A nicotine pouch is placed between the upper lip and gum to deliver nicotine.
このページを で読む
Leading Japanese oral health experts have voiced growing concern over the sale of nicotine pouches—small white packets placed inside the mouth to deliver nicotine—at convenience stores and other retailers.
While switching from cigarettes to nicotine pouches may reduce the risk of lung cancer, they warn that the risk of oral cancer and other diseases cannot be ruled out either.
Although oral cancer is relatively easy to detect in its early stages, advanced cases often require extensive surgery that can permanently alter a patient's appearance and make eating, drinking, and speaking difficult.
"Like other cancers, oral cancer can be life-threatening. But what makes it particularly devastating is that if extensive surgery is required, patients can lose much of their ability to lead the normal lives they once led," said Kazuhito Satomura, president of the Japanese Society of Oral Medicine.
He stressed that "the surest way to reduce the risk is to avoid using tobacco in any form."
The Risks of Smokeless Tobacco
Nicotine pouches belong to the broader category of smokeless tobacco products. Placed between the upper lip and gum, they are not burned and therefore produce no smoke or odor.
Tobacco companies market them as a way to consume nicotine in smoke-free environments or where consideration for passive smoking is required. They also say that while long-term health studies are still lacking, the products may reduce smoking-related health risks compared with conventional cigarettes.
Oral health specialists, however, remain concerned. Kazuto Hoshi, president of the Japanese Stomatological Society, noted that nicotine is highly addictive and can affect development and reproduction.
"Because these products remain in the mouth for long periods, there are concerns about their effects on the oral mucosa," he said. "Their potential carcinogenicity is also a concern."
Most oral cancers develop gradually as cells become malignant, often following precancerous conditions such as leukoplakia, a lesion of the oral mucosa. Tongue cancer is the most common type in Japan, accounting for about half of all oral cancer cases.
Impact on Quality of Life
Because lesions can be seen and felt directly, early detection is generally possible. However, the disease progresses rapidly, and surgical removal remains the primary treatment. Some patients require the removal of large portions of the jaw, tongue, or other oral tissues, followed by reconstructive surgery using tissue taken from the thigh or elsewhere.
In addition to dramatic changes in appearance, their ability to eat, drink, and speak may be severely impaired, resulting in a significant decline in quality of life.
Hiroyuki Harada, president of the Japanese Society of Oral and Maxillofacial Surgeons, examined the smoking histories of 1,642 oral cancer patients treated over the 20-year period ending in 2020. He found a strong correlation between smoking and cancers of the tongue and the floor of the mouth.
"It has long been established that holding chewing tobacco against the inside of the cheek can cause cancer of the buccal mucosa," said Tetsu Takahashi, executive director of the Asian Association of Oral and Maxillofacial Surgeons.
Higher Rates in South Asia
According to the latest Global Cancer Statistics (2022), the incidence of oral cancer among Japanese men is about 2% to 3%, compared with 12% to 15% among men in South Asian countries such as India and Sri Lanka.
The higher incidence in those countries has been linked to the widespread use of betel nut and chewing tobacco. In addition to betel nut's carcinogenic properties, its hardness causes chronic friction against the inside of the cheek, which is also thought to contribute to cancer development.
Sweden has the world's highest use of oral smokeless tobacco products. According to the Swedish Council for Information on Alcohol and Other Drugs (CAN), the country's daily cigarette smoking rate among people aged 17 to 84 fell below 5% in 2025. Meanwhile, daily use of snus, a traditional smokeless tobacco product placed under the lip, rose to 19%. Overall, 24% of the population used nicotine every day through cigarettes, snus, or e-cigarettes.
Sweden's Experience
According to Toru Nagao, an oral surgeon who heads the Tobacco- and Nicotine-Free Dental Research Committee, a Swedish epidemiological study published in 2007 found that switching from cigarettes to snus reduced the incidence of lung cancer while increasing the risk of pancreatic cancer.
At the time, snus was not believed to increase the risk of oral cancer. Since then, however, cases have been reported in which people who used snus for more than 40 years developed oral cancer on the lips or gums where the product was placed.
Nagao said cancer develops over many years and is influenced by numerous factors, including the frequency and type of tobacco use, alcohol consumption, and oral hygiene. He noted, however, that the International Agency for Research on Cancer (IARC), part of the World Health Organization (WHO), classifies smokeless tobacco—including snus—as a Group 1 carcinogen, meaning there is sufficient scientific evidence that it causes cancer.
The white nicotine pouches introduced in Japan in recent years resemble traditional brown snus in appearance, but differ in composition. According to Japan Tobacco Inc., the products are made from plant-derived fibers blended with powdered tobacco, nicotine extracted from tobacco leaves, and flavorings.
Push for Stronger Regulation
Modern nicotine pouches use plant fibers rather than tobacco leaf as their main ingredient. They have been on the market for only about a decade, having first been introduced in Sweden in 2016, so little is known about their long-term health effects.
According to a WHO report released in May, global retail sales of nicotine pouches exceeded 23 billion units in 2024, up more than 50% from the previous year. The global market was valued at about $7 billion in 2025.
Leaders of Japan's oral health societies are particularly concerned that the products could become popular among young people. They are calling for warning labels featuring photographs of patients who have undergone oral cancer surgery and for authorities to monitor whether manufacturers are engaging in excessive promotional activities.
Kanichi Seto, director of the Oral Cancer Treatment Center at Southern Tohoku General Hospital, warned that repeatedly placing highly irritating substances in the mouth over many years can eventually cause lesions that may develop into cancer.
"The oral mucosa readily absorbs substances, so nicotine may directly affect vital organs, including the heart," he said, adding that the public needs to be made more aware of these risks.
Author: Yuko Kano, The Sankei Shimbun
このページを で読む
