The Effects of Vaping on Oral Health


The negative effects of traditional tobacco products have been known for decades.1 More recently, vaping — or smoking electronic cigarettes (e-cigarettes) — has been promoted as a less harmful alternative to smoking.2,3  
E-cigarettes began to appear in the United States (US) market in the mid-2000s and have grown in popularity.4 In some regions of Europe, the prevalence of e-cigarette use was as high as 27% in 2020.5 
While e-cigarettes may have health benefits when used as a complete substitute for cigarettes, it is currently unknown what the long-term effects on one’s oral health and overall health will be. Recent research has discovered negative effects on patients' oral health that are distinct from conventional cigarettes.6 However, it is clear that e-cigarettes are not a harmless alternative to traditional cigarettes.7  

What Is Vaping? 

Vaping is another way of saying smoking electronic cigarettes (e-cigarettes).2 There are many different types of e-cigarettes that come in multiple shapes and sizes.7 Some are designed to look like traditional cigarettes, while others may resemble other everyday objects, such as pens or USB sticks. E-cigarettes typically have three components in common — a battery, a heating component, and a place to hold the liquid to be vaporised. Other names for e-cigarettes include:7 

  • Vape pens 
  • Vapes 
  • E-cigs 
  • E-hookas 
  • Mods 
  • Tank systems 

E-cigarettes produce an aerosol inhaled by the user by heating a liquid. This liquid usually contains nicotine but can contain other substances, such as flavourings, tetrahydrocannabinol (THC), or other drugs.7   

Lack of oversight means that users don’t always know what’s in the e-cigarette liquid and aerosol. While e-cigarettes generally contain fewer harmful substances than traditional cigarettes, the aerosol produced by e-cigarettes still contains several different harmful or potentially harmful substances, including:7 

  • Nicotine 
  • Ultrafine particles 
  • Diacetyl 
  • Volatile organic compounds 
  • Carcinogens 
  • Heavy metals — such as nickel, tin, and lead 


Who Uses E-Cigarettes? 

A 2020 systematic review of e-cigarette use in Europe found that the following factors were associated with an increased risk of using e-cigarettes:5 

  • Male sex 
  • Adolescents and young adults 
  • Current smokers of conventional cigarettes 
  • Former smokers of conventional cigarettes  


How Does Vaping Affect Oral Health? 

Initial reports on the effect of vaping on oral health show that it may be similar to the effect of conventional cigarettes.8 Smoking conventional cigarettes can increase a patient’s risk of:1 

  • Oral cancer 
  • Gum disease 
  • Tooth decay 
  • Tooth loss 
  • Oral leukoplakia 

As more research has become available specific to the effect of e-cigarettes, it has become clear that vaping can cause oral health problems that lead to an increased risk of gum disease and infection.  


Vaping Changes the Composition of the Oral Microbiome 

Conventional cigarettes have been found to have detrimental effects on the oral microbiome. Recent studies have found that e-cigarettes also promote a unique periodontal microbiome that is distinct from that of conventional cigarette smokers and nonsmokers.6  

The aerosol produced by e-cigarettes can promote an environment favourable to microbial adhesion and the production of biofilms. Some of the microbial species that are enriched due to vaping are associated with increased levels of proinflammatory cytokines. The inflammatory state can lead to systemic diseases if untreated.6  


Vaping Can Increase the User’s Susceptibility to Infection 

In vitro tests have found that exposure to e-cigarette aerosols can accelerate bacterial infection with Porphyromonas gingivalis or Fusobacterium nucleatum, two bacteria commonly found in periodontal infections. Further testing is needed to see if this is true in vivo.6  


How Does Vaping Affect Overall Health? 

Vaping can have many other health consequences beyond affecting oral health. Using e-cigarettes is linked to an increased risk of several health problems, including:9 

  • Lung disease 
  • Cardiovascular disease 
  • Asthma 
  • Lung cancer 


Tips for Encouraging Smoking Cessation 

As health care providers, dentists should encourage patients to quit smoking when possible. Surveys show that most patients who smoke want to quit.10 Despite a desire to quit, fewer than 1 in 10 people in the United States (US) successfully quit smoking each year. Nicotine is a very addictive drug that many people find difficult to quit.11 

Patients may be vaping to help them quit smoking cigarettes without being aware of the potential negative effects. It is important to educate these patients that even though vaping may be less harmful than smoking traditional cigarettes, it’s not harmless.10 


Dentists can help patients quit smoking by:10 

  • Providing education about the harmful effects of vaping 
  • Encouraging patients to quit 
  • Connecting patients to smoking cessation resources, such as a tobacco quitline 
  • Referring patients to other providers for counselling and cessation medications  



  1. Centers for Disease Control and Prevention. Tobacco use. Updated November 8, 2020. Accessed November 22, 2023. 
  2. Centers for Disease Control and Prevention. Electronic cigarettes. Updated September 4, 2023. Accessed November 22, 2023. 
  3. Johns Hopkins Medicine. 5 vaping facts you need to know. Accessed November 22, 2023. 
  4. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. E-cigarette use among youth and young adults: A report of the Surgeon General [Internet]. Atlanta (GA): Centers for Disease Control and Prevention (US); 2016. Chapter 1, Introduction, Conclusions, and Historical Background Relative to E-Cigarettes. Accessed November 22, 2023. 
  5. Kapan A, Stefanac S, Sandner I, et al. Use of electronic cigarettes in European populations: A narrative review. Int J Environ Res Public Health. 2020 Mar 17;17(6):1971. doi: 10.3390/ijerph17061971. PMID: 32192139; PMCID: PMC7142603. 
  6. Thomas SC, Xu F, Pushalkar S, et al. Electronic cigarette use promotes a unique periodontal microbiome. mBio. 2022 Feb 22;13(1):e0007522. doi: 10.1128/mbio.00075-22. Epub 2022 Feb 22. PMID: 35189698; PMCID: PMC8903898.
  7. Centers for Disease Control and Prevention. About electronic cigarettes (e-cigarettes). Updated November 2, 2023. Accessed November 22, 2023.
  8. Irusa KF, Vence B, Donovan T. Potential oral health effects of e-cigarettes and vaping: A review and case reports. J Esthet Restor Dent. 2020 Apr;32(3):260-264. doi: 10.1111/jerd.12583. Epub 2020 Apr 3. PMID: 32243711.
  9. American Lung Association. The impact of e-cigarettes on the lung. Updated May 31, 2023. Accessed November 22, 2023.
  10. Centers for Disease Control and Prevention. Smoking cessation - The role of healthcare professionals and health systems. Updated October 25, 2023. Accessed November 22, 2023.
  11. Centers for Disease Control and Prevention. Why quitting smoking is hard. Updated November 28, 2023. Accessed November 22, 2023.