In society, tobacco products, such as e-cigarettes, and smokeless tobacco products, such as snus and nicotine pouches, are becoming more attractive. There is still a lack of information regarding the effects of these products on the oral mucosa and oral saliva biomarkers. The aim of this study is to evaluate oral mucosa and the presence of inflammatory biomarkers IL-6, IL-1, IL-8, TNF alpha and LRG-1 in saliva. Respondents were divided in four groups based on their tobacco product usage. Oral examination was carried out, saliva samples were taken, and the detection of IL-6, IL-8, IL-1, TNF alpha and LRG-1 levels in saliva was carried out. Out of the tobacco users, 30.8% were snus users, 48.7% were cigarette users and 20.5% were e-cigarette users. The control group was composed of respondents who did not use any tobacco products. E-cigarettes were used more by women, but snus was used more by men. Mucosal changes were seen in the group of snus users, and mucosal changes were only seen in men who had used 5–10 tobacco units per day for 5–10 years. Increased IL-6 levels in saliva were detected in respondents who also experienced mucosal changes. Mucosal changes were white, leathery and localized at the site where snus sachets were placed. Saliva, as an easily available biofluid, could be used as a first tool to detect potentially precancerous signs, but the LRG1 marker cannot be used as a prognostic marker.

Background New tobacco products, such as smokeless tobacco, are becoming more popular every year. In talking with our patients, we determined several reasons for that trend. The sale of these products is prohibited in many countries; hence, people obtain the product illegally. This is important, since when these products are stored under inappropriate conditions and temperatures, the quality and properties of the product change, including their carcinogenic properties. Sometimes people use a lot of this product or more than one tobacco product daily. It is challenging for dental practitioners to question their patients about tobacco consumption and more challenging to visually detect oral mucosal changes, because patients usually do not have concerns or they do not pay attention. Methods In the two cases presented here, the patients did not have any pain, nor did they notice when the lesions appeared. These patients used conventional cigarettes for some time and then switched to smokeless tobacco due to relocation to Latvia. Soft tissue excision was performed and sent for histopathological examination. Results The findings were proliferation of oral epithelial cells from buccal region, their overgrowth, an excessive amount of fibroblasts, cell destruction and necrosis, and a large amount of inflammatory cells, eosinophil leukocytes, and plasma cells. Conclusions We can conclude that these intraoral findings are important risk factors for possibly developing precancerous lesions. Such mucosal changes can occur with different forms of tobacco, including Swedish snus and betel leaves. Dental practitioners should always question patients about tobacco use and regularly check for mucosal changes for early detection.