Vaping and Oral Health

Vaping with e-cigarettes has seen an enormous increase in recent years. Whilst it is encouraging news that smoking rates are down, many people are switching to vaping instead so they can continue to feed their nicotine fix.
There is, as yet, very little research on the long term effects of vaping on oral health. I am sure that in time research studies will become available, but until then we have to give our best guess on what the long term effects or vaping our likely to be. The most important issue is the effect of the nicotine in the mouth. Using a nicotine-free vaping liquid to vape rather than smoke as a substitute for the habit of smoking may avoid this. However it is apparent that the majority of vaping liquids contain nicotine.

So what do we know about nicotine and the mouth?
Nicotine causes constriction of blood vessels. This includes that hundreds of tiny blood vessels in our gums. The knock on effect of this is poor blood flow to the gums. When bacteria settle at , and under, the gumline in the plaque on our teeth we rely on antibodies to fight that bacteria. There is only one way for the antibodies to get there; via the bloodstream. So if the blood flow is poor, then the delivery of antibodies to the gums will be poor. So basically not many soldiers have shown up for the fight, and it’s likely to be a losing battle.

When nicotine is not present bacteria cause inflammation and that increases blood flow. This may be noticed by bleeding when you brush you teeth. The dentist will also see this and be able to find the exact areas of inflammation by checking all around the gums with a gum probe. When the gums are healthy and the dentist checks with a gum probe the gums will not bleed. If there is inflammation the gums will bleed. However if the nicotine has decreased the blood flow the gums may not bleed. This can therefore mask the signs of gum disease to both the dentist and patient and mean that the gum disease is not picked up until it is at a more advanced stage.

Having had a look at people’s own experiences online following a switch from smoking to vaping it seems there is a range of experience. Some people say their gums have been bleeding much more and some say less. I would assume that this depends on the concentration of nicotine in the liquid they are using. If the exposure of the mouth to nicotine is less, then the blood flow will increase and gum disease may no longer be masked. Worryingly I have seen some people suggesting they might start smoking again to stop their gums bleeding. However, if they are being exposed to similar levels of nicotine then the change will be less significant.

Other Chemicals in Vaping Liquid
Changes noticed on switching to vaping will also depend on the other constituents in both the cigarettes being smoking and the vaping liquid switched to, as both cigarettes and vaping liquids contain a range of chemicals which may have many and varied effects on the mouth. Research also suggests that many vaping liquids do contain carcinogens (cancer causing agents). However we do not yet have enough information to know how significant the long term effects of these carcinogens will be compared to tobacco smoking.

Other Effects
I have seen anecdotal reports from users suggesting that vaping can make their mouth more dry. Saliva is an essential defence mechanism in the mouth. It physically washes away debris, it neutralises acids and as well as diluting acids and sugars. We often see patients with dry mouths. These are elderly patients on a long list of medications for things like high blood pressure and other ailments. They can have quite high rates of tooth decay. These patients don’t tend to drink a lot of acidic fizzy drinks. However if you have a younger patient who vapes, with a dry mouth, drinking fizzy drinks, that is a sure recipe for acid erosion attacking the teeth.

So in summary I really feel the jury is out on the safety of vaping from an oral health point of view. If used as a step on the road to quitting then it serve a useful purpose. However, I personally would not recommend long term use of vaping and would questions marketing claims of the safety of these products. We simply don’t know enough yet.