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.

Oral nicotine pouches are the latest products in the tobacco industry. They are manufactured by large tobacco companies and entice tobacco or nicotine addicts, although the products are presented as a ‘harmless choice.’ Nevertheless, dentists and oral health specialists worry about oral mucosal changes due to product interactions with the oral mucosa. Unfortunately, there are no case reports of oral mucosal changes from nicotine pouches that are also investigated histopathologically. The aim of the present study was to visually and histopathologically investigate oral mucosal changes in nicotine pouch users. An online retrospective survey regarding medical and dental health, dietary habits, and tobacco consumption habits was conducted (n = 50). Respondents were selected for further intraoral and histopathological investigation based on the inclusion criteria. All five respondents had oral lesions that were histopathologically analyzed. Visually, the lesions varied in form and intensity, but all appeared white at the location where the pouches were placed. Histopathological analyses revealed parakeratosis with acanthotic epithelium, intraepithelial and connective tissue oedema, and chronic inflammatory infiltration with lymphocytes and macrophages. Participants received information about nicotine cessation and oral health recommendations. In conclusion, nicotine pouches significantly impacted oral mucosa with white lesions that revealed important changes at the cellular level.

It remains uncertain whether nicotine pouches and electronic cigarettes alter the oral environment and result in a high presence of periodontopathogenic bacteria in saliva, compared to that among cigarette users or non-tobacco users. In this study, saliva samples were collected from respondents using nicotine pouches, electronic cigarettes, and conventional cigarettes, alongside a control group of non-tobacco users. Polymerase chain reaction was used to identify clinical isolates of the following periodontal bacteria: Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, Fusobacterium nucleatum, Fusobacterium periodonticum, Porphyromonas endodontalis, and Rothia mucilaginosa. The presence of some periodontal pathogens was detected in the saliva samples from users of nicotine pouches, electronic cigarettes, and conventional cigarettes but not in samples taken from the control group. Therefore, the initial results of this pilot study suggest that the presence of periodontopathogenic bacteria in the saliva of nicotine pouch and electronic cigarette users could alter the oral microbiome, leading to periodontal diseases. However, further quantitative investigation is needed.

Statement of Problem: Restoring extensively damaged, endodontically treated molars with an indirect restoration that both preserves and protects the remaining tooth structure is a significant challenge. Overlays and endocrowns offer a less invasive alternative compared to conventional crowns. Purpose: The aim of this study was to evaluate the fracture resistance and fracture patterns of molars restored with different materials and designs. Materials and Methods: This study involved 40 extracted human molars, which underwent endodontic root canal treatment and were divided into four groups: composite core build‐up with pressed lithium disilicate overlay (OL) ( n = 10); composite core build‐up with milled composite overlay (OC) ( n = 10); pressed lithium disilicate endocrown (EL) ( n = 10); milled composite endocrown (EC) ( n = 10). The teeth were subjected to thermocyclic loading (10,000 cycles between 5 and 55°C), followed by chewing simulation (0–50 N at 1.6 Hz for 600,000 cycles with a 10° inclination), another round of thermocyclic loading (10,000 cycles between 5 and 55°C), and finally, a fracture strength test (5 mm steel ball at a 10° inclination with a load rate of 0.5 mm/min). Afterwards methylene blue was used to stain any cracks or fracture lines in the teeth for microscopic evaluation. Results: The findings suggest that while the material type may not significantly impact fracture resistance or catastrophic fracture likelihood, the type of restoration (endocrown vs., overlay) is a crucial factor to consider. Conclusions: Clinicians should weigh the higher risk of catastrophic fractures associated with endocrowns when selecting restorative options for endodontically treated teeth. Clinical Implications: Overlays and endocrowns offer similar overall tooth fracture resistance, making both viable options for restoring endodontically treated molars. However, OLs may better withstand chewing forces and posed no risk of catastrophic tooth fractures, unlike ECs, which carry a higher tooth fracture risk.

Snus is a tobacco product containing nicotine and is widely used in Sweden. Now it is becoming more and more popular among young athletes and teenagers in Latvia, even though it is forbidden for sale in the European Union. The use of snus is considered to induce various oral illnesses, especially periodontal diseases, diabetes, heart and cardiovascular diseases as well as cancer. Comparison of the microbiome of saliva and tooth biofilm in snus tobacco users with that in people who never use snus showed that, the number and diversity of periodontal pathogenic microorganisms was much higher in samples taken from snus users. The observed features of the oral microbiome, such as the presence of periodontal pathogens and their high concentration, may have adverse effect on periodontal tissues of snus users and their general health in the future.