The risk profile of electronic nicotine delivery systems, compared to traditional cigarettes, on oral disease: a review

Abstract

The use of electronic nicotine delivery systems (ENDS) has exploded, especially among teenagers and new smokers, amid widespread awareness of the dangers of traditional tobacco and restrictions on smoking. However, the risk effects of ENDS on physical health, especially oral health, are still ambiguous. The purpose of this study was to review the available evidence on risks of ENDS on oral health, and compares the differences between ENDS and traditional cigarettes. For heavy smokers, transferring the addiction of tobacco to ENDS can be less harmful to periodontal condition and physical health but is not completely without risk. The components of ENDS vapor have cytotoxic, genotoxic, and carcinogenic properties, and its usage may be associated with a wide range of oral health sequelae. The chemicals in ENDS increase the susceptibility to tooth decay, increase the risk of periodontal disease, peri-implant, and oral mucosal lesions. Nicotine aerosols from ENDS can be a potential risk factor for oral cancer due to the presence of carcinogenic components. Compared to smoking traditional cigarettes, the harm associated with ENDS use may be underestimated due to the reduced ability to control vaping behavior, ease of ENDS access, fewer vaping area restrictions, and better taste. Currently, the available evidence suggests that ENDS may be a safer alternative to traditional tobacco products. Though most oral symptoms experienced by ENDS users are relatively mild and temporary compared to traditional cigarettes, the dangers of ENDS still exist. However, further research with longer follow-up periods is required to establish the long-term safety of ENDS.

Oxidative stress and inflammation: elucidating mechanisms of smoking-attributable pathology for therapeutic targeting

“…ENDS, known colloquially as e-cigarettes or vapes, work by heating a liquid solution containing nicotine, flavors, solvents like propylene glycol (PG) and vegetable glycerin (VG), and other additives to generate an inhalable aerosol. ENDS may aid smoking cessation but health effects with long-term use are still debated (Zhang and Wen 2023). Acute ENDS use can deliver less nicotine than cigarettes, but newer generation devices offer more customization of nicotine concentrations and delivery profiles.…”

Effects of e-cigarette smoking on periodontal health: A scoping review

“…Periodontal disease is characterized by a progressive degeneration of tooth supporting soft and hard tissues, which is mediated by the interaction of dysbiotic microflora and aberrant immune responses in the gingival and periodontal tissues [ 15 , 16 ]. Tobacco smoking is a recognized risk factor in the pathogenesis of periodontal disease and its role in progression of periodontal disease is well established [ 17 , 18 ]. Tobacco smoking has been linked to exacerbated host immune response resulting in increased production of inflammatory mediators along with alteration in oral microflora [ 19 ].…”

“…Yet, there is no clarity about how it affects the periodontium and periodontal health status particularly with respect to clinical changes. Recently, research has been carried out to evaluate impact of e-cigarette vaping on periodontal health, and changes in common clinical indicators of periodontal disease [ 7 , 17 ]. Studies have also investigated levels of inflammatory mediators as well as, changes in periodontopathic microflora [ 21 , 24 , 25 ].…”

The impact of electronic and conventional cigarettes on periodontal health—a systematic review and meta-analysis

“…One of the main reasons is smoke-related functional and morphological impairment of gingival fibroblasts [ 19 ]. Besides, smokers have been reported to have a poorer oral hygiene when compared to non-smokers [ 20 ]; tar in tobacco products might conduct pigmentation and accumulation of bacteria on tooth surfaces [ 21 ]. Nicotine-dependent oral effects are local vasoconstriction and a reduced blood flow that will reduce gingival oxygen and blood supply.…”

“…Nicotine-dependent oral effects are local vasoconstriction and a reduced blood flow that will reduce gingival oxygen and blood supply. Tobacco and ENDS might also decrease oral immunoglobulin levels [ 22 ] and alter the oral microbiome [ 23 ], leading to several pathogenic microbes [ 21 , 24 ]. Smoking results in discoloration of the tooth structure; changes in taste and olfactory perception are also reported [ 5 ].…”