medicina

Review
Effects of Vape Use on Oral Health: A Review of the Literature
Alin M. Iacob 1 , Matías F. Escobedo Martínez 2, * , Enrique Barbeito Castro 3 , Sonsoles Junquera Olay 4 ,
Sonsoles Olay García 2 and Luis Manuel Junquera Gutiérrez 5

1 Asturian Institute of Dentistry, Oviedo University, 33003 Oviedo, Spain; alini63@yahoo.com

2 Department of Integrated Adult Dentistry, School of Dentistry, University of Oviedo, 33003 Oviedo, Spain;
olaymaria@uniovi.es
3 Department of Gastroenterology, Hospital Universitario Central de Asturias, 33003 Oviedo, Spain;
e.barbeitocastro@gmail.com
4 Department of Radiology, Hospital Universitario Central de Asturias, 33003 Oviedo, Spain;
junqueraolays@gmail.com
5 Head Department of Oral and Maxillofacial Surgery and Oral Medicine, School of Dentistry,
Oviedo University, 33003 Oviedo, Spain; junquera@uniovi.es
* Correspondence: escobedomatias@uniovi.es; Tel.: +34-645-32-42-43

Abstract: Background and Objectives: The widespread use of tobacco has evolved with the popularity
of vapes, especially among young people, despite the lack of clarity in warnings about their risks.
Studies indicate the need for more effective communication about the oral risks of vaping. In addition
to systemic, respiratory, and cardiovascular effects, vaping is associated with an increased risk of
gingivitis and periodontal disease as well as reduced antioxidant capacity of saliva. The objectives
of this narrative review are to summarize the existing information in the literature on the effects of
vaping at the oral level and to bring together knowledge about the mechanism of action of vaping in
oral tissues. Materials and Methods: In the present study, articles were searched in PubMed, Elsevier
Scopus, and Web of Science using the keywords “oral health”, “vaping”, and “vape”. Studies published
in the last 6 years that addressed the effects of oral vaping were selected, including comparisons
among vape users, smokers, and non-smokers. Repeated articles, prior to 2017 and in languages
other than English, were excluded. Two review authors (A.M.I and M.F.E.M) independently selected
Citation: Iacob, A.M.; Escobedo
Martínez, M.F.; Barbeito Castro, E.;
the papers based on titles and abstracts and conducted a full review of the remaining papers. In
Junquera Olay, S.; Olay García, S.; cases of disagreement, a third reviewer was used. Results: A total of 113 results were obtained,
Junquera Gutiérrez, L.M. Effects of distributed as 16 from PubMed, 35 from Web of Science, and 62 from Elsevier Scopus. After removing
Vape Use on Oral Health: A Review of duplicates, 67 articles were filtered by reviewing titles and abstracts, and finally, 22 articles were
the Literature. Medicina 2024, 60, 365. selected for comprehensive reading. Subsequently, eight of these articles were chosen for qualitative
https://doi.org/10.3390/ synthesis and are presented in standardized tables. The sample size of all included studies was
medicina60030365 composed of 31,647 participants, (14,477 male and 17,170 female) with a mean of 35.016 ± 7.57 years
Academic Editors: Jun-Beom Park of age. Conclusions: This review indicates that the use of vapes is associated with an increased risk of
and Bruno Chrcanovic periodontitis and caries. Although users experience more oral problems than non-smokers, these
are less severe than those of traditional smokers. The widespread prevalence, especially among
Received: 30 December 2023
young people, highlights the urgency of awareness campaigns to warn of risks and understand
Revised: 18 February 2024
potential harm.
Accepted: 20 February 2024
Published: 21 February 2024
Keywords: oral health; electronic cigarettes (e-cigs); vaping; smoking; periodontitis; caries

Copyright: © 2024 by the authors.

Licensee MDPI, Basel, Switzerland. 1. Introduction
This article is an open access article Tobacco has been a substance used in many social environments of society for centuries.
distributed under the terms and
Its consumption was so widespread that the possibility that it produced positive effects on
conditions of the Creative Commons
health was raised. In addition, the use of electronic nicotine-releasing devices (ENRDs) has
Attribution (CC BY) license (https://
increased in recent years, especially among adolescents and young adults [1,2]. It has been
creativecommons.org/licenses/by/
observed that the current presentation of these devices and the available commercial alerts
4.0/).

