New research suggests that while vaping can increase plaque and inflammation, its effects on gum disease remain unclear. Should vapers be worried? Here's what the latest science reveals.
Study: The impact of e-cigarette use on periodontal health: a systematic review and meta-analysis. Image Credit: My Ocean Production / Shutterstock
Bleeding gums and tooth loss might seem like concerns of old age, but could your electronic cigarette (e-cigarette) be a contributing factor? A recent study published in the journal Evidence-Based Dentistry systematically reviewed global research on e-cigarette use and gum health, highlighting potential risks, though traditional smokers remain at the highest risk.
Smoking and dental health
Healthy gums are essential for strong teeth and overall well-being, but maintaining them is not always straightforward. Gum disease is a widespread condition, affecting nearly half of adults globally, and is closely linked to tooth loss, heart problems, and diabetes.
Tobacco smoking is a well-known risk factor for worsening gum health, causing inflammation, bone loss, and slower healing. However, the rise of Electronic Nicotine Delivery Systems or ENDs, commonly known as e-cigarettes or vape, has introduced new questions. Marketed as a safer alternative to traditional smoking, these devices deliver nicotine through vapor rather than combustion, reducing exposure to harmful chemicals.
However, while e-cigarettes may lower some health risks compared to smoking, they still introduce chemicals and nicotine into the mouth, which could affect gum health. The extent of their impact remains uncertain due to study limitations. Current evidence on this subject remains mixed, with some studies suggesting that vaping harms gums and others finding little difference from non-smokers.
The current study
The present study systematically reviewed existing research to assess the relationship between e-cigarette use and periodontal health. The researchers examined studies involving individuals with healthy gums, gingivitis, or periodontitis, excluding reviews, case reports, and non-peer-reviewed sources, covering research available up to February 2024.
The team included 40 observational and interventional studies that analyzed clinical gum health indicators such as probing depths, bone loss, bleeding, plaque levels, patient-reported experiences, and biological markers. They compared e-cigarette users with non-smokers, former smokers, and tobacco smokers.
To assess reliability, the scientists also evaluated each study’s risk of bias using established tools such as the Newcastle-Ottawa Scale. Since many e-cigarette users were also past or current smokers, they grouped studies based on potential bias from tobacco smoking and analyzed the data accordingly.
The meta-analyses combined results from 18 studies to identify patterns across different health outcomes. Subgroup analyses were also performed to investigate how smoking history influenced outcomes. Given the overlap between the two behaviors, the study placed particular emphasis on distinguishing the effects of e-cigarette use from traditional smoking.
Despite rigorous analysis, many included studies relied on self-reported smoking habits rather than biochemical tests, which increased the risk of misleading results. The authors acknowledged this as a significant limitation and emphasized that no included study confirmed smoking status biochemically. This makes it challenging to separate vaping’s independent impact from the lingering effects of smoking.
Major outcomes
The findings reported that e-cigarette users experienced deterioration in some measures of gum health compared to non-smokers and former smokers, though tobacco smokers consistently experienced the worst outcomes. Specifically, vaping was linked to increased plaque levels and higher levels of pro-inflammatory biological markers, though the certainty of these findings remains low due to study design limitations.
However, it did not show significant differences from non-smokers in deeper gum damage indicators, such as probing depths or bone loss. Vapers had higher plaque buildup than non-smokers and former smokers, suggesting potential risks for cavities and gum disease. Tobacco smokers, however, had even higher plaque levels.
Bleeding gums and visible inflammation were lower in vapers compared to non-smokers, but the researchers explained that this finding mirrored the well-known effect of nicotine in suppressing gum bleeding, often masking underlying disease. Smokers showed the most significant gum bleeding reduction, likely due to similar nicotine effects.
Importantly, biological markers revealed that e-cigarette users exhibited elevated levels of pro-inflammatory molecules, including cytokines such as interleukin-1β and tumor necrosis factor-α, compared to non-smokers. However, due to the reliance on self-reported data, these findings should be interpreted with caution.
Additionally, microbiome analyses suggested that vaping altered the bacterial environment in the mouth. Some studies identified bacteria linked to periodontal disease, such as Porphyromonas gingivalis and Fusobacterium nucleatum, though these patterns differed from those seen in tobacco smokers.
Despite these findings, the study emphasized that many included studies carried a high risk of bias, primarily because e-cigarette users often had a history of tobacco smoking. Few studies used biochemical tests to confirm smoking status, relying instead on self-reports, which may underestimate smoking behavior. This lack of verification reduces the reliability of the conclusions.
Conclusions
Overall, the review highlighted that e-cigarette use may affect gum health, with increased plaque levels and inflammatory markers compared to non-smokers. However, vapers generally fared better than tobacco smokers, who showed the poorest outcomes.
The authors cautioned that while vaping appears less harmful to gums than smoking, its effects are still unclear, and more rigorous research is needed to draw definitive conclusions. They stressed the need for high-quality studies using verified smoking status to provide clearer guidance on how e-cigarettes truly affect gum health.