A comparison of the caries risk between patients who use vapes or electronic cigarettes and those who do not: A cross-sectional study

Toxic cultures: e-cigarettes and the oral microbial exposome

We tested the hypothesis that e-cigarette aerosol is metabolized by the indigenous oral microbiome, leading to structural and functional alterations. We combined untargeted metabolomics of in vitro commensal-rich and pathogen-rich biofilms with metatranscriptomics and fluorescent microscopy and verified the results in human samples. Spectral deconvolution of 4215 peaks identified 969 exposomal and endogenous metabolites that mapped to 23 metabolic pathways. The metabolites clustered by both aerosol characteristics and biofilm composition; and several were verified in human saliva of vapers. E-cigarette exposure upregulated xenobiotic degradation, capsule, peptidoglycan biosynthesis, organic carbon-compound metabolism, antimicrobial resistance, and secretion systems. E-cigarette exposure also altered biofilm architecture characterized by low surface-area to biovolume ratio, high biomass, and diffusion distance. In conclusion, our data suggest that bacterial metabolism of e-cigarette aerosol triggers a quorum-sensing-regulated stress response which mediates the formation of dense, exopolysaccharide-rich biofilms in health-compatible communities and antibiotic resistance and virulence amplification in disease-associated communities.

The effects of electronic smoking on dental caries and proinflammatory markers: a systematic review and meta-analysis

Introduction

Smoking and the use of electronic cigarettes (e-cigs) are common practices that have significant consequences for oral health. Although the negative impact of traditional tobacco products on oral tissues is widely known, the emergence of e-cigs poses a new obstacle. This review summarises existing data on the influence of e-cigs on oral health, with a specific emphasis on dental caries and pro-inflammatory agents.

Methods

A comprehensive search was conducted via PubMed, Web of Science, Embase, and Scopus to identify relevant studies published until September 2024. The structured search strategy uncovered 42 articles that were read in full text. The included articles consisted of clinical trials, observational studies, and laboratory investigations that examined the impact of e-cig aerosol on oral bacteria and pro-inflammatory markers and its potential to contribute to dental caries.

Results

The findings indicate that e-cig users may have a higher prevalence of dental caries compared with non-smokers. Most studies focusing on bacteria showed that vaping may inhibit normal flora, giving cariogenic bacteria a chance to grow more. This finding indicates a notable oral health risk associated with vaping. Meta-analyses suggest no effect of using e-cigs on the levels of TNF-α, IL-1β, IL-6, and IL-8 in saliva, even if it may affect their levels in GCF. However, in GCF, only one study reported TNF-α and IL-1β, and only two studies reported IL-6 and IL-8. Nevertheless, the effects of e-cigs on dental caries require further investigation since the data do not provide a clear picture.

Discussion

This review emphasises the necessity for ongoing research to clarify the mechanisms that cause these consequences and to guide public health policies aimed at reducing the harm caused by e-cigarettes.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024537910, PROSPERO (CRD42024537910).

Knowledge and Perceptions of Dentists Regarding E-Cigarettes: Implications for Oral Health and Public Awareness and Education

Background/Objectives: The rising popularity of e-cigarette use is creating new challenges for oral healthcare. Factors such as targeted marketing, appealing flavors, and the perception that e-cigarettes are a safer alternative to traditional smoking have contributed to their widespread adoption. This trend is particularly prevalent among young adults and teenagers, many of whom turn to e-cigarettes despite having no prior history of regular cigarette use. This study aimed to evaluate dentists' knowledge and perceptions regarding e-cigarettes, focusing on their health effects, regulatory status, and potential risks to oral health. Assessing dentists' knowledge of e-cigarette risks is important, as they guide patients on the potential oral health dangers of vaping. E-cigarette use has been linked to several oral health problems. Methods: A cross-sectional survey was conducted among 189 dentists in Kosovo, comprising both general dentists and specialists. The questionnaire assessed participants' awareness of e-cigarettes' FDA approval status, their perceptions of health impacts, and their understanding of e-cigarettes' association with oral conditions such as caries, periodontal disease, and oral cancer. Data were analyzed using SPSS 22, with significance set at p < 0.05. Results: The findings revealed significant knowledge gaps, with 74.1% of respondents being uncertain about the FDA approval status of e-cigarettes and 82.0% recognizing their harmful effects on general and oral health. Nearly half (49.7%) of the participants identified e-cigarettes as a potential risk factor for caries, while 66.1% and 64.6% associated their use with oral cancer and periodontal disease, respectively. Gender and professional specialization did not significantly influence these perceptions. Conclusions: Dentists need better education on the risks of e-cigarette use, including their harmful effects on oral health. Incorporating this knowledge into dental curricula and professional training is essential to give dentists the information needed to advise patients effectively. Raising public awareness through dental health professionals can help mitigate the oral health risks associated with e-cigarettes.

