{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T02:53:39Z","timestamp":1791341619824,"version":"4.3.1"},"reference-count":41,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Oral Diseases"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Users of Swedish nicotine pouches and traditional oral tobacco\u2010derived pouches were compared to non\u2010users for clinical tissue responses and oral health status. In addition, the habits associated with snus use were also evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>In this cross\u2010sectional study, participants aged 18\u201330 were recruited from nine dental clinics: 126 nicotine pouch users, 63 oral tobacco\u2010derived pouch users, and 83 non\u2010users. Clinical examinations assessed mucosal changes and dental status, including erythema, ulceration, oedema, hyperkeratosis, etching, bone defects, and gingival recession. Participants completed a questionnaire on snus use, oral hygiene, and education. Tissue responses were graded and intergroup differences analysed. The study followed the STROBE checklist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Oral lesions were identified in 79% of nicotine pouch users and 89% of oral tobacco\u2010derived pouch users. Nicotine pouch users more frequently exhibited erythema and reported more oral symptoms, while hyperkeratosis predominated among oral tobacco\u2010derived pouch users. A non\u2010significant trend suggested mint\u2010flavoured nicotine pouches may be associated with more pronounced lesions. No increased risk of caries or periodontal disease was observed for \u2264\u20096\u2009years of use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nicotine pouches appear to induce broader mucosal responses than tobacco\u2010containing snus. Further research is needed to clarify local and systemic effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/odi.70409","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T17:15:28Z","timestamp":1782926128000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Oral Lesions and Dental Status in Individuals Using Oral Tobacco\u2010Free Nicotine Pouches"],"prefix":"10.1111","author":[{"given":"Masoumeh","family":"Daneshian","sequence":"first","affiliation":[{"name":"Public Dental Services Stockholm County Council  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Fredriksson","sequence":"additional","affiliation":[{"name":"Public Dental Services Stockholm County Council  Stockholm Sweden"},{"name":"Department of Dental Medicine Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Skott","sequence":"additional","affiliation":[{"name":"Public Dental Services Stockholm County Council  Stockholm Sweden"},{"name":"Department of Dental Medicine Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Garming Legert","sequence":"additional","affiliation":[{"name":"Public Dental Services Stockholm County Council  Stockholm Sweden"},{"name":"Department of Dental Medicine Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"issue":"4","key":"e_1_2_13_2_1","doi-asserted-by":"crossref","DOI":"10.1111\/eos.12885","article-title":"The Effect of a Non\u2010Tobacco\u2010Based Nicotine Pouch on Mucosal Lesions Caused by Swedish Smokeless Tobacco (Snus)","volume":"130","author":"Alizadehgharib S.","year":"2022","journal-title":"European Journal of Oral Sciences"},{"issue":"2","key":"e_1_2_13_3_1","first-page":"67","article-title":"The Influence of pH and Nicotine Concentration in Oral Moist Snuff on Mucosal Changes and Salivary pH in Swedish Snuff Users","volume":"27","author":"Andersson G.","year":"2003","journal-title":"Swedish Dental Journal"},{"issue":"8","key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1177\/1403494820919572","article-title":"No Association Between Moist Oral Snuff (Snus) Use and Oral Cancer: Pooled Analysis of Nine Prospective Observational Studies","volume":"49","author":"Araghi M.","year":"2021","journal-title":"Scandinavian Journal of Public Health"},{"issue":"4","key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1111\/j.1600-0714.1976.tb01769.x","article-title":"The Relation of the Clinical Picture to the Histopathology of Snuff Dipper's Lesions in a Swedish Population","volume":"5","author":"Axell T.","year":"1976","journal-title":"Journal of Oral Pathology & Medicine"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcph.70090"},{"key":"e_1_2_13_7_1","doi-asserted-by":"crossref","first-page":"2246","DOI":"10.1080\/01480545.2021.1925691","article-title":"Chemical Characterization of Tobacco\u2010Free \u2018Modern\u2019 Oral Nicotine Pouches and Their Position on the Toxicant and Risk Continuums","volume":"45","author":"Azzopardi D.","year":"2021","journal-title":"Drug and Chemical Toxicology"},{"key":"e_1_2_13_8_1","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/S1470-2045(08)70173-6","article-title":"Smokeless Tobacco and Cancer","volume":"9","author":"Boffetta P.","year":"2008","journal-title":"Lancet Oncology"},{"issue":"1","key":"e_1_2_13_9_1","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1111\/prd.12395","article-title":"Oral and Periodontal Implications of Tobacco and Nicotine Products","volume":"87","author":"Chaffee B. 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