The Effects of Vaping on Oral Health.. What Does Science Tell Us?

Looking through the most recent studies and guidance by dental experts about the effects of vaping on oral health, as always we found arguments in favour and against. Here we aim to summarize and decipher these latest claims and findings.

Speaking recently for National Smile Month, Dr Affan Saghir, owner of Space Dental, a luxury cosmetic dental clinic in the UK, said that anyone wishing to maintain a healthy smile should steer clear of tobacco and vaping products. And while the effect of vaping is still debatable for many, the negative impact of combustible tobacco is a widely accepted fact.

In fact experts in the field are all in agreement that smokers’ teeth are less white than those of non-smokers. A study by award winning researcher Riccardo Polosa, Professor of Medicine and Founder of CoEHAR at the University of Catania, and Giovanni Zucchelli, professor of Periodontology University of Bologna, analysed this further.

Titled, “Repeatability of dental shade by digital spectrophotometry in current, former, and never smokers,” the study examined and compared the differences in the color of teeth withing a group of smokers and a group of non-smokers. The Italian researchers found that indeed the teeth of smokers were significantly less white than those of non-smokers.

On contacting Dr. Polosa to discuss the topic, he explained that in his opinion this is a good angle to tackle smoking cessation from, as aesthetics may be more of a current priority for young people. “The reason why I consider this important is because we are aware of an aesthetic narrative for younger smokers… We all agree that an
aesthetic-based narrative would convincingly resonate among young
smokers. The notion of improvement in dental whiteness could drive
thousands of young smokers away from combustible tobacco!”

He summarized three crucial points that emerged from the study:

“1. The study findings demonstrate that current smokers’ teeth are
significantly less white than nonsmokers’ teeth. Furthermore, after
quitting smoking, teeth whiteness improves.

2. Aesthetic considerations may become a much more compelling
motivation to quit smoking, especially for young smokers who perceive
bad breath and teeth appearance (owing to tooth discolouration and
“tar”/tobacco stains) as a major issue.

3. The use of tar-free nicotine delivery technology (such as
electronic cigarettes or heated tobacco products) is likely to improve
dental appearance, ongoing international research coordinated by
CoEHAR will soon provide definitive results.”

Another Italian observational study carried out at the Unit of Periodontology and Oral Hygiene of Calabrodental Clinic in Crotone, had analyzed the oral health of 110 smokers who had just switched to vaping. At the start of the study, 61% in group 1 and 65% in group 2, experienced gum bleeding, when re-examined at the end of the study, 92% and 98% respectively, experienced no bleeding.