Medicina 2024, 60, 365. https://doi.org/10.3390/medicina60030365 https://www.mdpi.com/journal/medicina

Medicina 2024, 60, 365 2 of 11

are not clear enough to make consumers aware that vaping produces harmful effects [3].
Studies like that by Hang et al. postulate that better communication is needed to dissem-
inate the harmful potential of vaping in the oral environment and note the importance
of dentists as entities to help disseminate the real information about these devices [2]. It
has been observed that the majority of ENRD users are likely to receive instructions from
dentists to stop using these devices [4].
The first identification of “vape” terminology dates back to the 1960s, when inventor
H. Gilbert introduced the first alternative to the conventional cigarette [5]. This device
represented an innovation for the cessation of the taboo habit (a practice widely spread at
the time) and lacked nicotine. Over the course of history, this device was progressively
modified until it reached the current form of vapes [6].
The question that arises is whether this device can effectively contribute to the sup-
pression of smoking. The World Health Organization (WHO) maintains that vaping cannot
be considered an effective tool for quitting tobacco use [7]. Other specialists, such as the
UK’s National Health Service, argue that vaping may be partially useful as long as nicotine
doses are gradually reduced [8].
The mechanism of the vape consists of a battery that generates an electric current,
which activates a filament located in an atomizer. This ignited filament causes the e-
liquid (the inhaled substance) to evaporate in the cartridge, generating an aerosol [9]. It is
important to note that the vapors produced by vaping are not only made up of water as each
inhalation introduces nanoparticles, volatile organic compounds, carbonyls, heavy metals,
and nicotine into our bodies, forming an amalgam of compounds potentially harmful to
health [10]. In addition to this group, substances, such as formaldehyde, acetaldehyde
and acrolein, that are considered to be possible cancer inducers are incorporated into the
aerosol during filament ignition [10].
Therefore, vaping persists as an element detrimental to health, despite the misinforma-
tion circulating in our society about the absence of negative effects. The journal “Pediatrics”
notes in an article that vaping use has become an increasingly common and harmful trend
among young people. In addition, it highlights that future efforts should examine the
progression and toxicity of vape use among young people and educate them about the
potential dangers of these behaviors [10].
Undoubtedly, its use can be double-edged. Although the possibility of quitting smok-
ing through these devices was previously considered, recent studies suggest the probability
of developing a new addiction, especially in individuals who have never used nicotine,
and this is more evident in the younger population [9,10].
In the clinical setting of the oral cavity, there is ample evidence establishing a connec-
tion between vaping smoke and an increased risk of developing gingivitis and periodontal
disease [11–14]. The use of the vape pen can introduce certain bacteria that contribute to the
development of oral diseases in our body. In addition, there are studies that suggest that
quitting vaping could be associated with an improvement in oral health [14]. In addition,
the use of e-cigarettes has a negative impact on the antioxidant capacity of saliva, compara-
ble to the effect observed in traditional cigarette smokers when compared to non-smokers.
This decrease in antioxidant capacity translates into a decrease in the defensive capacity of
the immune system in the oral cavity [15].
Therefore, given all the information provided, it is imperative to look for new data on
vapers to give us a more complete and realistic perspective of the impact that these new
trends can have on our health.

2. Objectives
The objective of this literature review is summarizing the information present in the
literature on the effects of vaping at the oral level and bringing together knowledge about
the mechanism of action of vapes at the level of oral tissues.
Medicina 2024, 60, 365 3 of 11

