Patients ask us about vaping and Zyn more every year, and the honest answer starts with an admission: these products are newer than the research on them. You’ll find long lists online, and even in dental lectures, of everything vaping supposedly does to your mouth. Most of those lists were built from what we know about cigarettes. This page sorts out what has actually been shown in people who vape or use nicotine pouches, what hasn’t, and what we do about it in the chair.
The short answer: in studies so far, people who vape have gums somewhere between people who never used nicotine and people who smoke. Like smokers, they tend to bleed less when we check, so healthy-looking gums aren’t proof of healthy gums. Zyn and other nicotine pouches often leave a white or red patch where they sit. And the stronger the product, the more nicotine reaches your blood and the more hooked you get. A “mild” 4 mg pouch is already close to a cigarette.
We ask now
We now ask every patient about vaping and nicotine pouches, not just smoking. Plenty of people who use Zyn don’t think of it as tobacco, so it never came up. We ask without a lecture attached, for the same practical reason we ask about smoking: it changes how we read your gums and what we look for.
What vaping does to your gums
Several large reviews have compared the gums of people who vape, people who smoke and people who never used either. They agree on the order: smokers do worst, and vapers land somewhere in between. Whether vapers really differ from never-users is less clear. The largest review, of 40 studies, found no difference in gum pockets or bone loss, but more plaque and more signs of inflammation in vapers’ gum fluid.
Every one of those studies is a snapshot. No one has yet followed a large group of vapers for years with regular dental exams, so where the long-term risk to your gums settles isn’t known. Anyone who tells you confidently that vaping is safe for your gums, or just as bad as smoking, is ahead of the evidence.
Alkattan R, et al. Int Dent J. 2025;75(3):2014-2024. Thiem DGE, et al. Clin Oral Investig. 2023;27(9):4911-4928. Tattar R, et al. Evid Based Dent. 2025;26(2):117-118.
Why quiet gums aren’t reassuring
Bleeding is the ordinary early warning that gums are in trouble. People who vape tend to bleed less when we check their gums, much like smokers. That can make gums look healthier than they are, which is why we look at more than bleeding: pocket depths, X-rays, and how your gums change from one visit to the next.
Why vapers bleed less isn’t known. The common explanation, that nicotine squeezes the blood vessels in the gums, doesn’t hold up well. When researchers measured blood flow in smokers’ gums, it went up during a cigarette, not down, and people who use snus, a tobacco pouch held against the gum, have more gum inflammation, not less.
Shabil M, et al. BMC Oral Health. 2024;24(1):1197. Baab DA, Oberg PA. J Clin Periodontol. 1987;14(7):418-424. Bankvall M, Jontell M. Acta Odontol Scand. 2026;85:84-95.
Cavities
You may have read that people who vape get more cavities. The study behind most of those headlines, from a dental school, didn’t count cavities. It compared risk ratings: 79% of patients who vaped had been rated high risk for decay, against 60% of patients who didn’t. The only review pooling the studies that did count cavities found no clear difference, and called the evidence very low quality.
In the lab, though, sweet-flavored vape aerosol helped decay bacteria stick to enamel and softened it, behaving more like sticky candy than like plain air. So a higher decay risk from an all-day sweet vape is plausible, but it hasn’t been shown in people yet.
Irusa KF, et al. J Am Dent Assoc. 2022;153(12):1179-1183. Fernandez MDS, et al. Arch Oral Biol. 2025;178:106366. Kim SA, et al. PLoS One. 2018;13(9):e0203717.
Dry mouth
In a national survey of almost 30,000 US adults, people who vaped every day had nearly twice the odds of reporting frequent dry mouth. That’s a survey, so it can’t prove the vape is the cause, and a similar study in teenagers didn’t find the link once other factors were accounted for. But dry mouth is one of the biggest drivers of decay, and it’s worth telling us about. More on dry mouth and what helps.
Chaffee BW, et al. JDR Clin Trans Res. 2026;11(3):484-492. Chaffee BW, et al. Community Dent Oral Epidemiol. 2023;51(2):180-186.
Other things we look for
In one study of 90 dental patients, people who vaped more often had, compared with former smokers, irritation on the roof of the mouth, a coated tongue, and cracks at the corners of the mouth. Small study, but those are easy to check, and we do.
Bardellini E, et al. Acta Odontol Scand. 2018;76(3):226-228.
The longer lists you may have seen
Lists of what vaping does to your mouth often add low oxygen, a weakened immune system, bad breath and tooth grinding. Here’s where each stands for vaping specifically:
- Less oxygen to the gums: not shown. No one has measured it in people who vape. The few small studies that measured blood flow in the mouth found little or no lasting change.
- A weakened immune system: changes in markers, not in infections. The mix of mouth bacteria and some inflammation markers differ in people who vape, but no study has shown that leads to more gum infections.
- Bad breath: reported, not measured. In one large survey, people who vaped were more likely to say they had bad breath. In a small study, funded by a tobacco company, where trained judges smelled it, vapers’ breath was similar to nonsmokers’.
- Grinding: not studied. Smokers report more grinding than nonsmokers, and nicotine may play a role, but no study has looked at grinding in people who vape.
