Small, White, Invisible, and Painless

Two studies published in 2025, separated by 4,500 kilometers, outline the contours of an expanding chemical intimacy. In Riyadh, a survey of more than 800 adults revealed that nicotine pouches are already circulating among young smokers, though surrounded by doubts and a lack of knowledge. In Stockholm, a pilot trial with 23 dentists showed that a minimal innovation—a thin waterproof membrane—can tangibly reduce oral irritation.

Fragments of evidence that, when placed in dialogue, do not announce either an immediate threat or salvation, but rather the possibility of a subtle shift in how bodies—and cultures—relate to an ancient molecule that never ceases to reinvent itself.

Riyadh means “gardens” in Arabic. It recalls the oases that once offered shade to the desert and promised fertility amid the sand. Today, however, the city rises with glass skyscrapers and mirrored facades that cast back an unrelenting sun onto tiles and domes.

Between that contemporary brightness and the memory of ancient oases, a group of researchers walks through plazas, cafés, and shopping malls with tablets in hand. They stop before strangers and ask three almost trivial questions:

Have you heard of nicotine pouches?

Have you ever tried them?

Did you feel anything afterward?

Minimal questions that, taken together, aim to sketch a new map of nicotine in twenty-first-century Saudi Arabia.

More than eight hundred voices responded. That collective murmur was transformed into data and, later, into an article authored by Hassan Alkharaan and colleagues from Prince Sattam Bin Abdulaziz University, published in Frontiers in Public Health in September 2025.

In Riyadh, the numbers are not cold. They carry a human texture. They say that 59.3% of adults are already aware of oral nicotine pouches, though only 14.2% have ever used them. Culture often precedes practice: the word takes root first, then the gesture follows. It is not yet a majority gesture, but it is already a visible one.

But the map of this use is not drawn evenly. Men are almost twice as likely to know about nicotine pouches and nearly three times as likely to have used them compared with women. The gender gap that runs through so many behaviors appears here as well: men explore first, while women later bear the heavier weight of judgment.

Age draws another decisive boundary. The youngest, between 18 and 39 years old, are five times more likely to be aware of nicotine pouches and six to seven times more likely to use them compared with those aged 40 to 69. This is no surprise: novelty usually seeps first into younger generations, less bound to the rituals of combustion and more exposed to devices that promise discretion and modernity, less tied to the stigma and smell of smoke.

The central finding, however, stands out forcefully: 95.8% of pouch users are smokers or former smokers, and among them combustible cigarette users dominate (73.7%), followed by vapers (56.8%) and hookah users (33.1%). The entry point, then, does not seem to open toward those who had never tried nicotine, but rather embeds itself within paths already marked by smoke or vapor.

And in that detour lies the possibility of harm reduction: trading fire for plant fiber, combustion for oral absorption. It is not the same to scorch the lungs as it is to release the substance in the mouth. A detour that, if it becomes substitution, could mean fewer ashes in the lungs and more oxygen in the blood.

The numbers also show that the experience of use is not without nuance. Those who consume pouches tend to view them more favorably than non-users—a common phenomenon when a practice becomes part of daily life, further reinforced by evidence positioning them as a less harmful option compared to smoke.

At the same time, the study identified a correlation: the higher the frequency of use, the greater the likelihood of reporting symptoms—mostly abdominal. It is not an alarm, but a reminder that even the safest products demand vigilance, for what feels minor today may tomorrow take shape as an undesirable pattern.

What emerges from the study is not a definitive verdict, but an ambivalent scenario. For now, pouches are integrated almost exclusively among smokers, offering potential for harm reduction compared with combustion. On the horizon, widespread curiosity suggests that their role will depend on political, educational, and regulatory decisions.

The dilemma is neither to demonize nor to glorify, but to recognize a tool that, when used in the right context—in the lives of those who already smoke—can mean less illness and less death. And to acknowledge that every body-related technology demands scientific, social, cultural, and health-based support.

Because the question posed in Riyadh is the same one running through global health: will we be able to turn data into care, or will we let the market alone decide where the balance tips—toward harm or possibility?

The risk is clear: if states and health institutions do not regulate with fairness and prudence, prohibition may fuel illegal markets, or condemn a less harmful product to never become more appealing than the one it could replace. At that crossroads lies not only the future of nicotine pouches, but also how we conceive of health—as a collective pact or as private business. And while in Saudi Arabia the numbers reveal political and social tensions, in northern Europe the question shifted to the body, to the tissue of the gum, and to clinical evidence.

The Intimate Anatomy of a Discreet Trial

Some 4,500 kilometers to the north, in Stockholm, the scene was different. No plazas or souks, but a white clinic with smooth walls and cold LED light, where silence replaced the bustle. There, a group of Swedish dentists—regular users of snus or nicotine pouches—agreed to an unusual experiment. For five weeks, they would set aside their usual products to use exclusively a special pouch: Stingfree Strong Blue Mint, designed with an inner waterproof membrane to soften gum irritation.

The study, led by Giusy Rita Maria La Rosa of the University of Catania, together with an international consortium of researchers, was published in Acta Odontologica Scandinavica. A modest, almost intimate trial—just 23 participants—but with the ambition of offering more than a datapoint: an early signal of how harm reduction can also be measured in the microscopic territory of the mouth.

