In recent years, vaping has emerged as a popular alternative to traditional cigarette smoking, particularly among young adults and teenagers. Proponents argue that it is a safer and less harmful alternative to smoking, citing reduced exposure to many of the toxic chemicals in tobacco smoke. However, the impact of vaping on oral health is a subject that has garnered increasing attention among researchers and dental professionals.
Here's a look into some research findings on vaping and its potential effects on oral health to shed light on the hidden risks associated with this trend.
The rise of vaping
Vaping, the act of inhaling aerosolized vapor produced by electronic nicotine delivery systems (ENDS) such as e-cigarettes, has gained widespread popularity in recent years. According to the Centers for Disease Control and Prevention (CDC), as of 2022, approximately 2.55 million American middle and high school students used e-cigarettes in the past 30 days, and in 2021 4.5% of adults in the US used e-cigarettes.1 This alarming statistic highlights the urgency of understanding the oral health implications associated with vaping.
Vapes come in different shapes and sizes, often taking the form of USB devices, toys, pens, highlighters, and lipsticks. These shapes can make it difficult to identify such items in a young person’s possession.
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Chemical composition and oral health
One of the primary concerns of vaping and oral health is the chemical composition of e-cigarette aerosols. Although e-cigarette aerosols are believed to contain fewer harmful chemicals than traditional cigarette smoke, they are by no means harmless. According to the CDC, e-cigarette aerosols can still contain harmful substances such as nicotine, heavy metals such as lead, and volatile organic compounds, all of which can have detrimental effects on oral tissues when inhaled.1
Formaldehyde, another known component of e-cigarettes, is a known carcinogen that can cause cellular damage and inflammation in the oral cavity.2 Acrolein, a highly reactive chemical used in herbicides, is often found in e-cigarettes and can irritate the mucous membranes in the mouth and throat, potentially leading to conditions such as dry mouth and chronic inflammation as well as COPD, asthma, and lung cancer.3
Oral health implications
A recent study showed that the oral microbiome of smokers and e-cigarette users is different from that of nonsmokers.4Smokers and individuals who vape exhibit a higher prevalence of multiple bacterial strains, including Selenomonas, Leptotrichia, and Saccharibacteria, in comparison to nonsmokers. E-cigarette users displayed a notable prevalence of various other bacteria, such as Fusobacterium and Bacteroidales, which are known to be linked with periodontal disease.4 This change in the microbiome leads to increased inflammation and probable worsening of periodontal disease.
Several oral health issues have been associated with vaping, including:
- Dry mouth: Dry mouth (xerostomia) can be caused by irritants in e-cigarette aerosols. Saliva is essential for safeguarding oral tissues and overall oral health. Reduced saliva can heighten the risk of dental issues such as dental caries, periodontal disease, and oral infections.
- Periodontal disease: A study published in 2016 found that e-cigarette users were more likely to exhibit signs of periodontal disease compared to nonusers.5 According to Jităreanu et al., there is evidence that vaping changes the oral microbiome, leading to an overgrowth of pathogens and loss of beneficial bacteria. This leaves the patient more susceptible to oral disease.6
- Tooth decay: The combination of dry mouth and exposure to harmful chemicals can contribute to dental caries. The lack of saliva makes it easier for decay-causing bacteria to thrive, leading to an increased risk of dental caries.
- Oral lesions: Some research indicates a potential connection between vaping and oral lesions, with vaping causing tissue damage that elevates inflammation and, in conjunction with DNA damage from e-cigarette chemicals, raises the risk of oral cancers.
The role of nicotine
Nicotine, which is in both traditional cigarettes and many vaping products, constricts blood vessels, reducing blood flow and oxygen supply to oral tissues. This impairs the body's ability to repair damaged oral tissues, elevating the risk of oral health issues.
Nicotine in e-cigarettes is a large concern. Forty-five percent of the nicotine from these devices is deposited in the oral cavity.6 Nicotine is a contributor to the development of oral cancer, as it promotes the growth of cancerous cells and inhibits apoptosis (cell death) in damaged cells. While the risk of oral cancer from vaping may be lower than from smoking, it is still a concerning factor for oral health.1
The role of dental professionals
While vaping is often promoted as a safer alternative to smoking, it carries unique risks to oral health. E-cigarette aerosols, containing harmful chemicals such as formaldehyde and acrolein, can lead to issues such as dry mouth, gum disease, tooth decay, and potentially oral cancer. Nicotine, a common ingredient in vaping products, exacerbates these dangers.
To safeguard oral health, individuals must be aware of vaping's potential hazards and consider alternative nicotine delivery methods or, best of all, quit nicotine use altogether. Dental professionals have a pivotal role in educating patients about vaping risks and monitoring their oral well-being. Although vaping may seem less harmful than smoking, it is not without harm, and its long-term impact on oral health continues to be the focus of ongoing research.
- About electronic cigarettes (e-cigarettes). Centers for Disease Control and Prevention. Accessed October 4, 2023. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html.
- Ruggiero JL, Voller LM, Shaik JA, Hylwa S. Formaldehyde in electronic cigarette liquid (aerosolized liquid). Dermatitis. doi:10.1097/DER.0000000000000771
- The impact of e-cigarettes on the lung. American Lung Association. Accessed October 4, 2023. https://www.lung.org/quit-smoking/e-cigarettes-vaping/impact-of-e-cigarettes-on-lung
- Urban J. Evidence grows for vaping’s role in gum disease. American Society for Microbiology. February 22, 2022. Accessed October 18, 2023. https://asm.org/Press-Releases/2022/Feb-2022/Evidence-Grows-for-Vaping-s-Role-in-Gum-Disease
- Cho JH, Paik SY. Association between electronic cigarette use and asthma among high school students in South Korea. PloS one. March 4, 2016. doi:10.1371/journal.pone.0151022
- Jităreanu A, Agoroaei L, Aungurencei OD, et al. Electronic cigarettes’ toxicity: from periodontal disease to oral cancer. Appl Sci. 2021;11(20):9742. doi:10.3390/app11209742