Smoking has declined, but new alternatives still pose health risks.
Cigarette smoking rates among both youth and adults are at historic lows, but these trends are not indicators that people are quitting nicotine altogether. On the contrary, newer products such as sleek e-cigarettes, flavored vape pens and nicotine pouches like Zyn have surged in popularity, especially among younger adults who see them as cleaner, safer alternatives. The absence of smoke and the stigma associated with traditional cigarettes make these products appear less harmful, but their growing use raises new health concerns.
Nicotine pouches and e-cigarettes deliver nicotine to the body without tobacco. Zyn and similar pouches contain nicotine, flavorings and fillers packaged in small sachets designed to steep between the lip and gum. Vapes and e-cigarettes, on the other hand, heat a liquid solution, usually containing nicotine, flavoring agents, carrier oils and stabilizers, into an inhalable aerosol. These products are more discreet than cigarettes and are often marketed as a less-harmful option. With no smoke, no ash, and, in the case of Zyn, no vapor, they can seem like an improvement.
But these alternatives to cigarettes are not a magically healthy option. Clinicians are seeing firsthand how they affect the body in the short-term.
Oral health concerns
From an oral health standpoint, Dr. Nicole Dahlkemper of Water’s Edge Dentistry regularly sees the consequences of nicotine pouches. While they lack the tar and combustion byproducts of cigarettes, she noted that they are far from healthy. “I still see the changes,” she said. “The tissue inside the mouth gets wrinkly; I can tell something is causing irritation.” Nicotine is absorbed through the oral mucosa at a faster rate than cigarettes, which makes pouches highly addictive. “People want to stop smoking and think this is healthier,” she explained. “But you’re not getting rid of the nicotine addiction itself.”
With Zyn pouch users, Dr. Dahlkemper sees inflammation and gum recession in the area where pouches sit, as well as a shift in the oral microbiome toward more aggressive bacteria. This mirrors what she sees in smokers and vapers, who experience dry mouth due to how nicotine affects saliva. A drier mouth increases the risk of cavities and slows the mouth’s ability to heal.
Vaping brings even more challenging issues: “You’re putting chemicals, thickening agents and flavoring agents into your lungs, and that dryness affects the mouth, too,” she continued.
The long-term risks of this new wave of nicotine products are yet to be determined. Chronic irritation, nicotine exposure and accidental swallowing of the contents of the pouch may all contribute to systemic effects that are not yet fully understood.
Pulmonary and cardiovascular risks
From the pulmonary perspective, Leslie Wilke, DO, of Lowcountry Lung and Critical Care confronts a different set of problems.
Nicotine pouches may avoid the inhalation hazards of smoke or vapor, but they still deliver nicotine. This substance raises blood pressure and heart rate and fuels addiction, no matter how it enters the body. “Our body doesn’t distinguish the form of nicotine,” she explained. “The addictive properties and cardiovascular reactions are the same.”
Vaping introduces risks far beyond nicotine. Because e-cigarettes are not tightly regulated, the composition of vape liquids can vary widely. “You never know what’s in them,” Dr. Wilke said. Over the last decade, physicians have seen the emergence of EVALI – e-cigarette or vaping product use-associated lung injury – a sometimes-fatal condition linked to contaminants such as THC derivatives and certain oils found in vape cartridges. Some cases initially appeared severe and required ventilation. Beyond acute injury, Dr. Wilke explained that e-cigarettes have been identified as genotoxic. They can contribute to chronic lung disease, worsening asthma or triggering inflammatory reactions in young users whose lungs respond aggressively to inhaled foreign substances.
Both physicians emphasized that misconceptions drive much of the appeal of these products. Patients often assume that “smokeless” or “tobacco-free” means low risk or that switching to pouches or vaping is a step toward quitting. In many cases, though, it becomes a reshaped but persistent addiction. Actual smoking cessation involves gradually reducing nicotine intake, something medical nicotine patches and structured therapies are designed to do, while products like Zyn maintain or even increase exposure.
The broader message from both experts is straightforward: These alternatives may eliminate smoke and some associated toxins, but they do not eliminate harm. Nicotine pouches and vaping devices are simply different delivery systems for an addictive substance with cardiovascular, oral and respiratory consequences. For anyone hoping to protect their long-term health, the safest choice is not choosing between cigarettes, vapes or pouches. It is finding support to eliminate nicotine use altogether.
By Anne Toole
