What is snus? And what is the impact of this tobacco product on oral health?

What is snuff?

Snus is a tobacco product.

A rectangular pouch containing powdered tobacco is tucked under the upper lip to allow nicotine to be absorbed into the bloodstream.

The nicotine content of snus varies from a few milligrams to over 25 milligrams per gram. The most common amount is about 7-8 mg.

In 2018, for the first time, there were more registered snus users than smokers in Norway.

In 2021, 20% of adult men aged 16 to 74 used snus daily. Women: 7%.

The daily frequency of snus use in Norway is 10 servings per day.

(Image source: Encyclopedia of Norway)

There is still a lot we don’t know about the effects of snuff on human health.

One thing is for sure, however: Many snus users find that their dentists can detect their snus use.

So how harmful is snuff to your gums?

Want young people to understand the consequences of using snus

In a study published in February 2023, Norwegian researchers surveyed nearly 1,400 people between the ages of 18 and 20.

They were visiting the dentist when they were asked to participate in the study. Just over 200 participants used snus daily.

Simen E. Kopperud is one of the researchers on this study. He works at the University of Oslo (UiO) and the Nordic Institute for Dental Materials. He is also a dentist and said one of the aims of the study was to be able to use the findings to educate young people about the effects of snus use.

He himself sees many snus-related lesions in his clinic.

A 20-year-old woman who uses snus daily. The gums above her canine teeth on the left side of the photo are receding.

Average use of snus for three years

“We mainly wanted to be able to show local effects in the mouth. If the teeth and gums are affected soon after starting snus use, this may outweigh the risk of long-term health effects in younger people,” Kopperud said.

Young people in the study had been using snus for an average of three years.

Researchers found that many changes can occur in the gums in such a short period of time. Copperud was not surprised.

Revealing occasional snus users

“This number is somewhat expected; I see this in the clinic as well,” Kopperud said.

He could almost always tell whether a patient was using snus by looking at his teeth and gums.

“Some patients tell me they only use snus at parties,” Koperud said.

Even then, it is often visible.

“In clinical practice, when I examine the mucosa and see snuff-related damage, I always comment on it,” he said.

You can also look in the mirror and check yourself. You can lift your upper lip and see that your gums are white and wrinkled where you would normally place your snuff bag.

“Hopefully this will be an incentive to stop using snus,” Koperud said.

On January 18, 2024, the national newspaper Aftenposten published an article about snus use data from Statistics Norway. The figures show that snus use has doubled in Norway over the past decade. The biggest increase is among young people.

Snuff was sold in cans with lids for storing used snuff bags.

Snuff was sold in cans with lids for storing used snuff bags.

The more you use, the worse the results

In this study, Kopperud and colleagues distinguished between snus in bulk and snus in prepackaged bags. However, few people use bulk snus.

This means it is impossible to check which type of snus is more harmful to the gums. Participants were also asked how often they used snus.

“Research shows that the more snus cans used, the more severe the damage is,” he said.

The researchers also distinguished two different types of damage. One is changes in the gum surface, where the gums become white and wrinkled.

particularly vulnerable groups

One in five snus users suffered more severe impairment. These people have gum recession around some of their teeth, exposing more of their tooth surface.

“This is more severe damage because it's permanent,” Koperud said.

One group is particularly vulnerable: boys.

“We speculated whether it was the concentration of the snus – snus with higher nicotine content was more concentrated,” he said.

He clarified that this was pure speculation. He thinks it could also be because little boys hold the snuff under their lips for longer than other users.

Follow-up research may be closer to a clear answer.

developing quite fast

The risk of this damage increases with the number of months and years a patient uses snus. However, a significant number of people develop this type of damage after an average of three years of use.

However, there is a glimmer of hope for those who manage to stop using snus.

“When you stop using snus, the oral mucosa regenerates very quickly,” Koperud said.

This means that smaller lesions with white and wrinkled gums will return to normal again. Koperud said that could happen within weeks or months.

There is also hope for gum recession. Admittedly, it’s not without effort.

Snus use doubled in ten years. Politicians are trying to solve the problem: prices are getting higher and cans come in less and less color.

Quitting smoking is critical to achieving positive outcomes

“You can help restore the gums, but this requires a minor surgery,” Anders Verket told sciencenorway.no. He is an associate professor in the Department of Clinical Dentistry at Ohio University.

He said the surgery was not guaranteed to be successful. One thing is for sure:

“This obviously requires you to stop using snus; otherwise, nothing will grow back,” he said.

Poor oral hygiene may increase risk

In addition to conducting research, Verket also works as a dentist. He shares Copperud's view.

“You can tell in their mucous membranes that some people are snus users. They develop a characteristic pattern under their lips. The change is reversible in almost everyone,” he said.

He believes some people may be more susceptible to such damage or changes.

“Some people have very thin bones and very thin gums,” he explains.

Weak gums may be more susceptible to damage than strong gums.

I'm also pretty sure that poor oral and dental hygiene increases the risk,” he said.

Poor dental hygiene increases the risk of gum inflammation. This in itself is a risk factor for gum recession.

Using snus increases additional risks. Verket clarified that there has not yet been enough research on these issues to draw firm conclusions.

Limited research

Overall, studies have shown that there are few problems associated with snus, except for the possible whitening, wrinkling, and receding of the gums.

“But in my opinion, this is one of the areas where too little research has been done. While we can't prove that there is an increased risk of gum disease, that doesn't mean there isn't a risk,” Verket said.

The gum disease he was referring to was periodontitis. This is a chronic inflammation of the gums that causes gum damage.

Snus is used in many parts of the world, but not in Scandinavia.

Verket said studying the damage caused by different types of snus is difficult.

It's also not a concern for the international community, as Norway and Sweden are the only countries that consume significant quantities of the type of snus used in Scandinavia.

refer to:

Koperud et al. “Oral pathology associated with daily use of snus, a moist smokeless tobacco product. A cross-sectional study of Norwegian adolescents, Acta Scandinavian Dentistry2023.


Translated by Nancy Basilchuk

Please visit forskning.no to read the Norwegian version of this article

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