E-cigarette exposure increases caries risk and modifies dental surface in an in vitro model

OBJECTIVE

Electronic cigarettes have become increasingly popular and can deliver nicotine at levels comparable to traditional tobacco cigarettes. However, the potential adverse effects of these alternative smoking devices on dental health remain uncertain. This study investigates changes in the cariogenic potential of tooth surfaces and analyzes alterations in the chemical composition of aerosols generated from sweet-flavored e-liquids used in electronic cigarettes.

DESIGN

Smoking was simulated using an electronic-cigarette testing machine. Eighty specimens of enamel, dentin and root dentin were divided in two groups according smoking: pre-smoke and post-smoke. The response variables were Microhardness (n=10), SEM (n=5) and FTIR (n=5). E-liquid was analyzed pre-smoke and post-smoke by HPLC-UV/Vis. Data were analyzed by one-way ANOVA and Tukey's tests, with a significance level of 5 %. SEM, FTIR and HPLC-UV/Vis data were qualitatively analyzed.

RESULTS

Enamel exhibited higher microhardness values before and after smoking, with all substrates showing significant microhardness reduction after smoking. All dentin specimens presented standard dentinal tubules, and post-smoke enamel prisms appeared disorganized with various orientations. The specimens' chemical constituents remained stable. Dentin and root dentin post-smoke, carbonate band intensity decreased. There was a thermal degradation of e-liquid products and the formation of new compounds post-vaporization.

CONCLUSIONS

E-cigarette smoking reduces the microhardness of enamel, dentin, and root dentin, alters enamel morphology, induces chemical interactions between e-liquid and tooth tissues, and may increase the risk of cariogenic potential.

Immunological Effects of Electronic Cigarette Use: A Review of Current Evidence

Electronic cigarettes (EC) have emerged as a popular alternative to traditional tobacco products, but their impact on immune function has raised significant health concerns. This review explores the immunological effects of EC exposure, focusing on innate and adaptive immune responses. Electronic cigarette aerosol (ECA) induces widespread inflammation. These changes compromise immune cell function, impairing neutrophil chemotaxis, phagocytosis, and oxidative burst while increasing macrophage and dendritic cell recruitment and activation. ECA also disrupts epithelial barriers, increasing susceptibility to bacterial and viral infections. Studies show enhanced biofilm formation in bacteria such as Staphylococcus aureus and Streptococcus pneumoniae and impaired antiviral responses against pathogens like influenza A and SARS-CoV-2. Additionally, EC exposure modulates adaptive immunity, affecting T and B cell function and increasing systemic inflammatory markers. The long-term consequences of these immunological disruptions include heightened risks for chronic inflammatory diseases, respiratory infections, and potentially autoimmune conditions. The widespread adoption of EC, particularly among younger users, poses a growing public health challenge. As the popularity of vaping continues to rise, these immunological disruptions could result in increased healthcare burdens in the future, with higher rates of infections, chronic inflammatory diseases, and immune system-related disorders among those who begin using e-cigarettes at a young age. Understanding the full scope of EC-related health risks is essential for informing public health policies and protecting future generations from the potential long-term effects of vaping.

Oral health risks in adults who use electronic nicotine delivery systems and oral nicotine pouches: a critical review of the literature and qualitative synthesis of the available evidence

BACKGROUND

Use of combustible cigarettes (CCs) and smokeless oral tobacco products are well documented risk factors for a variety of oral diseases. However, the potential oral health risks of using recently introduced (since about 2000) non-combustible tobacco/nicotine products (NCPs: electronic cigarettes (ECs), heated tobacco products (HTPs) and oral nicotine pouches (ONPs), remain poorly established.

METHODS

This review evaluates published human studies on detrimental oral health effects in people who use NCPs compared to those smoking cigarettes and those not using any tobacco/nicotine product (NU). We identified 52 studies, predominantly focusing on adults who used electronic cigarettes as an NCP. The studies exhibited significant heterogeneity regarding design, populations, endpoints and quality. Reported outcomes, based on both single and grouped endpoints were qualitatively evaluated by comparing people who use NCPs with NU and with people smoking CCs. Significant increases (indicating a worsening in oral health), significant decreases (indicating a lower level of detrimental effects) and no significant difference between groups were assigned scores of + 1, -1 and 0, respectively. Scores from studies belonging to the same single or grouped endpoints were averaged to a summary score ranging from - 1 to + 1.

RESULTS

The qualitative meta-analysis revealed that comparisons of EC versus NU groups yielded mean scores of 0.29 for pre-cancerous lesions (N = 14 observations), 0.27 for inflammatory processes (N = 83), 0.43 for oral clinical parameters (N = 93) and 0.70 for shifts in the oral microbiome (N = 10). The corresponding values for the EC versus CC group comparisons amounted to -0.33 (N = 15), -0.14 (N = 76), -0.27 (N = 78) and 0.57 (N = 7). Most studies had significant limitations regarding group sizes, duration of NCP use (mostly only a few years) and validity of self-reported exclusive NCP use. Notably, the implications of dual use (EC + CC) and prior CC use were often not adequately considered.

