Chemical Composition of Spitless Tobacco and Nicotine Pouch Products Commercially Available in Northern European and North American Markets: A Targeted Review of Manufacturing Processes and Harmonized Secondary Analysis Evaluating Impact on Dental Health

Abstract

Sales of moist snuff, snus, and nicotine pouch products (NPPs) have grown despite declining use of traditional tobacco products. We compare the differences in manufacturing processes and chemical composition of these products across North America and Northern Europe by performing a targeted review and harmonized secondary analysis of published datasets (2008–2025), evaluating implications for dental health. Reported values were unit-standardized; tobacco-leaf products were converted to dry-weight basis (DWB) where possible. Free nicotine (%) came from source data or was derived via the Henderson-Hasselbalch approximation (pKa 8.02). Conventional moist snuff exhibited the highest and most variable TSNAs, while snus generally showed lower TSNAs but substantial free-nicotine fractions at higher pH. NPPs were heterogeneous: most datasets reported basic pH and high free-nicotine percentages, and although TSNAs were frequently below detection limits, several products exceeded detection limits. Even where TSNAs and HPHCs are reduced (snus, NPPs), detectable toxicants remain. Prolonged use is linked to localized oral injury and periodontal risk; evidence for long-term outcomes is limited for NPPs. These findings underscore the need for greater regulation and education around the potential harms of all smokeless tobacco and nicotine products, including those positioned as harm-reduction alternatives. For dental practice, these findings support routine screening for mucosal changes and periodontal risk in users of moist snuff, snus, and nicotine pouches, with counseling on pH-driven free-nicotine exposure.