The Effects of Different Nicotine Products on Oral Health – The Latest Science

Vape critics have consistently argued that e-cig aerosols contain a mix of nicotine, flavourings, volatile organic compounds, heavy metals, carcinogens, and other hazardous substances. They highlight that these compounds are deposited in one’s mouth, potentially disrupting the delicate balance of host-microbial interactions and contributing to oral and systemic health issues.

Studies have linked vaping to various adverse effects on oral health:

• Oxidative Stress and DNA Damage: Toxic components in aerosols elevate cellular reactive oxygen species (ROS), decrease antioxidant defenses, and impair DNA repair mechanisms. This damage may lead to inflammatory responses and pre-malignant changes in oral tissues.
• Inflammation and Periodontitis: Proinflammatory cytokines triggered by aerosol exposure contribute to oral inflammation, gingivitis, and periodontitis.
• Oral Microbiome Disruption: E-cigarette aerosols disturb the microbial ecosystem of the oral cavity, which can exacerbate oral diseases.
• Genotoxicity and Cytotoxicity: The compounds in aerosols have demonstrated harmful effects at the cellular level, increasing the risk of oral pathologies.

The review, “E-Cigarette Effects on Oral Health: A Molecular Perspective” looked into the potential harmful effects of chemicals in vape aerosols, focusing on how they damage cells, cause inflammation, and affect oral health at a molecular level. The research team reported that vaping has been linked to inducing oxidative stress and inflammation, triggering immune system dysregulation and disrupting cellular homeostasis and repair processes.

These mechanisms, concluded the researchers, collectively heighten the risk of developing oral diseases, including inflammatory and pre-cancerous conditions. The review went on to highlight the urgent need for more research to clarify the full scope of e-cigarette effects on oral health. However, while acknowledging potential risks, another recent review exploring the impact of vaping on gum health, suggested it is less harmful than smoking.

The relative benefits when switching from smoking

Published in Evidence-Based Dentistry, the systematic review, “The impact of e-cigarette use on periodontal health: a systematic review and meta-analysis,” analyzed 40 studies on e-cigarette use and gum health, comparing vapers to non-smokers, former smokers, and tobacco smokers. The results indicated that vapers had higher plaque levels than non-smokers but lower than tobacco smokers. Some of the studies reviewed also indicated that vaping alters oral bacteria, with some research linking it to periodontal disease-associated microbes. Interestingly, added the research team, nicotine may suppress gum bleeding, masking signs of inflammation and disease progression.

In conclusion, the review found that traditional smokers faced the worst gum health outcomes, while vaping showed both potential risks and benefits. Some evidence suggested switching from smoking to vaping may improve gum health, but the researchers emphasized the need for biochemically verified data to better understand vaping’s long-term effects on oral health.

Vapers show similar oral health to non-smokers

Meanwhile, the SMILE Study, led by CoEHAR (The Center of Excellence for the Acceleration of Harm Reduction), a groundbreaking global initiative aimed at investigating the effects of combustion-free nicotine delivery products, particularly vapes and heated tobacco products (HTPs), on oral health compared to smoking, yielded positive results.

Participants were instructed to follow their regular oral hygiene routines and refrain from smoking or using other products for two hours before the study. Carbon monoxide tests were used to confirm smoking status. Plaque accumulation was assessed using high-definition camera images with light-induced fluorescence, analyzed at the pixel level to identify plaque on the front teeth. Researchers also examined tooth staining, dental discoloration, and oral health-related quality of life.

The study revealed that all these parameters were better in vapers than in smokers, and those who exclusively used vapes and heated tobacco products (HTPs) had significantly less dental plaque than current smokers. In fact, plaque levels in users of electronic nicotine delivery systems were comparable to those of never and former smokers, and much lower than those observed in active smokers.

What about nicotine pouches?

Recently, headlines have also been saturated with fear based messages on the potential dangers of nicotine pouches, but studies and real-world data indicate otherwise. A review by dental experts discussed the lower risk profile of the products in comparison to cigarettes. While, a study involving 23 Swedish dentists testing Stingfree nicotine pouches, the world’s only pouches with a built-in protective layer designed to reduce gum irritation and burning, reported unparalleled benefits.

The participants, all users of snus or nicotine pouches, documented their oral health before switching to Stingfree Strong Blue Mint for five weeks. The research team found that cases of irritated gums dropped from 43.5% to 4.3%, oral mucosal snus lesions decreased from 95.7% to 65.2%, with a 51.9% reduction in lesion severity, and 74% of participants reported healthier gums post-trial. These results led to 20 out of 23 dentists recommending Stingfree pouches to patients who experience gum irritation but are unwilling or unable to quit snus or nicotine pouches.

In conclusion, while concerns persist about the oral health risks of novel nicotine products, emerging research suggests a more nuanced picture. Studies indicate that such products pose fewer risks than smoking, with some more than others, showing potential benefits in reducing gum irritation and improving overall oral health outcomes.

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