A comprehensive clinical study from Karolinska Institutet and Stockholm Public Dental Service definitively debunks the myth that tobacco-free white snus (nicotine pouches) is gentle on the mouth. The study shows the alarming result that a full 79 percent of young users suffer from damage and sores on their oral mucosa – even though the average age of the participants is as low as 22 years.
How does white snus affect your oral health?
The scientific study, which was published in the international journal Oral Diseases, has investigated young adults with an average age of only 22 years. Results show on a database basis that the chemical and biological impact of nicotine pouches is significantly more aggressive than the industry previously wanted to claim.
Researchers conclude that it is not nicotine itself that damages the gums. Instead, it is the combination of high concentrations of Flavors (especially mint and menthol) along with the necessary chemicals used for pH regulation. A high and alkaline pH is an absolute requirement for the soft tissues in the oral cavity to absorb nicotine effectively, but this chemical composition simultaneously causes irritation and tissue damage to the mucous membrane.
The study's most important findings:
- Receding gums (Gingival recession): Nearly 50 percent (every other user) aged 18–30 have experienced permanent gum recession at the place where the snus pouch is placed.
- Comparison with non-users: Among those who do not use any nicotine products at all, the prevalence of receding gums was only 6 percent.
- Irreversible damage Receding gums never grow back, leading to exposed tooth roots, chronic sensitivity, and a long-term risk of tooth loss.
- Shorter time but worse injuries: Users of white snus have the pouch in their mouth for an average of 11–30 minutes, compared to tobacco snus users who often keep it in for up to an hour. Despite the white snus being under the lip half the time, it causes equally severe or worse tissue damage due to its aggressive chemical composition.
- Aggressive inflammation versus ”snuffly skin”: While traditional tobacco snus most often causes a local hardening of the mucous membrane (hyperkeratosis) as a biological protective reaction, white snus causes a significantly more aggressive biological reaction. Users more often suffer from intense redness (erythema), inflamed salivary glands, and open sores (ulcers) that spread far beyond the pouch's placement.
Growing international concern and a French total ban
Scandinavian research shows a clear scientific consensus. Results are supported by a previous Norwegian study on teenagers where over 79 percent also exhibited snus-related lesions , as well as research led by Professor Gita Gale at the University of Gothenburg. Gale's research shows that white snus triggers long-lasting inflammation that is difficult to heal even after the user stops..
These medical discoveries have already had major international political consequences. With reference to the extensive oral health problems, the French government decided to ban completely nicotine pouches. However, this type of ban has faced criticism for being deeply unscientific, as lethal smoking remains completely permitted in the country – despite smoking being proven to both shorten life and severely impair oral health at a completely different level than smokeless alternatives.
New technology demonstrably reduces the occurrence and severity of injuries.
Since the damage from white snus is proven to be chemical , they will be addressed through changed product design. Here, new Swedish barrier technology (Protex®) shows how the occurrence and severity of damage to the oral mucosa can be proven to be reduced.
An independent international clinical study published in Acta Odontologica Scandinavica shows a significantly reduced incidence and severity of injuries. By integrating an ultra-thin protective barrier on the prill's gum side – the patented Swedish technology Protex® – this blocks direct chemical contact between the white snus contents and the oral mucosa. Flavor and nicotine are instead effectively delivered via the other side of the pouch.
It is worth noting that in the clinical study on Stingfree lozenges, products with mint and menthol flavors were used.. The new independent KI/Public Dental Service study shows that this particular flavor profile is extra aggressive and linked to more prominent tissue changes.. The fact that the barrier technique showed such strong clinical results despite the use of the most challenging flavor profile makes the findings from the Stingfree study even more remarkable.
When the technology was clinically tested on Swedish dentists who use snuff, the results after five weeks of use showed very high effectiveness.:
- High scientific certainty (p=0.0002): Studies prove with 99.98 percent statistical certainty that the observed reduction in injuries was due to the protective barrier, not to chance.
- 90 % reduced perceived irritation: Participants' subjective experience was that snus with the Protex® barrier reduced gum irritation by 90 percent compared to their previous snus use.
- Clinically proven healing and reduction of inflammation: Studies showed comprehensive healing of the oral mucosa in participants with moderate to severe snuff-induced lesions (Grade 3-4 on the Axell scale), as well as a very significant reduction in gingivitis.
Comment from Bengt Wiberg, founder and Chairman of the Board of Stingfree AB: ”Mouth sores should not be the price you are forced to pay for quitting smoking.. At 8 out of 10 young users being affected, despite the products being in the mouth for a shorter time, proves that today's snus has a pure design flaw.. When heavy international expertise now shows that there is proven technology that reduces direct contact with the contents of portion bags, the industry can no longer simply turn a blind eye to consumer safety..”
Protex® technology is currently patent-approved in the USA and in 36 European countries..
Clinical resources and sources
- KI/Public Dental Service Study (2026): ”Oral Lesions and Dental Status in Individuals Using Oral Tobacco-Free Nicotine Pouches” – Oral Diseases, Wiley.
- The Clinical Barrier Study (2025): ”Self-reported oral health outcomes after switching to a novel nicotine pouch technology: a pilot study – La Rosa et al., Acta Odontologica Scandinavica.
- University of Gothenburg: Professor Gita Gale's research on long-term inflammation from white snus.