Study shows link between vaping and caries risk

A vaping habit can eventually lead to a dull smile and more frequent visits to the dentist.

Research by faculty at Tufts University School of Dental Medicine found that patients who said they used vaping devices were more likely to develop cavities. With CDC surveys reporting that 9.1 million American adults — and 2 million teens — use tobacco-based vaping products, that means a lot of fragile teeth.

This study’s findings on the link between vaping and caries risk – the dental term for cavities – 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 Nov. 23 in The Journal of the American Dental Association.

In recent years, public awareness has increased about the dangers of vaping to systemic health, especially after vaping device use has been linked to lung disease. Some dental studies have shown a link between e-cigarette use and elevated markers for gum disease, and, separately, damage to tooth enamel, the outer shell. But there’s been relatively little emphasis on the intersection between e-cigarette use and oral health, even by dentists, Irusa says.

Irusa says the recent Tufts finding may be just a hint of the damage vaping causes to the mouth. “The magnitude of the effects on dental health, particularly on tooth decay, is still relatively unknown,” she says. “Right now I’m just trying to raise awareness,” both among dentists and patients.

This study, says Irusa, is the first known to specifically examine the association of vaping and e-cigarettes with the increased risk of getting cavities. She and her colleagues analyzed data from more than 13,000 patients over the age of 16 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 dental caries risk levels between the e-cigarette/vaping group and the control group, Irusa found. About 79% of vaping patients were categorized as high caries risk compared to only about 60% of the control group. The vaping patients were not asked if they used devices containing nicotine or THC, although nicotine is more common.

It is important to understand that these are preliminary data. This isn’t 100% convincing, but people should know what we’re seeing.”

Karina Irusa, assistant professor of comprehensive care and lead author on the paper

Further studies need 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 could contribute to a high risk of cavities is the sugar content and viscosity of the vaping liquid, which when atomised and then inhaled through the mouth, sticks to the teeth . (A 2018 study published in the journal PLOS One compared the properties of sweet-flavored e-cigarettes to gummy candies and sour drinks.) Vaping aerosols have been shown to alter the oral microbiome, making it more hospitable to spoilage-causing bacteria. It has also been observed that vaping appears to promote tooth decay in areas where it usually does not occur, such as the underside of the front teeth. “It takes an aesthetic toll,” says Irusa.

The Tufts researchers recommend that dentists should 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 “stricter caries management protocol,” which includes prescription fluoride toothpaste and fluoride rinse, in-office fluoride applications, and checkups more often than twice a year.

“It takes a lot of time and money to treat dental caries, depending on how bad it gets,” says Irusa. “Once you start the habit, you’re still at risk for secondary caries, even if you get fillings, as long as you keep going. It’s a vicious cycle that won’t stop.”

Steven Eisen of Tufts University School of Dental Medicine is senior author of the paper. Full information on authors and conflicts of interest is available in the published article.


Magazine reference:

Irusa, K.F., et al. (2022) A comparison of caries risk between patients who vape or use electronic cigarettes and those who do not. The Journal of the American Dental Association.

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