Reuther WJ, et al. Br J Oral Maxillofac Surg. 2016;54(3):338-341. Vámos O, et al. J Oral Biol Craniofac Res. 2024;14(2):152-157. Thomas SC, et al. mBio. 2022;13(1):e0007522. Saleh SM, et al. Sci Rep. 2025;15(1):20287. Dalrymple A, et al. Sci Rep. 2022;12(1):2204. Rintakoski K, et al. Nicotine Tob Res. 2010;12(6):679-683.
If you switched from cigarettes
Switching cuts out the smoke, and in the reviews so far, smokers’ gums do worse than vapers’. Don’t be surprised if your gums bleed more for a while after the switch. In one small two-week study, bleeding went up when smokers moved to vaping, the same thing that happens when people quit smoking outright. That’s your gums’ normal response coming back, not a sign of new damage. The one real switching trial for gums hasn’t published its results yet.
Wadia R, et al. Br Dent J. 2016;221(11):722-726.
Zyn and other nicotine pouches
Zyn, on!, Velo, Rogue and similar products are small fiber pouches of nicotine with no tobacco leaf, tucked between the gum and lip. In January 2025 the FDA allowed 20 specific Zyn products, at 3 mg and 6 mg, to be sold to adults. In the FDA’s own words, that doesn’t mean they’re safe or “FDA approved.” It doesn’t cover other brands or other strengths.
The spot where a pouch sits often turns white or red. In small studies, most people who used pouches had some change there, and the patches usually improved when people stopped or switched. We’d expect a Zyn patch to look like the one a tobacco pouch leaves. When I see one, I often send a small sample for a biopsy so we have a baseline to compare against later. A few case reports describe the gum pulling back where a pouch sits, but whether pouches cause that hasn’t been shown.
FDA news release, January 16, 2025. Rungraungrayabkul D, et al. BMC Oral Health. 2024;24(1):889. Daneshian A, et al. Oral Dis. 2026.
Pouch or vape?
If you’re choosing between the two, our view is that a pouch is probably the better of the two, mainly because nothing goes into your lungs. Vape aerosol has far fewer harmful chemicals than cigarette smoke, but it isn’t harmless. It can carry metals and fine particles deep into the lungs, teens who vape have more cough and wheezing, and the long-term effects on the lungs aren’t known yet. Your physician is the right person for the lung side of it.
But nicotine in high amounts is bad either way, and that’s the part people underestimate.
CDC, Health Effects of Vaping, January 31, 2025. National Academies of Sciences, Engineering, and Medicine. Public Health Consequences of E-Cigarettes. 2018 (Conclusions 5-3 and 11-4).
How much nicotine you’re getting
Nicotine is a real drug. A single dose sharpens attention a little, which is part of why it’s so easy to get hooked. When researchers tested nicotine patches as a treatment for memory loss and for Parkinson’s disease, they didn’t work.
What clearly scales with the dose is how much nicotine reaches your blood and how hooked you get. A “mild” 4 mg pouch delivers close to the nicotine of a cigarette, and pouches of 8 mg and up deliver more. Some pouches sold in Europe have measured as high as 47.5 mg. The number on the can doesn’t even tell the whole story: two 5 mg pouches from different brands gave very different blood levels.
For long-term risk, though, years of use matter at least as much as the amount. In a study of Swedish men who used snus, the risk of dying rose with how many years they had used it, not with how much they used each week. So a low-dose habit isn’t a safe one.
If you’re a teenager, pregnant, or don’t use nicotine now, there’s no safe amount to start with. If you already vape or use pouches and aren’t ready to stop, tell us. Lower strengths and fewer of them mean less nicotine, and we’ll keep an eye on the spot where the pouch sits.
Heshmati J, et al. Drug Alcohol Depend Rep. 2025;17:100389. Mallock N, et al. Tob Control. 2024;33(2):193-199. Keller-Hamilton B, et al. Addiction. 2025. Byhamre ML, et al. Int J Epidemiol. 2021;49(6):2041-2050. MIND trial, ClinicalTrials.gov NCT02720445. Oertel WH, et al. NEJM Evid. 2023;2(9).
For parents
- It’s common. In the 2025 national youth survey, about 1 in 14 high school students vaped, and more than a quarter of them vaped every day. Fewer used pouches, and most of those used Zyn.
- It hooks fast. Teens can show signs of addiction within days of starting, even without using every day.
- Pouches poison toddlers. Swallowed nicotine pouches are a fast-growing cause of poisoning in young children. Keep them where kids can’t reach.
FDA, Results from the 2025 National Youth Tobacco Survey. DiFranza JR, et al. Arch Pediatr Adolesc Med. 2007;161(7):704-710. Olivas M, et al. Pediatrics. 2025;156(2):e2024070522.
What we do in the chair
- We ask about vaping and pouches at your exam, along with smoking.
- We look past bleeding: pockets, X-rays, and changes since your last visit.
- We check the spot where you tuck a pouch at every exam.
- If you’re having surgery, tell your surgeon you vape or use pouches.
Smoking is a different story, with far more research behind it. How smoking affects your teeth and gums.
Where to start
If you vape or use pouches and want to know how your gums are really doing, call 702-734-0776. If you’re thinking about stopping, free phone coaching is available at 1-800-QUIT-NOW (1-800-784-8669).
General education, and not a substitute for an exam.