A vaping habit could end up leading to a dull smile and more frequent visits to the dentist.
Research by professors at Tufts University School of Dental Medicine found that patients who said they used vaping devices were more likely to have a higher risk of developing cavities. With CDC surveys reporting that 9.1 million American adults and 2 million teens use tobacco-based vaping products, that means a lot of vulnerable teeth.
The results of this study on the association between vaping and the risk of cavities – the dental term for cavities – serve as a wake-up call that this once seemingly harmless habit can be very harmful, says Karina Irusa, assistant professor of comprehensive care and lead author on the paper. The study was published on November 23 in The Journal of the American Dental Association.
In recent years, public awareness of the systemic health dangers of vaping has grown, particularly after the use of vaping devices has been linked to lung disease. Some dental research has shown links between e-cigarette use and increased markers of gum disease and, separately, damage to the enamel of the tooth, its outer shell. But relatively little emphasis has been placed on the intersection between e-cigarette use and oral health, even by dentists, Irusa says.
Irusa says Tufts’ recent discovery may just be a clue to the damage vaping does to the mouth. “The extent of the effects on dental health, particularly on tooth decay, is still relatively unknown,” she says. “At this point, I’m just trying to raise awareness,” both dentists and patients.
This study, says Irusa, is the first known to specifically investigate the association of vaping and e-cigarettes with increased risk of cavities. She and her colleagues analyzed data from more than 13,000 patients over the age of 16 who were treated at Tufts Dental Clinics from 2019 to 2022.
While the vast majority of patients reported not using vaping, there was a statistically significant difference in levels of tooth decay risk between the e-cigarette/vaping group and the control group, Irusa found. Some 79% of vaping patients were classified as having a high risk of cavities, compared to just around 60% of the control group. Vaping patients were not asked if they used devices containing nicotine or THC, although nicotine was more common.
It is important to understand that this is preliminary data. It’s not 100% conclusive, but people need to be aware of what we’re seeing.”
Karina Irusa, assistant professor of comprehensive care and lead author of the article
More studies need to be done, and Irusa wants to take a closer look at how vaping affects saliva microbiology.
One of the reasons e-cigarette use could contribute to a high risk of cavities is the sugar content and viscosity of vaping liquid, which when aerosolized and then inhaled through the mouth, sticks to teeth. (A 2018 study published in the journal PLOS A compared the properties of sweet-tasting e-cigarettes to gummies and acidic drinks.) Vaping aerosols have been shown to alter the oral microbiome, making it more hospitable to cavity-causing bacteria. It has also been observed that vaping seems to promote cavities in areas where it does not usually occur, such as the lower edge of the front teeth. “It has an aesthetic impact,” says Irusa.
Tufts researchers recommend that dentists routinely ask questions about e-cigarette use as part of a patient’s medical history. This includes pediatric dentists who see teenagers; according to the FDA/CDC, 7.6% of middle and high school students reported using e-cigarettes in 2021.
The researchers also suggest that patients who use e-cigarettes should be considered for a “more rigorous caries management protocol,” which could include fluoride toothpaste and fluoride rinse on prescription, office fluoride applications. and exams more often than twice a year.
“It takes a lot of investment of time and money to manage dental caries, depending on their severity,” says Irusa. “Once you start making the habit, even if you have fillings, as long as you keep going, you’re still at risk for secondary cavities. It’s a vicious cycle that won’t stop.”
Steven Eisen of Tufts University School of Dentistry is the lead author of the article. Full author and conflict of interest information is available in the published article.
Iruse, KF, et al. (2022) A comparison of caries risk between patients who use vapes or e-cigarettes and those who do not. The Journal of the American Dental Association. doi.org/10.1016/j.adaj.2022.09.013.