Vaping and Gum Health: How Does It Compare to Smoking?

Vaping and Gum Health: How Does It Compare to Smoking?

New research suggests that while vaping may increase plaque and inflammation, its effects on gum disease remain unclear. Should vapers be concerned? Here's what the latest science reveals.

Bleeding gums and tooth loss may seem like age-related concerns, but could your electronic cigarette (e-cigarette) be a factor? A study recently published in the journalEvidence-based dentistrySystematically reviewed global research on e-cigarette use and gum health, highlighting potential risks, although traditional smokers remain at highest risk.

Smoking and dental health

Vaping can alter the oral microbiome - Studies in the review found that e-cigarette users had different microbial changes, including increased levels of Porphyromonas gingivalis and Fusobacterium nucleatum, bacteria linked to periodontal disease.

Healthy gums are essential for strong teeth and overall well-being, but maintaining them isn't always easy. Gum disease is a common condition that affects nearly half of adults worldwide and is closely linked to tooth loss, heart problems and diabetes.

Smoking tobacco is a known risk factor for worsening gum health, causing inflammation, bone loss and slower healing. However, the rise of electronic nicotine delivery systems or devices, commonly referred to as e-cigarettes or vapes, 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.

While e-cigarettes may reduce some health risks compared to smoking, they still introduce chemicals and nicotine into the mouth, which could impact gum health. The extent of their impact remains uncertain due to study limitations. Current evidence on the subject remains mixed, with some studies suggesting vaping gums and others finding little difference compared to non-smokers.

The current study

The present study systematically reviewed existing research to assess the relationship between e-cigarette use and periodontal health. Researchers examined studies involving people with healthy gums, gingivitis or periodontitis without reviews, case reports and unverified sources available through February 2024.

The team included 40 observational and intervention studies that analyzed indicators of clinical gum health, such as: B. Test depths, bone loss, bleeding, plaque levels, patients with patients and biological markers. They compared e-cigarette users with non-smokers, former smokers and tobacco smokers.

Nicotine may mask symptoms of gum disease - the review highlighted that nicotine in both cigarettes and e-cigarettes can reduce bleeding from the gums, potentially hiding underlying inflammation and disease progression.

To assess reliability, scientists also assessed each study's risk of bias using established tools such as the Newcastle-Ottawa Scale. Because many e-cigarette users were also former or current smokers, they grouped studies based on possible tobacco smoking bias and analyzed the data accordingly.

The meta-analyses collectively yielded 18 studies to identify patterns across various health outcomes. Subgroup analyzes were also conducted to examine how smoking history affected the results. 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 testing, which increased the risk of misleading results. The authors acknowledged this as a significant limitation and emphasized that no included study was biochemically confirmed. This makes it difficult to separate the independent effects of vaping from the lingering effects of smoking.

Important results

The results reported that e-cigarette users experienced worsening in some measures of gum health compared to non-smokers and former smokers, although tobacco smokers consistently had the worst outcomes. In particular, vaping was associated with increased plaque levels and higher pro-inflammatory biological markers, although the certainty of these results remains low due to study design limitations.

However, it showed no significant differences from non-smokers in deeper gum damage, such as: B. Depths or bone loss. The vapers had higher plaque buildup than non-smokers and former smokers, indicating potential risks for cavities and gum disease. However, tobacco smokers had even higher plaque levels.

Switching from smoking to vaping may improve gum health - Preliminary evidence suggests that smokers who switch to e-cigarettes may experience some gum health benefits, although more rigorous studies are needed to confirm this.

Bleeding and visible inflammation were lower in vapers compared to non-smokers, but the researchers said this finding reflected nicotine's known effect in suppressing bleeding gums and often masked underlying medical conditions. Smokers showed the most significant reduction in bleeding gums, likely due to similar nicotine effects.

Importantly, biological markers showed that e-cigarette users showed increased 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 results should be interpreted with caution.

Additionally, microbiome analyzes suggest that vaping altered the bacterial environment in the mouth. Some studies identified bacteria associated with periodontal disease, such as Porphyromonas gingivalis and Fusobacterium nucleatum, although these patterns were different from those in tobacco smokers.

Despite these findings, the study highlighted that many studies had included a high risk of bias, particularly because e-cigarette users often had a history of tobacco smoking. Few studies have 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 can affect people with increased levels of plaque and inflammatory markers compared to non-smokers. However, vapers generally performed better than tobacco smokers, who showed the poorest results.

The authors warned that while vaping appears to be less harmful to gums than smoking, its effects are still unclear and more rigorous research is needed to draw definitive conclusions. They emphasized the need for high-quality studies with verified smoking status to provide clearer guidance on how e-cigarettes really affect gum health.

Sources: