Nicotine polacrilex (Nicorette) is the only medication approved by the Food and Drug Administration for tobacco dependency treatment. It is available only by prescription. This study sought to determine whether this medication produced any adverse gingival effects. Thirty-one patients (91%) used the nicotine polacrilex for at least 1 month and 20 (59%) for 3 months or more. Five (15%) developed small (less than 2 mm), painless, clear, nonhemorrhagic vesicles which resolved immediately when patients were reinstructed to position the medication in different sites in the mouth. There were no changes in gingival color, contour, consistency and texture, tooth mobility, or periodontal pocket depth. Nicotine polacrilex does not appear to have any significant adverse effects on the gingiva even with up to 6 months of daily use.