Clinical and histopathological manifestations of snus use in Germany: parallels to betel nut-related oral submucous fibrosis in Asia.

While oral submucous fibrosis (OSMF) in Asia associated to betel nut usage has been extensively characterized both clinically and histologically, the effects of snus (a traditional Scandinavian oral tobacco product) use in Europe are far less well understood. With the growing popularity of snus across Europe, its impact on oral mucosal pathology has become an issue of increasing clinical relevance. In this study, 50 patients were examined, presenting with clinically detectable oral mucosal alterations, associated with habitual snus use. Clinically, the lesions typically appeared as leukoplakic, firm mucosal changes with surface corrugation. In the most severe cases, biopsies were obtained and histopathologically and immunohistochemically analyzed. This evaluation revealed lymphocytic infiltration, epithelial hyperplasia with keratinization, and varying degree of submucosal fibrosis. These findings demonstrate that snus use can induce significant pathohistological manifestations in the oral mucosa, closely analogous to those of the established potentially malignant disorder OSMF. Additional periodontal and dental effects, including gingival recession, erosions, and tooth discoloration, were also recorded. This study provides novel insights into the potential link between snus use and OSMF-like pathology and underscores the importance of vigilant clinical monitoring of affected individuals.