Vaping & Oral Health: What Every Dental Professional Needs to Know

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Vaping has exploded in popularity over the past decade especially among youth. In Canada alone, 30% of teens aged 15–19 have tried vaping, and the numbers continue to rise. While marketed as a “safer” alternative to cigarettes, e-cigarettes carry a hidden set of dangers that reach far beyond the lungs.

As oral health professionals, we’re on the frontline of this conversation. Dental Hygienists see patients more frequently than most other health providers, making us uniquely positioned to identify early signs of harm and support behaviour change.

Why Is Vaping So Appealing?

If you’ve ever wondered what drives young people toward vaping, one word stands out:

Flavour.

More than 99% of e-cigarettes contain flavouring chemicals, and they come in options like bubble gum, cotton candy, cherry, birthday cake, and fruit punch. These products are engineered to be enticing, especially to younger users.

The concern? These flavouring chemicals don’t just taste sweet. They:

  • Encourage growth of harmful bacteria

  • Adhere to enamel like sticky, sugary candy

  • Expose users to toxic compounds such as diacetyl, a chemical linked with “popcorn lung”—a severe, irreversible lung condition previously seen in factory workers.

When flavour-packed aerosols enter the mouth, they don’t simply disappear. They linger, attach to tissues, and disrupt the delicate balance of the oral microbiome.

How Vaping Fuels Periodontal Disease

One of the most concerning findings in recent research:
Vaping significantly increases the risk of periodontal disease.

Here’s what we now know:

1. It alters the oral microbiome.

Exposure to e-cigarette aerosols changes the bacteria below the gumline, increasing inflammation-causing species and reducing protective ones.

2. It slows healing.

A 2023 systematic review found that non-smokers respond far better to periodontal treatments, such as scaling and root planing, than both cigarette smokers and e-cigarette users.

3. It accelerates attachment loss.

In a 2021 longitudinal study, e-cigarette users experienced significantly worse clinical attachment loss over just six months.

4. It harms periodontal ligament fibroblasts.

Flavouring chemicals trigger oxidative stress and release inflammatory cytokines, directly damaging the cells essential to periodontal stability.

5. It more than doubles periodontal disease risk.

Multiple studies confirm that e-cigarette users are twice as likely to have periodontitis compared to non-users.

Bottom line:
For patients trying to maintain periodontal stability, vaping directly undermines their chances.

The Overlooked Link Between Vaping & Dental Caries

We often think of vaping linked to lung issues but its impact on dental caries risk is substantial and frequently underestimated.

What makes vaping cariogenic?

  • Sugars added to flavouring agents

  • Propylene glycol and glycerin, which coat enamel and soft tissues

  • Increased adhesion of Streptococcus mutans

  • Reduced enamel hardness

  • Dry mouth (reported in nearly 29% of users) caused by water-absorbing e-liquid ingredients

One study described the aerosol’s effect on teeth as similar to high-sucrose, sticky candies coating enamel with every puff.

For clinicians performing caries risk assessments, vaping must be considered a significant risk factor.

Is Vaping Linked to Oral Cancer? Emerging Evidence Says Yes.

While long-term data are still developing, early findings raise red flags.

E-cigarette aerosols release:

  • Carcinogens

  • Heavy metals

  • Nanoparticles

  • Volatile organic compounds

  • Nicotine

These substances damage epithelial cells, contribute to ulcerations, and may increase the likelihood of malignant transformation.

Studies show:

  • Vaping aerosols can damage DNA and trigger cellular changes linked to cancer development.

  • E-cigarette users show higher levels of carcinogenic biomarkers compared to non-users

Regular oral cancer screenings remain essential, but so do meaningful conversations about vaping and risk.

How Oral Health Professionals Can Make an Impact

We have a powerful role in prevention and it begins with conversation.

Use the 5 A’s (Ask, Advise, Assess, Assist, Arrange)

A long-standing framework used in smoking cessation—the 5 A’s (Ask, Advise, Assess, Assist, Arrange) remains highly effective for supporting behaviour change related to vaping. But to make the first step, Ask, meaningful, it must go beyond simply asking. 

Asking is your opportunity to open the door. Active listening is how you keep it open. It critical to be asking in a way that supports and expansive response. 

Instead of closed questions such as “Are you interested in quitting vaping ?”, open-ended questions invite patients to share their experiences, motivations, and concerns:

Consider how these questions open up the dialogue: 

“Tell me about your experience with vaping—what does your use look like day-to-day?”

“What do you enjoy about it? What concerns, if any, have come up for you?

“What changes have you noticed in your mouth since you began vaping?”

