MODERN NICOTINE DELIVERY SYSTEMS (E-CIGARETTES AND NICOTINE POUCHES) AND THEIR EFFECTS ON ORAL TISSUE: A LITERATURE REVIEW

Abstract

Introduction and Purpose: The global decline in traditional tobacco smoking has been accompanied by a rapid increase in the popularity of modern, tobacco-free nicotine delivery systems, primarily electronic cigarettes (ENDS) and oral nicotine pouches. Marketed as safer alternatives and available in numerous flavors, these products highly appealing to adolescents and young adults. The purpose of this narrative review is to evaluate and compare the impact of electronic cigarettes and tobacco-free nicotine pouches on oral health, focusing specifically on the oral microbiome, mucosa, periodontium, and dental Materials and Methods: A comprehensive review of the current literature was conducted. Relevant scientific articles, including in vitro studies, clinical evaluations, and systematic reviews, were analyzed to assess the pathophysiological mechanisms, cytotoxicity, and clinical oral manifestations associated with the exposure to e-cigarettes aerosols and the chemical components of tobacco-free nicotine pouches. Conclusions: Modern nicotine delivery systems are not safe smoking alternatives. ENDS disrupt the oral microbiome promoting periodontal pathogens and cariogenic bacteria. E-cigarettes induce mucosal lesions and enamel demineralization, while masking periodontal inflammation via vasoconstriction. Conversely, nicotine pouches cause cytotoxicity, mucosal keratosis, and severe, site-specific gingival recession independent of oral hygiene. Given these risks, there is an urgent need for  long-term clinical studies and proactive patient education by dental professionals to debunk misconceptions regarding their safety.