Nicotine lozenges are a popular form of Nicotine Replacement Therapy (NRT) designed to help people stop using tobacco products. These small, solid dosage forms deliver a controlled dose of nicotine into the bloodstream through absorption in the lining of the mouth (oral mucosa). While they are a less harmful alternative to smoking, they pose specific risks to oral health. The lozenge’s composition and usage introduce challenges to the teeth and gums distinct from those caused by combustible tobacco.
The Primary Dental Risk: Acid Erosion
Nicotine absorption is most efficient in a slightly alkaline environment, but lozenges are often formulated to be slightly acidic. This acidity facilitates the initial dissolution of the lozenge and the release of nicotine. Constant exposure to this low-pH environment is the primary chemical threat to the hard outer layer of the teeth.
Enamel begins to demineralize when the pH level in the mouth drops below 5.5. The prolonged contact time required for the lozenge to dissolve (often 20 to 30 minutes) means the area where it rests is bathed in an acidic solution for an extended period. This process slowly weakens the enamel structure through chemical erosion, similar to the damage caused by frequently sipping acidic beverages.
Unlike a quick sip of soda, the lozenge remains stationary, localizing the acid attack to a specific area of the teeth and gums. This continuous, localized exposure prevents saliva—the mouth’s natural buffer—from effectively neutralizing the acid and restoring a healthy pH balance. The result is a persistent weakening of the tooth surface, making it more vulnerable to wear and sensitivity.
Sweeteners and the Potential for Tooth Decay
A separate concern from acid erosion is the potential for tooth decay, or dental caries, which is primarily driven by oral bacteria. Nicotine lozenges are frequently labeled “sugar-free,” but this does not guarantee they are dentally benign. Many formulations contain sugar alcohols like mannitol or sorbitol, or bulking agents such as maltodextrin, to improve flavor and consistency.
While traditional sugar alcohols are considered non-cariogenic, ingredients like maltodextrin can still be metabolized by certain oral bacteria. These bacteria ferment the lozenge’s residual components, producing localized acid as a byproduct. This mechanism contributes to decay, especially in the areas where the lozenge is held.
The lozenge’s slow-dissolving nature ensures that these fermentable ingredients remain in contact with the teeth for a long time, often leaving a sticky film on the tooth surface. This prolonged exposure creates a highly localized, acidic microenvironment that encourages the development of root caries, especially in individuals with pre-existing gum recession and exposed root surfaces. Even without traditional sugar, the frequency and duration of use can overwhelm the mouth’s natural defenses, leading to tooth damage.
Minimizing Dental Harm While Using Lozenges
Users can take several practical steps to mitigate the risks of both acid erosion and decay associated with lozenge use. One effective technique is to “park” the lozenge in different locations within the cheek pouch throughout the day, preventing continuous acid exposure to a single spot. It is also important to resist the urge to chew, suck, or aggressively move the lozenge, which increases the concentration of dissolved ingredients across the tooth surfaces.
Immediately after the lozenge has fully dissolved, rinsing the mouth thoroughly with plain water helps restore the oral pH balance. Water washes away residual acids and fermentable ingredients, allowing saliva to quickly return the mouth to a neutral state. Users should wait approximately 30 minutes after using a lozenge before brushing their teeth.
Brushing immediately after an acid attack can mechanically rub the softened enamel surface, causing further erosion. Maintaining a disciplined oral hygiene routine, including brushing twice daily with fluoride toothpaste and flossing once a day, helps fortify the enamel. Regular dental check-ups and cleanings allow a dentist to monitor for early signs of localized demineralization or decay.