  • Ask about vaping at every visit

  • Advise clearly about oral health risks

  • Assess readiness to change

  • Assist by offering strategies, referrals, and resources

  • Arrange follow-up support or check-ins

Engage patients early

Youth often start vaping before they fully understand the risks. Early, non-judgmental guidance can make a difference.

Provide credible resources

Share evidence-based tools, including:

  • Online support programs

  • Text-message, based quit programs

  • Print materials for patients and families

  • Youth-focused prevention resources

Team alignment 

The evidence is evolving. Staying updated empowers your practice to deliver accurate, relevant, and timely information.

Final Thoughts

The link between vaping and oral health is no longer speculative, it’s well established and deeply concerning. From periodontal disease to dental caries to the potential for oral cancer, vaping poses significant risks that patients deserve to understand.

As oral health professionals, we can lead the way by:

✔️ Prioritizing vaping discussions
✔️ Educating patients of all ages
✔️ Incorporating vaping into risk assessments
✔️ Supporting behaviour change with compassion and evidence

Vaping may be marketed as harmless—but the research tells a different story. Now is the time to talk, listen and help support positive actions to protect the oral and overall health of our patients. 


References: 

1. Statistics Canada. Tobacco and Nicotine Survey. The Daily. 2022 Available from: https://www150.statcan.gc.ca/n1/dailyquotidien/230911/dq230911aeng.htm?utm_source=chatgpt.com

2. Ebersole, J., Samburova, V., Son, Y., Cappelli, D., Demopoulos, C., Capurro, A. Khlystov, A. Harmful chemicals emitted from electronic cigarettes and potential deleterious effects in the oral cavity. Tobacco Induced Diseases. 2020;(18):41. doi:10.18332/tid/116988

3. Casey AM, Muise ED, Crotty Alexander LE. Vaping and e-cigarette use. Mysterious lung manifestations and an epidemic. Curr Opin Immunol. 2020;(66):143-50. doi:10.1016/j.coi.2020.10.003.

 4. Rouabhia, M. Impact of electronic cigarettes on oral health: A review. J Can Dent Assoc. 2020;86(7).

5. Iacob, A. M., Escobedo Martínez, M. F., Barbeito Castro, E., Junquera Olay, S., Olay García, S., Junquera Gutiérrez, L. M. Effects of vape use on oral health: A review of the literature. Medicina. 2024;60(3):365. dio:10.3390/medicina60030365

 6. Lisa Catanese.  Popcorn lung: What is it, and who is at risk? January 2, 2024 , https://www.health.harvard.edu/diseases-and-conditions/popcorn-lungwhat-is-it-and-who-is-at-risk

7. Sukirth M. Ganesan et al. Adverse effects of electronic cigarettes on the disease-naive oral microbiome. Sci. Adv.2020;6(22):doi:10.1126/sciadv.aaz0108

 8. Camoni, N., Conti, G., Esteves-Oliveira, M., Carvalho, T. S., Roccuzzo, A., Cagetti, M. G., Campus, G. Electronic cigarettes, heated tobacco products, and oral health: A systematic review and meta-analysis. Applied Sciences. 2023;13(17):9654. doi:10.3390/app13179654

 9. Yang I, Sandeep S, Rodriguez J. The oral health impact of electronic cigarette use: a systematic review. Crit Rev Toxicol. 2020;50(2):97-127. doi:10.1080/10408444.2020.1713726

 10. Xu F, Aboseria E, Janal MN, Pushalkar S, Bederoff MV, Vasconcelos R, Sapru S, Paul B, Queiroz E, Makwana S, Solarewicz J, Guo Y, Aguallo D, Gomez C, Shelly D, Aphinyanaphongs Y, Gordon T, Corby PM, Kamer AR, Li X, Saxena D. Comparative effects of e-cigarette aerosol on periodontium of periodontitis patients. Front Oral Health. 2021;7(2):729144. doi:10.3389/froh.2021.729144

 11. Kim SA, Smith S, Beauchamp C, Song Y, Chiang M, Giuseppetti A, Frukhtbeyn S, Shaffer I, Wilhide J, Routkevitch D, Ondov JM, Kim JJ. Cariogenic potential of sweet flavors in electronic-cigarette liquids. PLoS One. 2018;7(13)9:e0203717. doi:10.1371/journal.pone.0203717

 12. Bakerywala A, Agarwal A, Shaikh H. Effects of e-cigarettes (vaping) on the oral microbiome – a narrative review. Oral Maxillofac Pathol J. 2024;15(1):81-6.

 13. Adams, A & Lamphere, A. Electronic cigarette use among youth and adolescents: Oral health professionals are on the frontline of helping youth avoid or quit e-cigarette use. Dimensions of Dental Hygiene.2024;22(4):42-5.

 14. Interventions for quitting vaping. Cochrane Library.  2025.

 


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