The pilot was small: just 23 participants, almost all men. But the numbers carried weight. The prevalence of mucosal lesions fell from 95.7% to 69.6%. Severity, measured by the Axell scale, dropped from a median of 2 to 1—a statistically significant difference (p = 0.0002). In practice, this meant that the visible white patches on the gums faded and that moderate or more severe cases disappeared entirely: gingivitis receded until it vanished; gingival irritation was reduced by 90%. None of the participants worsened. Only one reported increased dry mouth. In a study so brief and limited, it was enough to suggest that a simple membrane could leave a perceptible clinical mark.

Not everything changed. Gum recession remained the same: 39.1% at the start and the same percentage five weeks later. Science explains it clearly: recession is a chronic wound, not something that reverses in a month. However, what did change was the texture of the mucosa—less inflamed and more stable. And in that microscopic shift lay the broader logic of harm reduction: not erasing the past, but preventing the damage from moving forward.

The design had clear limitations: it was an open pilot study, with no parallel control group, where each participant served as their own control. The sample was small—just 23 dentists, almost all of whom were men—and the follow-up brief was only five weeks long. The product, moreover, was provided by its own creators. But this was not a powerful multinational; it was a family venture. The inventor, Bengt Wiberg, a snus user tired of gum irritation, designed, together with his son Daniel, a pouch with an internal barrier to reduce contact with the mucosa.

The difference is that this invention did not remain in the home garage: it was tested by an academic consortium led by Giusy Rita Maria La Rosa, from the Department of Clinical and Experimental Medicine at the University of Catania, which brought together experts from different continents.

Among them were Karl Fagerström, a pioneer in the study of nicotine dependence and creator of the test that bears his name; Jan Kowalski and Renata Górska, from the Medical University of Warsaw, recognized in the field of periodontology; Iain Chapple, from the University of Birmingham and the UK’s NHS, one of the most influential voices on gum disease; and Riccardo Polosa, founder of the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), an international leader in alternative strategies to tobacco.

Joining them were Sebastiano Antonio Pacino, from the Addendo dental clinic in Catania; Stefan Gospodaru, Gheorghe Bordeniuc, and Valeriu Fala, from the “Nicolae Testemiţanu” Institute of Medicine and Pharmacy in Moldova, along with the Faladental clinic in Chișinău; and Amaliya Amaliya, from Padjadjaran University in Indonesia, a periodontology specialist in Southeast Asia. Together, the team represented an international mosaic of institutions with a long tradition in oral health, periodontal medicine, and nicotine studies. The pilot had narrow margins, but the signal was clear: 0,025 millimeter (or 25 micron) of waterproof cellulose was enough to modulate the damage.

A White Pouch Linking Desert and Snow

Two investigations, two worlds. Riyadh and Stockholm. The bustle of the desert against the calm of the north. Public health unfolding in open plazas and clinical dentistry confined within white walls. In Saudi Arabia, a massive questionnaire maps who uses it and what they think. In Sweden, a consumer’s intimate discomfort becomes an invention, and under expert scrutiny, it gains academic validation among professional users.

Both settings, so different, converge on the same rising object: small white pouches that dissolve nicotine beneath the lip, promising stimulation without combustion, presence without smoke, desire without ash.

In Saudi Arabia, where alcohol is prohibited, nicotine holds a distinct social place: tolerated, visible, with its own cultural weight. In Sweden, by contrast, where snus is regarded almost as a national heritage, nicotine pouches are seen more as continuity than novelty. The same molecule—nicotine—shifts in meaning depending on context, setting, and form: a symbol of modernity in Riyadh, of tradition in Stockholm.

But in both settings, the mouth appears as a sociopolitical field. In the Saudi surveys, it became clear that available information lags behind the market; in the Swedish clinics, gums told stories of relief. The body, in the end, speaks first what statistics take longer to say.

Both articles offer only fragments of a future under construction. Riyadh exposes the social demand for information and regulation; Stockholm suggests that design can, quite literally, soften wounds. Neither delivers definitive answers, but together they illuminate the same frontier: that of white, discreet, invisible nicotine, capable of saving lives if it comes to replace the cigarette, still responsible for eight million deaths every year.

A frontier minimal in appearance, yet with the power to reconfigure global public health.

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• Alkharaan, H., Alrubayyi, A., Kariri, M., Alasqah, M., Alnufaiy, B., Alzahrani, H. G., Gufran, K., Altkhais, Y., Algharbi, M., & Alarfaj, F. (2025). Investigating oral nicotine pouch use among adults in Riyadh, Saudi Arabia: Prevalence, awareness, susceptibility, and associated symptoms. Frontiers in Public Health, 13, 1607656. https://doi.org/10.3389/fpubh.2025.1607656

• La Rosa, G. R. M., Fagerström, K., Pacino, S. A., Kowalski, J., Górska, R., Gospodaru, S., Bordeniuc, G., Fala, V., Amaliya, A., Chapple, I., & Polosa, R. (2025). Self-reported oral health outcomes after switching to a novel nicotine pouch technology: a pilot study. Acta odontologica Scandinavica, 84, 292–298. https://doi.org/10.2340/aos.v84.43805

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