Tuesday, January 16, 2024

Zyn: Beyond the Nicotine Buzz - Potential Oral Health Risks for Your Patients


 For probably the last 5 years or so... most likely more, the concern for high schoolers and nicotine has been vaping.  It seemed that once cigarettes became more heavily regulated (and somewhat uncool to boot), someone figured out a different way to deliver nicotine to customers.  The idea of living on the edge has always been something that is attractive to young folks.

Have you heard of Zyn yet?  Until recently I had not.  However, once I heard about it, I decided to do some checking.  While today's post is by no means scientific, it certainly is culled from what I learned about the product from the comfort of my desk and doing some searches.  What really triggered my interest is when I learned that in 2022 Phillip Morris International (PMI) acquired the company Swedish Match for a rumored $16 billion (with a B).  That acquisition meant that Swedish Match, which manufacturers Zyn, was now owned by a huge corporate powerhouse that has made a large portion of their profits from products that contain nicotine.

Zyn pouches, the sleek, flavored nicotine pouches seemingly taking the world by storm, have become a popular alternative to traditional cigarettes and vaping among teenagers and young adults. While marketed as "smoke-free" and "tobacco-free," these products pack a hidden punch, especially for your dental patients. As dental professionals, it's crucial to be aware of the potential oral health risks Zyn poses and effectively communicate them to your patients.

A Nicotine Trojan Horse in Disguise:

Zyn pouches may not contain tobacco leaves, but they're far from harmless. Each pouch is loaded with synthetic nicotine, highly addictive and capable of wreaking havoc on the developing brain and body. Studies have linked nicotine use to numerous health problems, including:

Gum recession and tooth loss: Nicotine constricts blood vessels, limiting blood flow to the gums and supporting tissues. This can lead to gum disease, bone loss around the teeth, and eventual tooth loss.

Increased risk of oral cancer?:  While nicotine is not a known carcinogen, it can be involved in promoting the growth and spread of cancer cells.  According to a study that can be read on the NIH website:  

At present, it is not possible to draw a conclusion whether nicotine itself may act as a complete carcinogen. In mice studies with NNK as an initiator, nicotine acts as a promoter after injection or dermal absorption, but not after oral administration. In drinking water experiments, there is considerable first-pass metabolism of nicotine before nicotine enters the systemic circulation. As a result, serum concentration is much lower after ingestion than after i.p. administration. Nicotine enhanced tumor growth and progression after injection of malignant cells in mice. Enhancements were found both after exposure of nicotine by i.p. injection, oral, and skin administration. Moreover, cotinine did also enhance tumor growth.

While the long-term cancer risk of Zyn is still being studied, any nicotine exposure raises concerns... especially in young humans whose bodies are still undergoing growth and development.

Sensitivity and staining: Zyn's high acidity and abrasive ingredients have the potential to wear down tooth enamel, leading to increased sensitivity to hot and cold. The pouches can also stain teeth, impacting aesthetics.

Beyond the Individual:

The popularity of Zyn among teenagers is particularly alarming. Its candy-like flavors and discreet use make it an attractive gateway to nicotine addiction and potentially more harmful tobacco products later. As dental professionals, we have a responsibility to educate our young patients and their parents about the dangers of Zyn and advocate for stricter regulations to curb its accessibility.  It seems to be advertised heavily on TikToc and the social media advertising algorithms have it popping up on teens phones frequently.

My Take:

My nicotine story is a bit interesting for someone in healthcare.  I grew up when "dipping" was a huge thing socially.  There were lots of young men in my circle of friends and acquaintances who constantly carried a can of smokeless tobacco with them... and I was one of them.  When I started dental school I was "a closet chewer" who used smokeless tobacco, but hid it from most people.  I knew it wasn't good for me, but in my 20's I was "bulletproof" and I was convinced I "would live forever".  Even though I knew it was a poor choice I thought I would be the one who would never have to deal with adverse consequences of that action.

Then one day I was sitting in a lecture about Oral Pathology and the instructor began to discuss oral cancers.  Over the next few lectures we covered all the different forms of the disease and many of the known causes.  I can still remember the turning point for me.  The screen at the front of the room showed a horribly disfigured man.  His cancer had been severe and the only chance of survival was a procedure called a "hemi-mandiblectomy" which was a surgical procedure that removed half of the patient's lower jaw.  The disfigurement was startling and frightening to me.

Suddenly, out of the blue, it occurred to me that the result on the screen was not something the patient had ever expected would happen to him.  No one would want that.  No, the patient on the screen had been just like me, expecting "that won't ever happen to me".

The result for me was that I stopped "dipping and chewing"... and it wasn't easy.  I had no idea how addictive nicotine is  Quitting was awful.  I don't remember how long it took before the nicotine cravings left me, but it was a long time.  

We are all a sum of our experiences and my experiences began to create in me an interest in early detection systems for oral cancers.  Of course one of the potential contributing factors is nicotine.

I make it a point to tell my patients who use smokeless tobacco that I once was just like them.  I tell them, "I will never guilt you or lecture you about this.  Everyone knows this is bad for you.  If you ever want to try to quit, I'm here for you and there are cessation programs that can be very effective."  

We all know the easiest way to stop a bad habit is to not start it in the first place.  Studies I've seen over the years have shown that the earlier a patient gets a nicotine addiction, the harder it is for them to stop.  Hopefully I've given you enough information today that you are encouraged to do some research on your own and that this can help you talk to your young patients about this.

In closing, I'd like to provide 3 links.  The first 2 are from "big media" companies.  Those are the New York Times and GQ.  I salute both publications for bringing this topic to light.  New to the market products used by young people usually take a pretty long time to come to the attention of anyone over 30, but both the NYT and GQ are out in front of this story.  The third article is what I really find interesting.  It is a story that appeared in The Harbinger which is the student publication of Shawnee Mission East High School.

I discovered the Harbinger story while I was reading the NYT piece and I was delighted to see it.  First of all, SME is just a few miles from my home and is located on the Kansas side of the Greater Kansas City area.  The piece is incredibly well written and it brings the perspective of a high school senior to this subject.  It's one thing for "old people" to wring their hands and talk about how the latest trend is corrupting the youth.  It is another to see something written by a young man who is "in the trenches" and seeing this subject up close.  The piece is very well written and brings some really fascinating information to the reader.

  1. Our Kids are Living in a Different Digital World - from the New York Times
  2. Why Are Zyn Nicotine Pouches Suddenly Everywhere?  - from GQ
  3. A Smokeless Buzz:  A rise in oral nicotine pouch use raises health concerns for high schoolers - from The Harbinger - The Student Publication of Shawnee Mission East High School

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