A newly published systematic review and network meta-analysis by La Rosa et al. (2025) offers valuable insights into the oral health effects of non-combustible nicotine products (NCNPs). As these products gain popularity as reduced-risk alternatives to smoking, understanding their broader health impact—including on oral health—is critical for clinicians, policymakers, and harm reduction advocates alike.
The Study at a Glance
This peer-reviewed review analyzed data from 36 randomized controlled trials (21 included in meta-analyses) comparing NCNPs—such as nicotine gum, lozenges, sprays, e-cigarettes, and snus—with placebo, standard care, or each other. The primary aim was to assess oral adverse events including mouth ulcers, mucosal irritation, dry mouth, and general tolerability.
Key Findings
- No major increase in oral side effects: Across most products, NCNPs did not significantly increase oral adverse events compared to placebo or standard care.
- Specific concerns identified:
- Nicotine gum was associated with a higher risk of aphthous ulcers (OR 2.36, 95% CI 1.05–5.30).
- Mouth irritation was more commonly reported with e-cigarettes (OR 4.06), nicotine gum (OR 4.25), sprays (OR 4.36), and snus (OR 13.56).
- Quality of evidence: The review rated most findings as low to very low certainty, due to limited precision and potential reporting bias in the underlying trials.
Implications for Harm Reduction
This analysis provides the first comprehensive comparison of oral side effects across multiple NCNP types. The overall conclusion—that NCNPs are largely well tolerated and pose a lower oral health risk than combustible cigarettes—is encouraging for the harm reduction community. However, the presence of mild local effects (especially mouth irritation) warrants continued monitoring and education.
Policy and Clinical Relevance
- Dental and primary care professionals should be aware of potential oral side effects in patients using NCNPs and provide appropriate advice or follow-up.
- Regulatory authorities should consider both systemic and localized health impacts when assessing relative product risks and designing nicotine policy frameworks.
- Manufacturers may use these findings to inform product design and improve user tolerability.
Areas for Further Research
The study underscores the need for:
- Standardized outcome reporting for oral health effects in NCNP trials.
- Long-term studies assessing chronic oral impact.
- Broader inclusion of diverse populations and product types, particularly emerging pouch-based systems.
Conclusion
This systematic review adds an important dimension to our understanding of NCNPs, affirming their general oral tolerability while identifying areas for caution and improvement. For the global public health community focused on tobacco harm reduction, it reinforces the value of evidence-based, proportionate regulation grounded in scientific assessment of relative risk.
Reference:
La Rosa, E. C., et al. (2025). Oral health effects of non-combustible nicotine products: A systematic review and network meta-analysis of randomized controlled trials. Clinical Oral Investigations.
https://www.sciencedirect.com/science/article/pii/S0300571225003549
