Study shows link between vaping and tooth decay risk
A vaping habit could lead to a tarnished smile and more frequent visits to the dentist.
A study by faculty from the Tufts University School of Dentistry found that patients who said they used vaping devices had a higher risk of developing cavities. With CDC research reporting that 9.1 million American adults — and 2 million teenagers — use tobacco-based vaping products, that means a lot of vulnerable teeth.
This study’s findings on the link between smoking and the risk of tooth decay — the dental term for tooth decay — serve as a warning that this once-seemingly harmless habit can be very harmful, says Karina Irusa, assistant professor of comprehensive care and lead author on the paper. The study was published on November 23 Journal of the American Dental Association.
In recent years, public awareness of the systemic health risks of vaping has increased – especially after vaping device use was linked to lung disease. Some dental research has shown links between the use of e-cigarettes and increased markers of gum disease, and, separately, damage to tooth enamel, its outer shell. But relatively little emphasis has been placed on the intersection between e-cigarette use and oral health, even by dentists, Irusa says.
Irusa says the recent Tufts discovery may be just a hint of the damage vaping does to the mouth. “The extent of the effects on dental health, especially tooth decay, is still relatively unknown,” she says. “At this point, I’m just trying to raise awareness,” both among dentists and patients.
This study, says Irusa, is the first known specifically to investigate the association of vaping and e-cigarettes with an increased risk of tooth decay. She and her colleagues analyzed data from more than 13,000 patients over the age of 16 who were treated at Tufts Dental Clinics from 2019-2022.
Although the vast majority of patients said they did not vape, there was a statistically significant difference in caries risk levels between the e-cigarette/vaping group and the control group, Irusa found. Some 79% of vaping patients were categorized as having a high risk of tooth decay, compared to only about 60% of the control group. Vaping patients were not asked whether they used devices containing nicotine or THC, although nicotine is more common.
It is important to understand that this is preliminary data. It’s not 100% definitive, but people need to be aware of what we’re seeing.”
Karina Irusa, assistant professor of comprehensive care and lead author of the paper
Further research needs to be done, and Irusa wants to take a closer look at how vaping affects the microbiology of saliva.
One of the reasons why e-cigarette use may contribute to a high risk of tooth decay is the sugar content and viscosity of the vaping liquid, which, when sprayed and then inhaled through the mouth, sticks to the teeth. (A 2018 study published in the journal PLOS One compared the properties of sweet e-cigarettes to gummies and fizzy drinks.) Vaping aerosols have been shown to alter the oral microbiome, making it more hospitable to putrefaction-causing bacteria. Vaping has also been observed to promote tooth decay in areas where it would not normally occur – such as the lower edges of the front teeth. “It takes an aesthetic toll,” says Irusa.
The Tufts researchers recommend that dentists routinely ask about e-cigarette use as part of a patient’s medical history. That includes pediatric dentists who see adolescents — according to the FDA/CDC, 7.6% of middle and high school students said they used e-cigarettes in 2021.
The researchers also suggest that patients who use e-cigarettes should be considered for a “more stringent cavity management protocol,” which could include prescription fluoride toothpaste and fluoride rinses, in-office fluoride applications, and checkups more often than twice a year.
“It takes a lot of investment of time and money to treat tooth decay, depending on how bad it gets,” says Irusa. “Once you start the habit, even if you get fillings, as long as you continue, you’re still at risk of secondary tooth decay. It’s a vicious cycle that won’t stop.”
Steven Eisen of Tufts University School of Dentistry is the senior author of the paper. Full information on authors and conflicts of interest is available in the published paper.
Irusa, KF, et al. (2022) Comparison of caries risk between patients who use vapes or electronic cigarettes and those who do not. Journal of the American Dental Association. doi.org/10.1016/j.adaj.2022.09.013.
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