What Does Science Say About Oral Health and Vaping?

Media coverage of vaping and oral health still tends to focus on the negative – and this mainly being the reporting of statements based on poor science or bias opinion. As time rolled by, there has been an increasing number of quality studies demonstrating that swapping smoking for vaping has a beneficial impact on the mouth.

A typical case in point is a 2017 study that is frequently referenced by opponents of vaping, conducted in Ho Chi Minh, where three Vietnamese dental researchers wrote up the case of two Vietnamese men who presented with oral cancer.

In Oral Carcinoma Associated with Chronic Use of Electronic Cigare Otolaryngol, the team say: “We report two cases of oral carcinoma associated with chronic use of E-cigarettes. These highlight the need for increased awareness of this important, and potentially fatal, risk.”

They go on to conclude: “Tobacco cigarette smoking is a known risk for cancers, including oral cancer. Patients and clinicians (physicians, dentist and nurses) need to be aware that the use of electronic-cigarettes (E-cigarettes) or other electronic nicotine delivery systems (ENDS) may also be associated with an increased risk of oral cancer.”

Now while this sounds bad, there are a number of issues with the work:

·Firstly, this is just two individuals, and the very small sample size already limits any conclusions that could be drawn.
·Secondly, subjects self-reporting information tend to answer in a way that they think the people asking questions would like them to answer. It is well documented that such studies frequently fall down at this stage as subjects exaggerate or omit key points.
·Lastly, despite a comprehensive list of things the two men had never done (including chewing tobacco or related products), the team did not identify a previous history of smoking – something almost all vapers used to do prior to e-cigarettes.

The probability of a previous life of heavy smoking being to blame for the mouth cancers is far, far higher than of it being related to vaping.

Skip forward five years and we come across a pair of dentists from Essex with an opinion they wanted to share.

A freshly qualified dentist with no history of involvement in research projects gave an interview to a Chinese news agency, wrongly stating that “vaping is smoking” and questioning the whole of the UK’s public health system by asking if they have got it wrong by embracing tobacco harm reduction in the same way they did for combatting AIDS or the introduction of seat belts to reduce car fatalities.

His opinion was shared widely, including the allegation that there is such a thing as “vaping-related pneumonia”, but not one of his points were evidenced.

He even attacked free vape kits for smokers. “I find it bizarre that instead of increasing nurses wages or creating more ICU units, the NHS has opted to facilitate the nation’s nicotine habit,” he said. The point of the free kits is the cost is far outweighed by the savings to the NHS treating smoking-related diseases – but this wasn’t covered.

Another dentist from Essex wrote an article in the journal Nature, saying: “E-cigarette exposure can increase the risk for deteriorating periodontal health as well as changes to the oral microbiome. Components of e-cigarette vapour also contain known cytotoxic, genotoxic and carcinogenic properties. As healthcare professionals, we have a pivotal role in educating our patients in order to prevent an addiction which may be very difficult to overcome once established.”

The trouble with these unevidenced opinions is that they feed into what the larger population of dentists think as they are too busy to sift through the research evidence.

So, does vaping pose a risk to the mouth?

Let’s start with the Oral Health Foundation (formerly the British Dental Association). In 2015, the Foundation made two powerful statements about vaping that the dental community should have picked up on:

·“Smoking is the cause of many serious oral health problems, including worsening gum disease, which is one of the most common causes of caries in UK adults. It is also responsible for the majority or mouth cancers and is the direct cause of thousands of deaths every year. Every year almost seven thousand people in the UK are diagnosed with mouth cancer, and it leads to more deaths than testicular and cervical cancer combined.”

·“We need to spread the message that e-cigarettes, while not risk free, are much less harmful than smoking, as currently nearly half the population are not aware of this… The British Dental Health Foundation believe that there is a long way to go to before we get to a smoke-free lifestyle but any way which smoking numbers can be cut, and therefore lives saved, is positive and one which we will support.”

·“Electronic cigarettes are many magnitudes safer than smoking.”

·“The message for now is that there are no circumstances in which it is safer to smoke than to use an electronic cigarette. Given the dreadful burden of disease caused by smoking we must find a way to make the most of the opportunities and ensure that risks are minimised.”

This support for switching to vaping has not changed since then.

The following year, a study showed that switching to vaping drastically reduced the risks of contracting oral cavity cancer. They concluded: “The use of electronic cigarettes seems to be safe for oral cells and should be suggested as an aid to smoking cessation.”

2017, a study looking at oral symptoms compared smokers to vapers/never smokers. They found that problems being reported were much lower in the vaper/never smoker group – concrete evidence of the benefits of switching.

The following year, study data showed that vaping was far better for microorganisms in the mouth than smoking. This research team concluded: “The current pilot data demonstrate that the use of ECs [electronic cigarettes] may represent a safer alternative compared to tobacco smoking.”

Another study the same year demonstrated that smoking stains teeth whereas vaping had the same results as not smoking or vaping.

Also in 2018, researchers compared the impact of smoking and vaping on gum tissue, finding that although vaping did have a measurable impact on things like wound healing in the mouth, “it should be noted that [smoking] was much more damageable to gingival fibroblasts”.

In 2019, a study showed that ecig use had as much impact on the mouth as not smoking or vaping – while smoking had a very noticeable damaging impact. Another study found that gum disease was worse in smokers than vapers or non-smokers.

The 2019 findings were confirmed by Richard Holliday (Centre for Oral Health Research, School of Dental Sciences, Newcastle University) in his systematic review – and went on to say that not only is there good evidence to say that e-cig use is far safer to the mouth, but that there is “limited” evidence from reliable studies to the contrary.

In fact, Richard Holliday was so convinced by the evidence that he has repeatedly attempted to convince the dental community of the benefits of encouraging their smoking patients to switch to vaping.

So, while outlandish evidence-free opinions may continue to make the headlines, the truth is that there is strong evidence to support e-cigarette use during quit attempts and that it does not have a negative impact on the mouth. Moreover, many studies show vaping has the same impact as found in never smokers.