Oral nicotine pouch exposure increased in the United States. Youth lifetime use rose from 3.0% in 2023 to 5.4% in 2024, and past-30-day use increased from 1.3% to 2.6%; among adults (~40,000 surveyed), 2.9% had ever used pouches, with higher prevalence among current smokers than never-smokers. On January 16, 2025, the FDA authorized marketing for 20 oral nicotine pouch products and indicated ongoing monitoring of youth use and marketing compliance. Some products contained low levels of formaldehyde, chromium, nickel, and tobacco-specific nitrosamines; reports noted local oral findings (e.g., gingival blisters, smokeless-tobacco–type keratosis) and elevated inflammatory markers. Evidence summarized was largely observational and cross-sectional, and long-term oral-health risks remained undetermined.