Vaping and oral health: Unveiling the hidden risks


In recent years, e-cigarettes have become a popular alternative to traditional smoking, especially among young people and teenagers. Supporters argue it is a safer and less harmful alternative to smoking, citing reduced exposure to the many toxic chemicals in tobacco smoke. However, the impact of e-cigarettes on oral health has attracted increasing attention from researchers and dental professionals.

Here are some research findings on e-cigarettes and their potential impact on oral health to shed light on the hidden risks associated with this trend.

The rise of e-cigarettes

E-cigarettes, the act of inhaling atomized vapor produced by electronic nicotine delivery systems (ENDS) such as e-cigarettes, have become widely popular in recent years. According to statistics from the U.S. Centers for Disease Control and Prevention (CDC), as of 2022, approximately 2.55 million American middle school students have used e-cigarettes in the past 30 days, and 4.5% of adults in the United States use e-cigarettes in 2021.1 This alarming statistic highlights the urgency of understanding the impact of e-cigarettes on oral health.

E-cigarettes come in different shapes and sizes, often taking the form of USB devices, toys, pens, highlighters and lipsticks. These shapes can make it difficult for young people to identify such items in their possession.

You may also be interested in: Teens and e-cigarettes: What dental professionals need to know

Chemical composition and oral health

One of the major concerns about e-cigarettes and oral health is the chemical composition of e-cigarette aerosols. Although e-cigarette aerosols are thought to contain fewer harmful chemicals than traditional cigarette smoke, they are by no means harmless. According to the Centers for Disease Control and Prevention, e-cigarette aerosols may still contain harmful substances such as nicotine, heavy metals such as lead, and volatile organic compounds, all of which can have harmful effects on oral tissue when inhaled.1

Formaldehyde, another known ingredient in e-cigarettes, is a known carcinogen that can cause cell damage and inflammation in the mouth.2 Acrolein, a highly reactive chemical used in herbicides and commonly found in e-cigarettes, can irritate the mucous membranes of the mouth and throat, possibly leading to dry mouth and chronic inflammation, as well as conditions such as chronic obstructive pulmonary disease, asthma and lung cancer.3

oral health effects

A recent study showed that smokers and e-cigarette users have different oral microbiomes than non-smokers.4Smokers and individuals who use e-cigarettes show higher prevalence of multiple bacterial strains, including Lunaria, Trichophytonand glycobacteria, compared with non-smokers.E-cigarette users showed a significant prevalence of various other bacteria, e.g. Fusobacterium and Bacteroidetesknown to be associated with periodontal disease.4 This change in the microbiome leads to increased inflammation and may lead to worsening of periodontal disease.

Some oral health problems have been linked to vaping, including:

  1. Dry mouth: Irritants in e-cigarette aerosol may cause dry mouth (xerostomia). Saliva is essential for protecting oral tissues and overall oral health. Reduced saliva increases the risk of dental problems such as cavities, periodontal disease, and oral infections.
  2. Periodontal disease: A study published in 2016 found that e-cigarette users were more likely to show signs of periodontal disease than non-users.5 According to Jităreanu et al., there is evidence that e-cigarettes alter the oral microbiota, leading to the overgrowth of pathogens and the loss of beneficial bacteria. This makes patients more susceptible to oral disease.6
  3. Tooth decay: The combination of dry mouth and exposure to harmful chemicals can lead to tooth decay. The lack of saliva makes it easier for cavity-causing bacteria to multiply, leading to an increased risk of cavities.
  4. Oral lesions: Some studies have shown a potential link between e-cigarettes and oral lesions, with e-cigarettes causing tissue damage and exacerbating inflammation, which, coupled with DNA damage caused by e-cigarette chemicals, can increase the risk of oral cancer.

The role of nicotine

Nicotine, found in traditional cigarettes and many e-cigarette products, constricts blood vessels and reduces blood flow and oxygen supply to oral tissues. This impairs the body's ability to repair damaged oral tissue, increasing the risk of oral health problems.

Nicotine in e-cigarettes is a big problem. 45% of the nicotine from these devices is deposited in the mouth.6 Nicotine is a factor in the development of oral cancer because it promotes the growth of cancer cells and inhibits apoptosis (cell death) of damaged cells. While the risk of oral cancer from vaping may be lower than smoking, it is still a concerning factor in oral health.1

The role of dental professionals

While e-cigarettes are often promoted as a safer alternative to smoking, they pose unique risks to oral health. E-cigarette aerosol contains harmful chemicals such as formaldehyde and acrolein, which can cause problems such as dry mouth, gum disease, tooth decay, and potential oral cancer. Nicotine, a common ingredient in e-cigarette products, can exacerbate these dangers.

To protect oral health, individuals must be aware of the potential harms of e-cigarettes and consider alternative nicotine delivery methods or, most importantly, abstain from nicotine use entirely. Dental professionals play a key role in educating patients about the risks of vaping and monitoring their oral health. Although vaping appears to be less harmful than smoking, it is not without its dangers, and its long-term effects on oral health remain the focus of ongoing research.

refer to

  1. About electronic cigarettes (e-cigarettes). Centers for Disease Control and Prevention. Date viewed: October 4, 2023.
  2. Ruggiero JL, Voller LM, Shaik JA, Hylwa S. Dermatitis. doi:10.1097/DER.0000000000000771
  3. Effects of e-cigarettes on the lungs. American Lung Association. Date viewed: October 4, 2023.
  4. Urban J. Growing evidence for the role of e-cigarettes in gum disease. American Society for Microbiology. February 22, 2022.
  5. Cao JH, Baek SY. Association between e-cigarette use and asthma among Korean high school students. PLOS One. March 4, 2016.
  6. Jităreanu A, Agoroaei L, Aungurencei OD, et al. Toxicity of e-cigarettes: From periodontal disease to oral cancer. applied Science. 2021;11(20):9742. doi:10.3390/app11209742



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