Studies suggesting that vapes have a negative impact on dental health
In contrast, earlier this year CareQuest Institute for Oral Health, a non-profit focused on contributing to a better national oral health system, released a report suggesting several oral health risks associated with the use of e-cigarettes.
Among these health risks, says the report, are gum disease, dental decay, bone loss, and hairy tongue. The paper said that medical professionals need to educate their patients about these risks, however it did not compare the relative benefits for users when they switch from smoking cigarettes.
Another relatively recent study indicated that the sugar content of e-liquids may promote teeth cavities. Titled, “A comparison of the caries risk between patients who use vapes or electronic cigarettes and those who do not,” the study was published online in the Journal of the American Dental Association. Analysing the association between vaping and possible caries risk level, the research team found that vapers had a higher risk of developing them.
Similarly North Carolina dentists have reported noticing an increase and tooth and gum problems among young people who vape. These problems include chronically dry mouth and increased risk for tooth decay, sore gums, grinding the teeth and tooth decay according to Dentist Dr. Anbec DeShield-Mayes, owner of BestMouth Dental in Greensboro.
“We try to give them things to help rehydrate their teeth,” said DeShield-Mayes. “We tell them to drink plenty of water, brushing twice a day, flossing. These are things that I’m seeing with my patients that I’m finding out now are new ‘vapers,’ or have switched from smoking to vaping.”
While another study published in JAMA Network Open, warned that people who vape may be putting themselves at risk of developing gum disease. Titled, “Tobacco Use and Incidence of Adverse Oral Health Outcomes Among US Adults in the Population Assessment of Tobacco and Health Study,” the study used data from the National Institutes of Health (NIH), to look at associations between the use of combustible tobacco products and electronic nicotine delivery systems (ENDS), and developing oral health problems like gum disease.
The research team analyzed data about respondents aged 18 years and above, without lifetime history of oral health conditions. They found associations between current combustible tobacco use with the incidence of adverse oral health outcomes and also links between current ENDS use and the incidence of bleeding after brushing or flossing.
Dentists in Australia are also growing increasingly concerned about the effects of vaping on their patients’ oral health in general. Among other things, the dentists in question mentioned stained teeth, gum disease, bad breath, tooth decay, and also wounds from exploded devices. Principal surgeon Michael Cai from Pitt Street Dental Centre said that the negative impact of vaping is as serious as the one from smoking. “One of the explosions was so bad it broke off two lower front teeth, it was pretty horrible,” said Dr Cai. “The patient ended up having dental implants and they are costly.”
He added that some e-liquids contain components that stain teeth. “For example watermelon flavour will have pink dye in it that stains the teeth pink,” he said. While Australian Dental Association spokeswoman Sue Ching-Yeoh said that the extent of damage is difficult to measure.
Inaccuracies spread about vaping and oral health
The Independent British Vape Trade Association (IBVTA) discussed a recently published inaccurate article linking vaping to gum disease. The Times newspaper recently published an article  titled “Elf bars and me: I am a vaping addict, so will I get gum disease?,” in their health section. Amongst other things, the author inaccurately claims that using just one disposable vape roughly equates to consuming the same amount of nicotine found in 45 cigarettes. This is not even possible explained the IBVTA.
“The UK legal limits on these products are a maximum of 2 millilitres of liquid and 20 milligrams of nicotine per ml. That is 40mg of nicotine in total. Given the average nicotine content of a tobacco cigarettes is 10-12 mg, it is difficult to see how the journalist came up with her figure of 45 cigarettes. It is more like 4.”
The article author goes on to irresponsibly make refer to unsubstantiated claims made by teenagers in social media videos, claiming that vaping is causing them gum disease. Professor Linda Bauld, Bruce and John Usher professor of public health at Edinburgh University responded to the piece saying it is a “good example of how not to write a health-related article and how not to consult anyone from the UK who has conducted research on the topic”. She added that it was “unusually poor from The Times’’.
Similarly, four dental experts from Newcastle University’s School of Dental Sciences have recently spoken up against some inaccuracies recently spread by two food science lecturers at the Cardiff Metropolitan University School of Sport and Health Science, who have recently made several claims on how vaping allegedly causes tooth damage.
Dr Richard Holliday, Professor Elaine McColl, Anthony Weke, and Zella Sayeed, published a letter in the British Dental Journal by Newcastle University, explaining how the claims are inaccurate.
“Tellingly, all UK public bodies, including the NHS, ignore the WHO’s advice. They support vaping, knowing it does not erode teeth nor lead to gum disease.” They said they would like to, “point UK dental professionals to the well-considered public health guidance which basically concludes that, for the best chances of quitting smoking, one should use support and pharmacotherapy and that e-cigarettes can be part of that package.”
The experts explained that the two authors cited a WHO poster and incorrectly claimed that nicotine causes a “high risk of oral and whole-body health complications.” When in reality, they added, nicotine replacement therapy (NRTs) have been safely used in the form of patches and gum for over 30 years.
Moreover, they concluded, UK dental professionals should be pointed to the well-considered public health guidance on the topic. The experts highlighted that this guidance actually states that for the best chances of quitting smoking, one should use support and pharmacotherapy, adding “e-cigarettes can be part of that package.”
Context is key
In conclusion, many medical and oral health practitioners, as well as smoking cessation  experts insist on the relative benefits of vaping for those smokers who struggle to quit unaided. While no one disputes the fact that non-smokers should not take up vaping, given the proven relative safety of the products, switching from smoking to vaping decreases health risks for smokers and improves their oral health.