Nicotine pouches have expanded rapidly across the Gulf region, yet population-based evidence on gingival health remains scarce and users differ widely in intensity of consumption. We examined the association between nicotine pouch use and self-reported gingival symptom burden among 655 adults in Saudi Arabia using a bilingual self-administered online questionnaire. All data, including the outcome, were self-reported; no clinical periodontal examination was performed, so the study does not provide a clinical diagnosis of periodontal disease. Self-reported gingival symptom burden was assessed with a ten-item screening scale validated in Saudi adults, analysed as a continuous score and dichotomised at the sample median, and dependence among users was quantified with a six-item index adapted from the Fagerström Test for oral nicotine products. Tobacco exposure was modelled as a single four-level mutually exclusive variable. An above-median self-reported gingival symptom score was present in 277 participants (42.3%), and 180 (27.5%) reported pouch use. Pouch use status was not associated with the outcome (adjusted odds ratio 1.06, 95% CI 0.67–1.69). Among 179 users, the screening score rose by 1.63 points per dependence stratum (95% CI 0.88–2.37), and prevalence rose from 28.2% at low dependence to 38.9% and 58.3% at moderate and high dependence (Kendall τ-b = 0.186, p = 0.002), with adjusted odds of 5.86 (95% CI 2.30–14.96) for high dependence and a per-stratum trend of 2.43 (95% CI 1.52–3.87). The gradient persisted after additional adjustment for smoking status, former smoking and use of other tobacco products (trend odds ratio 2.53–2.65), and across ten sensitivity analyses. Self-reported gingival recession showed the steepest gradient across dependence strata, whereas gingival bleeding showed none. Self-reported gingival symptom burden among pouch users was associated with intensity of consumption rather than with use status; these findings are hypothesis-generating rather than evidence of a clinical effect, and require confirmation by studies with clinical periodontal assessment and longitudinal follow-up.

Background: Tobacco smoking cessation is a complex process influenced by biological, psychological, and social factors. Despite the availability of effective cessation interventions, relapse remains common among smokers attempting to quit. This study aimed to identify factors associated with previous smoking relapse and nicotine dependence among smokers attending anti-smoking clinics in Abha City, Saudi Arabia. Methods: An analytical comparative cross-sectional study was conducted among 330 adult Saudi smokers attending the Abha Anti-smoking Clinic and the Erada Anti-smoking Clinic. Previous smoking relapse was defined as having one or more unsuccessful smoking cessation attempts after a period of abstinence. Data were collected using a structured interviewer-administered questionnaire covering sociodemographic characteristics, smoking history, nicotine dependence, withdrawal symptoms, motives for smoking cessation, and relapse-related factors. Nicotine dependence was assessed using the Fagerström Test for Nicotine Dependence (FTND). Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were performed. Results: Most participants were male (84.2%) and aged 20–39 years (59.4%). Smoking initiation most commonly occurred between 15 and 20 years of age (68.8%), while 66.4% reported previous quit attempts. Nervousness (84.2%) and stress or tension (74.2%) were the most frequently reported withdrawal symptoms. High and very high nicotine dependence were reported by 26.1% and 14.2% of participants, respectively. High nicotine dependence (AOR = 1.39, 95% CI: 1.15–1.69, p = 0.001) and very high nicotine dependence (AOR = 1.62, 95% CI: 1.21–2.17, p < 0.001) were independently associated with greater odds of previous smoking relapse. Attendance at the Erada Anti-smoking Clinic was associated with lower odds of relapse (AOR = 0.52, 95% CI: 0.29–0.91, p = 0.021). Conclusions: Higher nicotine dependence was independently associated with previous smoking relapse among smokers attending anti-smoking clinics. Comprehensive cessation programs integrating behavioral counseling, pharmacological treatment, and sustained follow-up may improve long-term abstinence and reduce relapse.