The oral health impact of electronic cigarette use: a systematic review

Abstract

Introduction: Electronic cigarette (e-cigarette) use is becoming more prevalent and is particularly popular among adolescents and conventional smokers. While the oral health sequelae of conventional smoking are well-established, the impact of e-cigarettes on oral health is still unknown. This study aims to systematically review the available research evidence on the oral health impact of e-cigarette use.

Methods: This systematic review was conducted according to PRISMA guidelines and used the Effective Public Health Practice Project Quality Assessment Tool to evaluate the evidence. Three electronic databases (PubMed, Web of Science, and Embase) were systematically searched for studies including case reports. Two independent reviewers extracted data and synthesized the findings.

Results: Ninety-nine articles were included in this systematic review. Analyses of the articles yielded seven categories based on symptom similarity and/or focus: mouth effects, throat effects, periodontal effects, dental effects, cytotoxic/genotoxic/oncologic effects, oral microbiome effects, and traumatic/accidental injury. The majority of mouth and throat symptoms experienced by e-cigarette users were relatively minor and temporary, with some evidence that conventional smokers who switched to e-cigarettes experienced mitigation of these symptoms. E-cigarette exposure increased the risk for deteriorating periodontal, dental and gingival health as well as changes to the oral microbiome. Extensive dental damage as a result of e-cigarette explosions were described in case reports. Components of e-cigarette vapor have known cytotoxic, genotoxic, and carcinogenic properties.

Conclusions: Although switching to e-cigarettes may mitigate oral symptomatology for conventional smokers, findings from this review suggest that a wide range of oral health sequelae may be associated with e-cigarette use. Well-designed studies to investigate oral health outcomes of e-cigarette use are needed.

Keywords:

• ENDS
• e-cigarettes
• vaping
• oral health
• systematic review

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Acknowledgments

The authors are grateful to the two anonymous reviewers whose comments and suggestions helped to improve and clarify this manuscript.

Declaration of Interest

The authors declare that there are no conflicts of interest. The employment affiliations of the authors are shown on the cover page. These authors have the sole responsibility for the writing and content of this article. Thoughts and opinions expressed within this work are those of the three authors and do not necessarily reflect those of their employers. The authors involved with this project have received support from numerous other sources for other research projects (detailed below). No funding from these other sources, however, was used in the current review, evaluation, or preparation of this manuscript.

I. Yang and J. Rodriguez have conducted research investigating the oral microbiome of e-cigarette users, and secondhand e-cigarette vapor exposure among children of vapers. Funding for this work was from NIEHS; however, none of it was received for the preparation of this manuscript.

I. Yang has published articles related to prenatal smoking (combustible cigarettes) funded by the University of Louisville, School of Interdisciplinary Graduate Studies Research Fund, Grant no. T32NR01275 from the National Institute of Nursing Research, and #1P30 GM110788-01 from the National Institute of General Medical Science. As a doctoral student, I. Yang interned at the Kentucky Center for Smoke Free Policy. Located in the College of Nursing at the University of Kentucky, this center provides policy advocacy and data support for those advocating for local smoke-free workplace ordinances and tobacco-free policies within the state of Kentucky. I. Yang received no funding support throughout her time there. Currently, I. Yang serves on the board of directors of Healthy Mothers, Healthy Babies Coalition of GA whose legislative agenda includes advocating for increased state tobacco taxes. Other research projects of I. Yang (unrelated to tobacco or e-cigarette use) have been supported by the US National Institute of Nursing Research, National Institute of Aging, and the Association of Women’s Health, Obstetric, and Neonatal Nurses.

J. Rodriguez has received funding from NIEHS/EPA for research on environmental exposures, the gut microbiome, the metabolome, and neurodevelopment among African American infants. She has also been funded by the NIMHD for research on maternal stress, the gut microbiome, and neurodevelopment among African American infants.

S. Sandeep has no declarations of interest to report.

None of the authors have participated in legal, advocacy, regulatory, or other proceedings related to the contents of this manuscript.