CONCLUSIONS

The evaluated studies suggest that use of ECs is associated with relatively fewer detrimental oral health effects compared to smoking, yet oral health status remains poorer compared to not using any tobacco/nicotine products. These results have to be interpreted with caution due to a number of limitations and uncertainties in the underlying studies, particularly the potential biases and confounding factors inherent in cross-sectional study designs.

Adverse effects of electronic cigarettes on human health

Many people have associated e-cigarettes with adjectives such as trendy and cool, and regarded vaping as "a safer alternative to cigarette smoking". Compared with the conventional cigarettes, the public is less familiar with the dangers of e-cigarettes. E-cigarettes produce an aerosol by heating the e-liquid (usually comprising nicotine, flavorings, propylene glycol, vegetable glycerin, and other additives). Harmful substances are generated during the vaporization, such as formaldehyde. Cellular damages and DNA hypermethylation are also found to be associated with vaping. We reviewed the clinical neoplastic cases of patients with vaping history (three oral squamous cell carcinomas, one conjunctival squamous intraepithelial neoplasia, and one thoracic NUT-midline carcinoma). These patients tend to be younger than the average cancer patients. Although the exact relations between the cellular damages or DNA hypermethylation and vaping still need further investigations, we should be very careful about the dangers of using e-cigarettes as aids for cigarette smoking cessation.

Assessment of Respiratory Health Implications of Vaping: A Systematic Review of Toxicity Mechanisms and Adverse Effects of Electronic Nicotine Delivery Systems

E-cigarettes are thought to aid in tobacco smoking cessation, but there are concerns about their overall effectiveness and safety for the general population, particularly adults. This review aims to investigate the mechanisms of toxicity and adverse effects of e-cigarettes on the respiratory system, comparing these effects with those of conventional smoking. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were performed on PubMed, Embase, and the Cochrane Library using keywords, controlled vocabulary, and text words, with the following criteria: studies published in English from 2014 to 2024, open access, peer-reviewed, and full-text availability. Study selection, quality assessment, and data extraction were carried out by two independent reviewers. The Cochrane Risk of Bias 2.0 tool was used to evaluate the risk of bias in included randomized controlled trials, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was employed to assess the strength of evidence and determine its generalizability. Electronic nicotine delivery systems (ENDS) have diverse mechanisms of toxicity, including inflammation, hypoxia, cardiovascular stress, and metabolic changes. Reported adverse effects include cough, throat irritation, nausea, and hemodynamic changes. However, ENDS are associated with fewer risks compared to conventional cigarette smoking. ENDS users experience fewer respiratory and cardiovascular issues and have lower levels of biomarkers such as NNAL and CO compared to traditional smokers. Additionally, ENDS are more effective than nicotine replacement therapy (nicotine patches) for smoking cessation, particularly in pregnant women. The side effects of ENDS and nicotine-free vaping are similar to those of conventional smoking in pregnant women, with the exception of a lower birth weight among newborns exposed to ENDS (p < 0.05). ENDS present a complex balance of benefits and risks regarding respiratory health. While there are adverse effects, ENDS are considered less detrimental than conventional smoking and a viable option for smoking cessation. Longitudinal studies are needed to evaluate their safety with long-term use (>16 weeks). Policymakers and health practitioners should use these findings to develop balanced public health policies that weigh the benefits of ENDS against potential health risks, enabling informed decision-making for users.

The Effect of New Trend Electronic Cigarettes on Dental Caries in Relation to Glucosyltransferase B and Secretory Immunoglobulin A (A Case-control Study)

Electronic cigarettes (vapes) are actively used, and their use is growing globally, especially among young people. Its spread is rapid due to the presence of unproven rumors that it is used to treat smoking addiction as it aids in smoking cessation. However, E.C has a negative impact on dental health by affecting the oral microbiome and salivary components. The goal of this study was to evaluate the impact of electronic cigarettes on dental caries in relation to glucosyltransferase B and secretory immunoglobulin in the saliva of electronic cigarette users. Ninety active males were divided into two groups: 45 electronic-cigarette smokers in addition to 45 non-electronic-cigarette smokers as a control group. An oral examination was performed on the studied groups, and decayed missing filling tooth surfaces (DMFS) were documented. Additionally, unstimulated saliva was collected to evaluate salivary glucosyltransferase B and secretory immunoglobulin A by using a sandwich enzyme-linked immune-sorbent assay (ELISA). The obtained outcomes showed that decayed, missing, and filled Surfaces values(DMFS), salivary glucosyltransferase B, and salivary secretory immunoglobulin A were greater in the study group than in control group. Additionally, a correlation between glucosyltransferase B, secretory immunoglobulin A, and DMFS was positive and significant. It was concluded that e-cigarettes may have an effect on saliva components and dental caries.

