It is common knowledge that a healthy oral hygiene routine is crucial to prevent diseases that damage teeth and gums, which are often at risk due to harmful habits like cigarette smoking. Tobacco combustion is known to release compounds that contribute to dental plaque accumulation, a bacterial biofilm on teeth surfaces that can lead to gingivitis and periodontitis. Known to pose a reduced health risk compared to traditional smoking, the arrival of safer nicotine products on the market, prompted questions on whether these alternatives can also mitigate oral health damage.
Seeking to answer this question, the SMILE Study, a pioneering global health initiative led by CoEHAR (The Center of Excellence for the Acceleration of Harm Reduction), set out to examine the oral health impacts of combustion-free nicotine delivery products, specifically focusing on vapes and heated tobacco products (HTPs) in comparison to smoking.
The truth about vaping and oral health
Study co-author Dr. Professor Riccardo Polosa pointed out the support from major health organizations in the UK for ENDS and the lack of evidence linking these products to tooth decay or gum disease. The SMILE Study aimed to set the record straight on vaping and oral health, thereby contributing significantly to global smoking cessation initiatives.
Volunteer enrolment was completed in August 2023. The study included current smokers, individuals switching to combustion-free products, and non-smokers, allowing for comprehensive comparisons. A total of 136 participants were divided into four groups: 30 current smokers (≥10 cigarettes/day); 24 former smokers (quit ≥6 months); 29 never-smokers; 53 exclusive ENDS users (e-cigarettes and HTPs combined, quit ≥6 months).
Participants were asked to maintain their usual oral hygiene habits and to abstain from smoking or using other products two hours before the study. Smoking status was verified using carbon monoxide level tests. Plaque accumulation was measured with high-definition camera images using light-induced fluorescence, processed at the pixel level to detect plaque on the front teeth. The researchers also looked for variations in tooth staining, dental discoloration, and quality of life assessments related to oral health.
The oral health of vapers was similar to that of never smokers
The study found that exclusive use of vapes and HTPs led to significantly lower dental plaque accumulation compared to current smokers. The plaque levels in ENDS users were similar to those in never and former smokers, and significantly lower than those of current smokers.
These findings suggest that e-cigarettes and HTPs may offer a less harmful alternative for maintaining oral health compared to conventional cigarettes. However the research team emphasized that daily tooth brushing and mouthwash use were significant factors affecting plaque levels.
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