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These lesions are reversible after cessation. This study evaluated the effects of two non-tobacco-based nicotine pouches (ZYN\n                      <jats:sup>\u00ae<\/jats:sup>\n                      Dry and ZYN\n                      <jats:sup>\u00ae<\/jats:sup>\n                      Moist) on SIL severity, salivary cytokines, epithelial thickness, and inflammatory cell presence after 28 days of exclusive use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      In this open-label, randomized longitudinal study, 45 daily snus users were assigned to either the dry formulation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200923) or the moist formulation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200922) for four weeks. Clinical assessments were performed at baseline, day 14, and day 28. Lesions were graded on a four-point scale. Biopsies and saliva samples were collected at baseline and day 28.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both groups showed significant improvement in lesion severity (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). No significant changes were observed in epithelial thickness, inflammatory cell infiltration, total protein levels, IL-1\u03b2, TNF-\u03b1, or MCP-1. IL-8 levels increased significantly in the dry formulation group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Switching to nicotine pouches improved SILs without major changes in the inflammatory markers assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical relevance<\/jats:title>\n                    <jats:p>Nicotine pouches were associated with improvement of snus-induced lesions in this study population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ISRCTN13243849, registered 01\/09\/2022.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00784-026-07087-0","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T08:08:14Z","timestamp":1787386094000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Oral health effects of nicotine pouches in snus users: clinical and immunological findings"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1587-9508","authenticated-orcid":false,"given":"Sara","family":"Alizadehgharib","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9457-988X","authenticated-orcid":false,"given":"Anna-Karin","family":"\u00d6stberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5915-734X","authenticated-orcid":false,"given":"Anna","family":"Lehrkinder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3620-1288","authenticated-orcid":false,"given":"Jisha","family":"Varghese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2497-8783","authenticated-orcid":false,"given":"Taha Abdul","family":"Jabar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2264-5269","authenticated-orcid":false,"given":"Filip","family":"Ilver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0798-8520","authenticated-orcid":false,"given":"Peter","family":"Lingstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,22]]},"reference":[{"key":"7087_CR1","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1111\/j.1600-0714.1989.tb01349.x","volume":"18","author":"G Andersson","year":"1989","unstructured":"Andersson G, Axell T, Larsson A (1989) Histologic changes associated with the use of loose and portion-bag packed Swedish moist snuff: a comparative study. 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The authors declare no other competing interests.","order":5,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"407"}}