Unveiling the Impact of Electronic Cigarettes (EC) on Health: An Evidence-Based Review of EC as an Alternative to Combustible Cigarettes

Cigarette smoking has been considered a major public health concern due to its serious impact on health. However, smokers intending to quit may find long-term abstinence challenging. When smoking an electronic cigarette (EC), users can experience a sensation and taste similar to that of smoking a combustible cigarette. Therefore, manufacturers promote these products as a viable substitute for combustible cigarettes. However, several researchers report the serious health impacts experienced by EC users. Therefore, this review aims to examine the health impacts of EC use. Based on the findings of the research papers reported in the literature, the role of EC as a smoking cessation tool is unclear. Several researchers have also reported a significant association between EC usage among non-smokers at baseline and the future initiation of combustible cigarette smoking. EC use significantly impacts user health. The nicotine that is present in EC e-liquids can elevate blood pressure, resulting in blood vessel constriction and an increase in heart rate, ultimately leading the body to an ischemic condition, resulting in myocardial infarction (MI), stroke, and increased arterial stiffness. Researchers report a higher likelihood of prediabetes among EC users; its usage was associated with higher OR of having asthma attacks and higher OR of reporting depression and has an impact on birth outcomes among pregnant women. Men using EC are more likely to report erectile dysfunction than non-users. EC also has a significant impact on oral health, which includes periodontal diseases, mucosal lesions, irritation in the mouth and throat, reduced salivary flow, and an increased risk of developing cancer. The physical injury resulting from exploding EC is another health concern. The frequently burned areas included the hands, face, genitalia, and thighs. Marketers promote EC as an alternative to combustible cigarettes and a tool for quitting smoking. However, the Food and Drug Administration has not approved them for smoking cessation. EC can have a serious impact on the health of their users; hence, the findings of this paper have several implications, including the need for regulation of the sales and marketing of these products and educating the users on the impact of these products on their health and safety.

Dental Hygienists Knowledge, Beliefs, and Intentions Regarding Asking Adolescents About Electronic Nicotine Delivery Systems Use

PURPOSE

The purpose was to assess clinical dental hygienists' knowledge, beliefs, and intentions regarding asking adolescents about electronic nicotine delivery systems (ENDS) use.

METHODS

Cross-sectional survey research was conducted with a convenience sample of dental hygienists using a validated instrument developed based on the theory of planned behavior (TPB) that contained the following sections: demographics, knowledge, behavioral belief (BB), normative beliefs, control beliefs, and behavioral intention. Outcomes were analyzed using descriptive statistics, correlations, and multivariate regression analysis.

RESULTS

Of the 360 participants who opened the survey, 257 completed it for a completion rate of 71.4%. The knowledge score mean was 72%. BBs suggested that a majority (83%) of participants were likely to ask adolescent patient about ENDS use, however, normative beliefs showed that only about half had the support of their dentist/supervisor, and one-third (33%) felt they had sufficient tobacco/nicotine use and dependency guideline resources. This resulted in only half having the behavioral intention to ask adolescents about ENDS use. Demographic variables were not significantly correlated with the TPB subscales or intention. In the regression model all three TPB subscales predicted intention (F3, 251) = 46.1; p < .001). The coefficient of determination (R2 = 0.35) suggested 35% of the variation in the intention to ask about ENDS use can be explained by the model.

DISCUSSION

Most participants had favorable BBs toward asking about ENDS use among adolescents. However, adequate support from dentists/supervisors and training on guidelines for prevention and cessation of ENDS is needed to encourage dental hygienists to ask adolescents about ENDS use.

IMPACT OF E-CIGARETTES ON THE ORAL HEALTH - LITERATURE REVIEW

E-cigarettes are electronic devices used to inhale aerosols generated from the vaporization of flavored liquids. Nowadays, the use of e-cigarettes has become one of the most popular alternatives to traditional smoking. The wide variety of devices and liquids makes it challenging to assess the health effects of using e-cigarettes. During the vaporization of e-liquids, toxins, carcinogens, and various other chemicals can be released and inhaled by the user. Limited data exist regarding the potential health impact of exposure to e-vapors, primarily derived from animal studies and in vitro research. The oral tissues are the first site of direct interaction with the components of the inhaled vapor. While e-cigarettes are commonly portrayed as safer alternatives to tobacco cigarettes, little is known about the short- or long-term health effects of their use. The aim of this review is to briefly present the available data regarding the impact of chemical ingredients and toxins present in e-cigarette vapors on oral cavity cells.