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Vaping and Oral Health

Not as Safe an Alternative to Smoking as You May Think

A Consultation with Dr. Scott Froum and Dr. Alisa Neymark

Dear Doctor,
My dentist diagnosed me with gum disease and said that my smoking is a factor. Would it be healthier for me to switch to e-cigarettes?

Dear Sylvie,
Many people have turned to vaping because they believe that it’s healthier than smoking. On the surface, e-cigarettes seem to have advantages over regular cigarettes: They are definitely less smelly and they don’t present the same chemical dangers that come from burning tobacco. However, e-cigarettes come with their own set of problems. The more we learn about them, the more evidence we have that vaping may be just as damaging to your oral health as smoking.

Vaping and oral health.

What’s the Big Deal?

E-cigarettes deliver a heated mixture of water, flavoring, nicotine and other chemicals. What makes them potentially dangerous is that they produce an aerosol, not just a vapor as the term “vaping” might imply. While vapor is simply a gaseous form of a substance, an aerosol means that particles are suspended in the vapor. E-cigarette aerosols contain particles of various chemical compounds, several of which pose a risk to your oral health as well as your general health.

For example, both regular cigarettes and e-cigarettes are mainly delivery systems for nicotine, which has long been associated with gum disease and tooth loss. Nicotine constricts blood vessels so there is less blood flow to the gums, it interferes with immune function, and it damages the connective tissues that hold teeth in place. All of this results in a much greater chance of gum disease and eventual tooth loss.

Vaping damage to teeth.
Here is a patient who used to smoke but quit and then vaped for four years. Because his mouth was so dry from using e-cigarettes, he consumed sports drinks regularly, the majority of which are highly acidic and contribute to tooth erosion. Although he is still a young man, the combination of vaping and exposure to sports drinks have ruined his teeth.

Although earlier e-cigarettes provided less nicotine than regular cigarettes, today’s e-cigarettes deliver nicotine more efficiently. The nicotine in e-cigarette aerosols is absorbed mainly by the mucous membranes of the mouth rather than by the lungs as with smoking, potentially harming the oral cavity. In addition, one vaping cartridge can equal the nicotine of 20 cigarettes.

The Dark Side of Fun Flavors

Vaping has become dramatically more popular over the last five years, especially among young people. Sweet flavors like cotton candy, chocolate chip cookie and cherry crush are a big draw, as are “cool” flavors like mint and menthol—and it’s the flavorings that cause many of the oral health problems associated with vaping.

Even though many of the flavorings used in e-liquids have been approved for use in food, their safety is untested when inhaled instead of swallowed. It is now known that some flavoring additives change the chemistry of e-liquids by reacting to form new compounds that could irritate oral membranes and trigger an inflammation response.

A study comparing the effects of flavored versus unflavored e-cigarette liquid on dental health found a 27% decrease in enamel hardness when flavored e-cigarettes were used. Compromised dental enamel paves the way for serious tooth decay, particularly since the thick e-liquid enables cavity-causing bacteria to adhere to tooth surfaces. A different experiment found that e-cigarette flavorings increase cell damage and cell death, with menthol flavoring causing the most damage.

Other Harmful Ingredients

A main ingredient in e-cigarettes is propylene glycol, a thick, slightly sweet liquid that can harm tooth enamel and the soft tissues of the mouth. Another major component of e-liquids is vegetable glycerin, used in the food industry to add sweetness and retain moisture. When combined with flavoring compounds, vegetable glycerin causes a fourfold increase in how microbes stick to tooth enamel and a twofold increase in the formation of plaque biofilm—the major culprit in gum disease and tooth decay.

Other chemicals found in e-cigarette liquids or aerosols include formaldehyde, lead and several other toxins and carcinogens. Exposure to some of these chemicals may increase the risk of oral cancer.

One of the most common side effects reported by e-cigarette users was dryness and irritation of the mouth and throat. Dry mouth, especially in conjunction with the sugar concentrations in e-liquids, can lead to oral health problems. When your mouth lacks sufficient saliva, harmful bacteria can thrive, making the development and progression of tooth decay and gum disease more likely.

Nobody’s Fool

Many people think vaping is a healthy alternative to smoking, and that’s the way it has been marketed to the public. But current research and clinical experience paint a very different picture. We now understand that when exposed to e-cigarette aerosols, teeth start to break down because bacteria in the mouth digest the sugar in the e-liquid and begin to produce acid. This is especially true in the areas of the mouth that get the most exposure to e-liquid, most often the front teeth and the surfaces in between the teeth.

There is still much to learn about the long-term effects of e-cigarette use on oral and overall health. But based on what we know so far, vaping may be just as dangerous to oral health as smoking, and perhaps even more so. It can’t be considered a healthier alternative to smoking, particularly if you have gum disease. However, many people have been able to successfully stop smoking, often with the help of online programs, local or online support groups, over-the-counter or prescription medications, or other smoking cessation aids. Breaking the tobacco habit in all forms is one of the best things you can do for your gums—and your general health.

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