Smokeless tobacco, real risks: evidence on the impacts of snus on oral health

The use of smokeless tobacco, particularly snus, has gained popularity as an alternative to conventional cigarettes and is often promoted as a harm reduction strategy. However, its effects on oral health remain controversial and are not widely discussed among oral health professionals and educators. This systematic review aimed to gather and critically analyze the scientific evidence on the impact of snus on oral health. A structured search was conducted in four databases (PubMed, SciELO, Scopus, and ScienceDirect) using controlled descriptors and combinations of relevant keywords. Fourteen studies published between 2015 and 2025 were included, comprising systematic reviews, observational studies, in vitro research, and pharmacokinetic trials. The results indicate associations between snus use and oral lesions, gingival inflammation, dental staining, high nicotine absorption, and, in some cases, a potential risk for oral cancer. The presence of toxic compounds and the early use of snus among adolescents highlight the need for more effective educational, regulatory, and clinical measures. It is concluded that snus is not harmless to oral health and should be addressed in tobacco control strategies and in the training of public health and preventive dentistry professionals.