3. Materials and Methods

This narrative review has been carried out following a series of steps that are set
out below.
Search Strategy
On 19 October 2023, a bibliographic search of three databases, PubMed, Elsevier
Scopus, and Web of Science, was carried out, using a search strategy formulated by com-
bining the keywords “oral Health” [MeSH], “vaping”, and “vape” and the Boolean operators
“OR” and “AND”, from which the following syntax resulted: ““oral health” AND (“vaping”
OR “vape”)”.
Inclusion Criteria
Articles published in the last 6 years were selected. We included all articles in English
that seemed relevant and could provide us with information about the effects of oral vaping
and the possible etiology, epidemiology, and diagnosis of diseases of the mouth that are
related to the administration of vapes. In addition, articles comparing patients who used
vapes with those who smoked tobacco and non-smokers have been included.
Exclusion Criteria
We excluded all articles that did not study the consequences of oral vaping as well as
those that only studied tobacco use, both systematic and narrative reviews, and letters to
the editor.
Study Selection and Data Collection
Initially, the following were eliminated: (a) duplicate articles; (b) pre-2017 articles;
(c) non-English language articles; (d) articles with patients < 18 years of age. Subsequently,
independent reviewers (A.M.I. and E.B.C.) made the second selection through the reading
of the titles and the abstracts of articles that potentially met the inclusion criteria. Finally,
these works were read and analyzed in their entirety for their inclusion or exclusion in the
literature review. In cases where there was no agreement for the inclusion or exclusion of
an article, it was submitted to a third reviewer (M.F.E.M).

4. Results
The syntax was entered into the different databases (Figure 1—see flowchart) and
obtained a total of 113 results, of which 16 were obtained from the PubMed database,
35 from Web of Science, and 62 from Elsevier Scopus. Subsequently, duplicates were
eliminated, resulting in 67 articles to be filtered by the reading of each title and abstract.
After this step, a total of 22 articles were obtained for comprehensive reading.
Finally, after reading them completely, eight articles were selected for the qualitative
synthesis, which are included in a standardized table (Table 1). The included articles were
from the following countries: one in Saudi Arabia, one in Malaysia, four in the United
States, one in South Korea, and one in Switzerland. Three of them were cohort studies,
two case control studies, two in vitro studies, and one cross-sectional study. A table was
created (Table 2) including the author and year of publication of the articles, the number
of patients included in the studies, the gender of patients classified as male or female and
number in each category, and the age of the participants expressed as mean age or age
range depending on the case.
Medicina 2024,60,
Medicina2024, 60,365
x FOR PEER REVIEW 44 of 11
11

Identification of studies

Studies identified by the search (n = 113): Studies eliminated because they were

IdentIfied
PubMed/MEDLINE (n = 16) repeated (n = 46)
Elsevier SCOPUS (n = 62)
Web of Science (n = 35)

Studies excluded after reading the Title

Filtering studies (n = 67) and Abstract (n = 45)
Screening

Studies Selected for Comprehensive Reading

Studies excluded after full reading
(n = 22)
according to the inclusion and
exclusion criteria (n = 14)
Included

Studies included in the qualitative synthesis

(n = 8)

Figure 1. Flowchart explaining the series of steps that have been followed for the selection of the articles
Figure1.1.Flowchart
Figure Flowchartexplaining
includedthe
explaining the series
in theseries of
ofsteps
qualitative stepsthat
thathave
synthesis havebeen
beenfollowed
followedfor
forthe
theselection
selectionof
ofarticles
articles
included
includedin inthe
thequalitative
qualitativesynthesis.
synthesis.

