer of the mucosa is seen (keratinization)
Grade 2: Moderate change. The mucosa is whitish and has folds or wrinkles, but no red features or irregularities. Histologically, there is further thickening of the keratin layer, as well as thickening of the underlying
the connective tissue layer (fibrosis).
Grade 3: Severe change. The mucosa is whitish and has distinct folds or wrinkles, as well as red features or bumps. Histologically, there is severe thickening of the keratin and connective tissue layers, and inflammation of the mucosa (granuloma)
Grade 4: Severe change. The mucosa is whitish with deep folds or wrinkles, and red streaks or bumps that may be bleeding or ulcerated. Histologically, there is extreme thickening of the keratin and connective tissue layers, and severe inflammation of the mucosa with signs of cellular changes (dysplasia).
Figure 1: Snuff lesion injury grade 3 of 4.
Snus-using dentist 40-45 years old who uses an average of 9 cans of snus a week. The white wrinkled skin is known as a snuff lesion and was grade 3 or 4 on the Axell scale before the dentist tried Stingfree Strong Blue Mint.
Figure 2: Snus lesion O au 4 after 5 weeks of Stingfree.
Snus-using dentist 40-45 years old who uses an average of 9 cans of snus a week. The white wrinkled skin is known as a snuff lesion and was grade 3 or 4 on the Axell scale before the dentist tried Stingfree Strong Blue Mint.
Are you a dentist or dental hygienist?
Please contact us if you have any questions, would like the full report of our dental test or wish to participate in future Stingfree tests.