Study shows link between vaping and risk of caries

A vaping habit could eventually lead to a stained smile, and more frequent visits to the dentist.

Research by the faculty of the Tufts University School of Dental Medicine found that patients who said they used vaping devices were more likely to have a higher risk of developing cavities. With CDC surveys reporting that 9.1 million American adults-; and 2 million teenagers; Using tobacco-based vaping products means a lot of vulnerable teeth.

The results of this study on the association between vaping and risk of cavities – 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 on November 23 The Journal of the American Dental Association.

In recent years, public awareness of the dangers of vaping to systemic health has increased – especially after the use of vaping devices was linked to lung disease. Some dental research has shown the relationship between e-cigarette use and increased markers for dental 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.

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Irusa says the recent Tufts discovery may just be a hint of the damage vaping causes in the mouth. “The extent of the effects on dental health, specifically on tooth decay, are 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 to specifically examine the association of vaping and e-cigarettes with the increased risk of cavities. She and her colleagues analyzed data from more than 13,000 patients older than 16 who were treated at Tufts dental clinics from 2019-2022.

While the vast majority of patients said they did not use vapes, there was a statistically significant difference in the dental caries risk level between the e-cigarette/vaping group and the control group, Irusa. Some 79% of vaping patients were categorized as high caries risk, compared to just about 60% of the control group. The 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. This is not 100% conclusive, but people need to be aware of what we are seeing.

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

Further studies need to be done, and Irusa wants to look more closely at how vaping affects the microbiology of saliva.

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One reason e-cigarette use could contribute to a high risk of cavities is the sugar content and viscosity of the vaping liquid, which, when aerosolized and then inhaled through the mouth, sticks to the teeth. (A 2018 study published in the journal PLOS One comparing 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 friendlier to disease-causing bacteria. It has also been observed that vaping seems to encourage decay in areas where it would not normally occur – such as the lower edges of front teeth. “It takes an aesthetic toll,” says Irusa.

The Tufts researchers recommend that dentists regularly ask about e-cigarette use as part of a patient’s medical history. This 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.

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The researchers also suggest patients who use e-cigarettes should be considered for a “more rigorous caries management protocol,” which could include prescription-strength 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 manage dental caries, 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 doesn’t stop.”

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


Journal reference:

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


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