Table Finally, after

1. Studies reading
collected forthem completely,
qualitative eight articles were selected for the qualitative syn-
synthesis.
thesis, which are included in a standardized table (Table 1). The included articles were from
Author the following countries: one in Saudi Arabia, one in Malaysia, four in the United States, one in
Number (Year of South Korea, and Full Title
one in Switzerland. Three of them wereSummary
cohortand Conclusions
studies, two case control
Publication)
studies, two in vitro studies, and one cross-sectional study. A table was created (Table 2) in-
The study
cluding the author and year of publication of the articles, compared
the number periodontal
of patients included in
parameters and self-perceived
the studies, the gender of patients classified as male or female and number in each oral
category,
symptoms between cigarettes
and the age of
Comparison ofthe participants
periodontal expressed
parameters andas mean age or age range depending on the case.
smokers, individuals using e-cigarettes,
Javed et al. self-perceived oral symptoms among cigarettes
1 and non-smokers.
(2017) [16] smokers,
Table individuals
1. Studies collectedvaping electronicsynthesis.
for qualitative The study concluded that the periodontal
cigarettes, and never-smokers
inflammation and self-perceived oral
Author symptoms were poorer among cigarette
Number (Year of Full Title smokersSummary
than amongand Conclusions
vaping individuals.
Publication) The study compares the oral health of cigarette,
The study
e-cigarette, compared
and periodontal
vape smokers and
Ghazali et al. Oral health of smokers and e-cigarette users: A
2 parametersnon-smokers.
and self-perceived oral
(2018) [17] case-control study
The study concludedbetween
symptoms that e-cigarettes have
cigarettes
potentially detrimental effects on oral health.
Comparison of periodontal parameters and smokers, individuals using e-cigarettes,
Javed et al., self-perceived oral symptoms among cigarettes study was on
The andinflammatory
non-smokers. biomarkers
1 Inflammatory biomarkers and growth factors in and growth factors in saliva and crevicular
(2017) [16]
Ye et al.
smokers, individuals vaping electronic
saliva and gingival crevicular fluid of e-cigarette
The study concluded that the periodon-
fluid of e-cigarette users, cigarette smokers,
3 cigarettes, and never-smokers tal inflammation and self-perceived
(2020) [18] users, cigarette smokers, and dual smokers: A and both.
pilot study Inoral symptoms
conclusion, were poorerproduces
smoking/vaping among cig-
significant
arette smokerseffects
thanon among
oral health.
vaping in-
The study examines dividuals.
the associations of
e-cigarette and conventional
The study compares the cigarette use withof
oral health
Associations of electronic and conventional
Ghazali
Jeong etet
al.al., Oral health of smokers and e-cigarette users: Aperiodontal disease in South Korean adults.
42 cigarette use with periodontal disease in South cigarette, e-cigarette, and vape smokers
(2020)
(2018)[19]
[17] case-control They concluded that smoking and vaping
Korean adults study and non-smokers.
produce incremented rates of periodontal
disease.
Medicina 2024, 60, 365 5 of 11

Table 1. Cont.

Author
Number (Year of Full Title Summary and Conclusions
Publication)
The study examines the relationship between
Velmulapalli Association between vaping and untreated caries vaping and the presence of untreated cavities.
5 et al. (2021) A cross-sectional study of National Health and In conclusion, both vaping and dual smoking
[20] Nutrition Examination Survey 2017–2018 data are associated with an increased occurrence of
untreated caries.
The study deals with the risk of tooth decay
A comparison of the caries risk between patients
Irusa et al. associated with vaping.
6 who use vapes or electronic cigarettes and those
(2022) [21] The authors concluded that vaping patients
who do not: A cross-sectional study
had a higher risk of developing caries.
The study investigated the effects of
e-cigarettes and traditional cigarettes on oral
Cytotoxic and inflammatory effects of electronic
Ramenzoni gingival cells using a novel automated
and traditional cigarettes on oral gingival cells
7 et al. (2022) smoking instrument.
using a novel automated smoking instrument: An
[22] The conclusions drawn stated that e-cig
in vitro study
smoking may contribute to the cell damage of
oral tissue and tissue inflammation.
The mechanistic effects of e-liquids on biofilm
formation and the growth of oral commensal
Mechanistic effects of e-liquids on biofilm
streptococcal communities were investigated.
Xu et al. formation and growth of oral commensal
8 The findings of the study indicate that flavored
(2022) [23] streptococcal communities: Effect of flavoring
e-liquids have a more detrimental impact on
agents
the formation and growth of oral commensal
bacteria compared to unflavored e-liquids.

Table 2. Demographic data of the included articles.

Gender
Author Number of Age
Number (M: Male//F: Female)
(Year of Publication) Patients (Mean Age/Age Range)
(Number of Cases)
1 Javed et al. (2017) [16] 94 M (94) Mean age: 39.87 ± 2.17 years
2 Ghazali et al. (2018) [17] 120 M (89)//F (31) Mean age: 27.66 ± 7.58
Ye et al.
3 48 M (24)//F (24) Mean age: 37.56 ± 13.03 years
(2020) [18]
4 Jeong et al. (2020) [19] 13,551 M (5715)//F (7836) Mean age: 29.18 ± 4.24 years
Velmulapalli et al. (2021)
5 4618 M (2234)//F (2384) Mean age: 41.81 ± 6.11 years
[20]
Age range
Irusa et al. Age: 16–25 years—845 patients
6 13,216 M (6321)//F (6895)
(2022) [21] Age: 26–40 years—4336 patients
Age: >40 years—8014 patients
Ramenzoni et al. (2022)
7 No data No data No data
[22]
Xu et al.
8 No data No data No data
(2022) [23]
No data: no information.
Medicina 2024, 60, 365 6 of 11

