What is the impact of vaping on teeth and oral health?

Is smoking bad for teeth?

A hefty proportion of vapers are former smokers or smoke as well as vape, so the first port of call is the impact of smoking. Humans started smoking long before modern science and there is a wealth of robust evidence on its health effects. The message is clear: smoking is extremely damaging to oral health.

Beyond the bad breath, brown stains and loss of taste, tar and toxins in tobacco smoke increase the risk of gum disease. In severe cases, this can cause teeth to fall out. The disease can be harder to spot in smokers though, because nicotine reduces blood flow in the gums. This makes them less likely to bleed, which is one of the early warning signs of disease. Smokers may also struggle to overcome gum disease because of the continued onslaught of smoke and the effect smoking has on the immune system.

Smoking causes more than a dozen types of cancer throughout the body and more than half of mouth cancers are linked to the habit.

What about vaping?

The impact of vaping on teeth and oral health is still being thrashed out. Far fewer studies have looked at the issue and many that have are flawed. A common problem is that studies fail to ensure vapers are not smoking cigarettes as well.

“The absolute effects of vapes and their impact on oral health are unknown,” a spokesperson for the British Dental Association said. But they added that recent, limited evidence did raise concerns over oral dryness, irritation and gum disease caused by vapes.

What do the studies say?

Researchers at Newcastle University published a major review this year into the impact of vaping on periodontal health, meaning the gums, ligaments and bone that supports our teeth.

Two markers of long-term disease are bone loss and pockets in the gum tissue around teeth, but there was no evidence these were any worse in vapers than in non-smokers or former smokers. The vapers did have slightly worse gum disease, “but it was pretty marginal”, said Dr Richard Holliday, a senior lecturer and honorary consultant in restorative dentistry at Newcastle.

What about tooth decay?

Again, the evidence is tentative, but there are some concerns. In one recent study, US researchers analysed patient records for more than 13,000 people who attended dental clinics between 2019 and 2022. “Patients who vaped did show an increased risk of developing dental caries when compared to non-smoking and non-vaping patients,” Dr Karina Irusa, the study’s first author, told the Guardian.

The Newcastle team also found higher levels of plaque in vapers compared with non-smokers or former smokers, which would be in keeping with a greater risk of dental caries. But more studies are needed to investigate whether vaping itself is to blame for tooth decay. There’s evidence that nicotine users eat more sugar, so vapers may have bad teeth for reasons other than their nicotine habit.

How might vaping cause tooth decay?

A common claim is that sugar in flavoured vapes drives tooth decay, but manufacturers tend to use artificial sweeteners instead of sugar. This is because sugar burns at vape-operating temperatures, so using them would produce a burnt flavour and clog up the heating coil.

If vaping does drive tooth decay, Holliday suspects that having a dry mouth, which vapers often mention, is part of the problem. “Saliva is a wonderful thing to protect your teeth. When you reduce that, tooth decay can happen more rapidly and gum disease can happen more rapidly, too,” he said.

Saliva helps to keep teeth clean and it also contains calcium and phosphate that help withstand acid attacks from bacteria, and from drinks such as fruit juices, which are the key drivers of tooth decay.

How vapes cause a dry mouth isn’t entirely clear, but vape liquids are the prime culprits. They are mostly propylene glycol and vegetable glycerol, which are hygroscopic, meaning they absorb and hold on to water.

What about cancer?

People who vape do not inhale anything like the number and variety of carcinogens in cigarette smoke. For this reason, the risk appears low. But it is an area scientists are watching, because vapers are still regularly inhaling chemicals into their bodies and the long-term effects on the delicate tissue in the lungs and elsewhere are not yet known.

Is vaping safe for young people?

England’s chief medical officer, Prof Chris Whitty, summed it up like this: “If you smoke, vaping is much safer; if you don’t smoke, don’t vape.” According to Holliday, that is sound advice. “If you’re a young person, don’t vape,” he said. “You are putting something into a complicated ecosystem, so there will be risks from vaping long term. But compared to smoking, they’ll be minuscule.”