Description of the Studies

The study carried out by Javed et al. [16] aimed to compare periodontal parameters
and self-perceived oral symptoms among cigarette smokers, vaping individuals, and
non-smokers. The research was conducted as a comparative study and received research
support. The study focused on the medical field and investigated the potential impact of
vaping on periodontal health. The study’s findings revealed that a large portion of patients
reported quitting smoking combustible cigarettes as the most common reason for vaping.
Some individuals reported vaping for social entertainment and fun. This suggests that
vaping may serve as a smoking cessation aid for some individuals, while for others, it may
be more of a recreational activity. In addition, the comparison of periodontal parameters
and self-perceived oral symptoms among the different groups sheds light on the possible
oral health implications of vaping, as the non-smokers in the study had the least bleeding
on probing and the lowest plaque index on examination.
The case-control study conducted by Ghazali et al. [17] aimed to investigate the oral
health of smokers and users of ENRDs. The study compared the oral health status of these
two groups with a focus on identifying potential differences in oral health outcomes. The
research design involved the selection of a group of smokers, a group of ENRD users as
cases, and a matched group of non-smokers and non-ENRD users as controls. Several
oral health parameters were evaluated and compared between the two groups, including
periodontal health, dental caries, oral hygiene practices, and oral mucosal lesions. The
study found that smokers exhibited a higher prevalence of periodontal disease compared
to non-smokers. In addition, smokers were more likely to have tooth decay and poorer oral
hygiene practices. On the other hand, ENRD users showed similar oral health outcomes to
non-ENRD users in terms of periodontal health, tooth decay, and oral hygiene practices.
However, the study also identified a possible association between the use of ENRDs and
oral mucosal lesions, warranting further research into this aspect of oral health among
e-cigarette users.
The study conducted by Ye et al. [18] investigated the levels of inflammatory biomark-
ers and growth factors in saliva and crevicular fluid (CF) of ENRD users, cigarette smokers,
dual smokers, and non-users. The researchers found that ENRD users had significantly
elevated levels of inflammatory biomarkers, such as interleukin-1β (IL-1β) and interferon-γ
(IFN-γ), in their CF compared to non-users. In addition, ENRD users showed increased
levels of growth factors, including the epidermal growth factor (EGF) and the vascular
endothelial growth factor (VEGF), in their CF. These findings suggest that the use of ENRDs
may have a remarkable impact on oral inflammatory response and tissue repair processes,
as reflected in biomarker levels in CF.
The study by Jeong et al. [19] studied the associations between the use of ENRDs and
conventional cigarettes and periodontal disease in South Korean adults. The research is
particularly relevant given the increasing implementation of anti-smoking laws in South
Korea. The authors stated that periodontal disease is much more prevalent in smokers of
both conventional cigarettes and vapes than in non-smokers. However, both vaping and
smoking were significantly linked to tooth decay and other dental disorders. The study
suggested that vaping is not a safe alternative to tobacco and that smoking must be quit in
any form for oral health to be maintained.
The study conducted by Vemulapalli et al. [20] investigated the association between
vaping and untreated cavities. Using data from the National Health and Nutrition Ex-
amination Survey, the study employed an odds ratio analysis to assess the relationship
between vaping and untreated cavities. The results indicated a significant association
between vaping and untreated cavities, suggesting that people who vape are more likely to
have untreated cavities. This finding has implications for dental health and underscores
the importance of addressing vaping as a potential risk factor for oral health problems such
as cavities.
Irusa et al. [21] compared the risk of caries between patients who use vapes or e-
cigarettes and those who do not. The study used machine learning techniques to analyze
Medicina 2024, 60, 365 7 of 11

the risk of tooth decay associated with vaping. The results of the study provide insight into
the potential impact of vaping on tooth decay. This study contributes to understanding the
oral health implications of the use of ENRDs and provides valuable information for dental
and public health professionals.
Ramenzoni et al. [22] conducted an in vitro study to evaluate the cytotoxic and in-
flammatory effects of e-cigarettes and traditional cigarettes on oral gingival cells. The
study aimed to compare ENRDs as a safer alternative to traditional cigarettes. The findings
indicated that ENRDs are commonly marketed as a safer alternative to traditional cigarettes
as well as a smoking substitution or cessation tool. This suggests that there is a percep-
tion that ENRDs are less harmful than traditional cigarettes, which may influence their
usage patterns.
Xu et al. [23] examined the effects of e-liquids on biofilm formation and the growth of
oral commensal streptococcal communities as well as the population of other opportunistic
pathogens [22,23]. The study found that flavored e-liquids had a more detrimental effect
on biofilm formation and the growth of oral commensal bacteria compared to unflavored
e-liquids. This suggests that the flavoring agents in e-liquids may play a significant role in
influencing oral microbiota.
Overall, it has been noted in the articles included in this review that vaping patients
have some increased risk for dental sedation, so dentists should be aware of vaping
patients [24,25]. On the other hand, it has been observed that the use of these devices
increases the occurrence of complications in existing oral pathologies [26]. In addition,
vaping must be considered by dentists as an important piece of information for the inclusion
of a medical record [21] Therefore, dentists should remain alert to the emergence of new
information in order to educate patients and warn them of the risks that this practice may
have on their oral health [27].

5. Discussion
Vape use has increased considerably in recent years, leading to a growth in research
into its potential impact on oral health. Several studies have investigated the effects of
vapes on oral tissues, periodontal health, and the development of oral diseases [6,28].
These studies have shed light on various aspects of the relationship between the use of
ENRDs and oral health, including the biological effects of ENRDs, the relevance to oral
health, and the potential oral health consequences of their use in different populations.
The literature has highlighted the need to understand the potential implications of the
use of ENRDs for oral health, especially given the growing popularity of these devices as
alternatives to traditional smoking [6]. It should be noted that the involvement of smoking
in the progression of periodontal diseases as well as in other pathologies of the oral cavity,
like oral cancer, has been well documented, emphasizing the importance of exploring the
impact of vapes on oral health [29]. On the other hand, the growing popularity of pipe
tobacco and the use of ENRDs has raised implications for oral care, demanding a deeper
understanding of the biological effects of these products on oral health [30].
Other authors, such as Almeida et al., have explored the effects of aerosols from
these devices on the cells and tissues of the oral cavity, providing information on possible
relapses into traditional smoking due to vaping [6]. In addition, the growing number of
studies conducted to explore the effects of ENRDs on oral health underscores the need
for comprehensive research in this area [14]. As the popularity of vaping continues to
rise, it is vital that dental professionals stay informed and provide patients with accurate
information based on emerging data [31]. On the other hand, research has delved into
the self-reported adverse effects of the use of ENRDs among dental students, highlighting
the importance of including information on the oral/general health impact of these in the
curricula of dental and health disciplines [27]. However, a cross-sectional questionnaire
study conducted by Huilgol et al. has underscored the need for more research on the
association between the use of these devices and oral health, especially in adolescents [32].
Medicina 2024, 60, 365 8 of 11

Studies have observed damage to cell DNA, increased oxidative stress, inflammation,
and alterations in healing [33]. The impact of these on DNA damage in human oral cells,
changes in antioxidant capacity and nucleotide metabolites in saliva, and the antibacterial
properties of saliva has also been the subject of research, calling for further longitudinal
studies to assess the effect of these changes on oral health [15,29]. On the other hand,
the evaluation of oral changes resulting from the use of ENRDs and the review of the
literature related to traditional cigarettes and vapes and oral health have provided valuable
information on the potential oral health consequences of their use [34,35].
Based on the references included in our qualitative synthesis, it can be concluded
that vaping is associated with several adverse effects on oral health. Xu et al. [23] demon-
strated that flavored vaping liquids have a more detrimental effect on biofilm formation
and the growth of oral commensal bacteria compared to unflavored liquids. This sug-
gests that additives used to flavor vaping liquids may exacerbate oral health problems. In
addition, Jeong et al. [19] found that both the use of ENRDs and conventional are signif-
icantly associated with increased rates of periodontal disease, indicating that regardless
of the type of cigarette used, there is a negative impact on periodontal health. Notably,
Ye et al. [18] reported the presence of inflammatory biomarkers and growth factors in the
saliva and gingival crevicular fluid of ENRD users, cigarette smokers, and dual smokers.
This statement suggests that the use of ENRDs contributes to an inflammatory response in
the oral cavity, which may have implications for overall oral health. Javed et al. [16] com-
pared periodontal parameters and self-perceived oral symptoms among cigarette smokers,
vaping individuals, and non-smokers and found differences indicating possible oral health
risks associated with vaping. At the same time, it has been observed that patients who
smoke conventional cigarettes have more gingival pain and other oral symptoms than those
who vape [16]. Ramenzoni et al. [22] also demonstrated the cytotoxic and inflammatory
effects of ENRDs on oral gingival cells, further emphasizing the potential damage caused
by them in oral tissues. On the other hand, Irusa et al. [21] compared the risk of tooth decay
between patients who vape and those who do not, indicating a possible association between
vaping and an increased risk of tooth decay. Finally, Vemulapalli et al. [20] investigated the
association between appraisal and untreated caries, evidencing the need to explore the oral
health implications of vaping in the context of dental caries.
According to Bardellini et al., hyperplastic candidiasis is identified as a common oral
mucosal lesion among e-cigarette users. The study found a high prevalence of hyperplastic
candidiasis in the retrocomissural area of individuals who use electronic cigarettes, with a
prevalence rate of 17.8%. The authors suggest that this high prevalence may be attributed
to a pH alteration induced by the chemical constituents present in e-liquids. This finding
underscores the potential impact of e-cigarette usage on the oral mucosa, particularly in
relation to the development of hyperplastic candidiasis in specific oral regions [36]. This
is particularly concerning as the aerosol produced by e-cigarettes can contain harmful
ingredients, including flavorants and solvents, in addition to nicotine [37]. Further in-
vestigation regarding vaping effects on oral mucosa pathology and morphology need to
be undertaken.
The ethical considerations of vaping involve public health, harm reduction, messaging,
and regulations. Concerns have arisen regarding the pro-vaping messages dominating
social media, raising ethical questions about the industry’s impact on public perception and
behavior [38]. While e-cigarettes may serve as a tool for risk reduction among smokers, there
are concerns regarding the uptake of vaping among youth and never smokers, necessitating
a balanced approach to address potential public health implications [39]. Banning non-
therapeutic nicotine vaping products presents an ethical dilemma, as it may deny addicted
smokers access to a potentially less harmful alternative for quitting smoking [40]. It is
imperative to gain a better understanding of vaping outcomes and adolescents’ perceptions
while identifying potential ways to lessen or eradicate the health burdens associated with
vaping [41]. The ethical dilemma surrounding restricting access to vaping products is
Medicina 2024, 60, 365 9 of 11

complex, and common-sense reasons for prioritizing the young do not necessarily apply to
vaping restrictions and harm reduction [42].
The principal limitation of this work was the scarcity of quantitative studies assessing
vaping effects on oral health not only regarding periodontal health but also in the field
of oral pathology. The lack of homogeneity among the studies was also an important
factor that limited our capability to extract consistent conclusions on the appraised as-
pects. Finally, our review was also narrowed by the small number of studies comparing
exclusive vape consumers to healthy subjects. We deduce that exclusive vape users and
healthy subjects should be assessed quantitatively in the future to draw more consistent
conclusions in this area; fields such as oral pathology should also be included in these types
of studies as they represent some prevalent conditions that are being diagnosed daily by
dental professionals.

6. Conclusions
From the present study, we can conclude that vaping may be linked to increased rates
of periodontitis as well as an increased risk of developing a carious pathology. The literature
suggests that patients who vape could experience more gum pain and oral symptoms than
non-smokers, although this would be less than those who smoke conventional cigarettes.
Also, the widespread use of vapes, especially among young people, may require the
carrying out of more effective awareness campaigns to warn of their risks for increasing
the awareness of the population of the possible potential harms caused by their use in the
oral cavity.

Author Contributions: Conceptualization, A.M.I. and L.M.J.G.; methodology, M.F.E.M.; software,

E.B.C.; validation, S.J.O. and S.O.G.; formal analysis, M.F.E.M. and L.M.J.G.; investigation, A.M.I.;
resources, S.J.O. and S.O.G.; data curation, S.J.O. and S.O.G.; writing—original draft preparation,
A.M.I.; writing—review and editing, M.F.E.M.; visualization, M.F.E.M.; supervision, L.M.J.G.; project
administration, L.M.J.G. All authors have read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Conflicts of Interest: The authors declare no conflicts of interest.

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