Common Conditions

No Smoke, But Plenty of Fire: How Do E-Cigarettes Affect Oral Health?

E-cigarettes are said to be safer than regular cigarettes since they produce an aerosol instead of smoke. Since nicotine is delivered, there are large oral health implications for users of e-cigarettes.

by Dr. Burhenne

No Smoke, But Plenty of Fire: How Do E-Cigarettes Affect Oral Health?

E-Cigarettes Question: I was never really a smoker, but I’ve used an e-cigarette for about two years, although I hardly put any nicotine in it these days. (Dropping from 18 mg to probably 4-6 mg the past year). I’ve always had healthy teeth, but recently realized that my gums are receding, especially on the side where I “vape” from. Using an e-cigarette hasn’t seemed to impact my teeth at all, but is it unhealthy for gums? Is there anything I should be doing aside from flossing and delicate brushing that could help keep my gums healthy or stop the recession?

Answer: It’s easy to see why e-cigarettes seem like a fantastic alternative to regular cigarettes. E-cigarettes don’t contain tobacco, although they do contain nicotine derived from the tobacco plant, and they don’t produce smoke — instead they are battery-powered and work by producing an aerosol that you “vape” — so you can use them anywhere.

The problem is, e-cigarettes have not been fully studied.

In 2014, the US Food and Drug Administration (FDA) concluded that “e-cigarettes have not been fully studied, so consumers currently don’t know the potential risks of e-cigarettes when used as intended, how much nicotine or other potentially harmful chemicals are being inhaled during use, or whether there are any benefits associated with using these products.”

Clinical studies are in progress at the moment to understand e-cigarettes’ impact on health — so until these are out, there’s a lack of definitive research on the health effects and still much we can’t know for sure.

I can say that e-cigarettes can still cause gum recession and other oral health problems because they still deliver nicotine, even if it’s in smaller doses than traditional cigarettes.

What Are the Effects of Nicotine on Gum Health?

Studies have shown that nicotine — whether delivered via traditional cigarette or other means — does harm to the mouth, gums and tongue.

A report published in the Journal of the Indian Society of Periodontology has stated that nicotine may contribute significantly to the development of gingivitis and periodontitis, which can cause bad breath and inflammation throughout the body.

Here’s how nicotine can impact your oral health:

Nicotine Causes Gum Recession

Nicotine is a vasoconstrictor, meaning it reduces the amount of blood that can flow through your veins.

Without sufficient blood flow, the gums do not get the oxygen and nutrients they need to stay healthy. Nicotine chokes tissues in the mouth from the blood it needs to survive, causing death of the gum tissues.

Nicotine Masks Symptoms of Gum Disease

“Almost two years vaping and my gum disease has dramatically improved.”

“I just got back from the dentist and he said my gum health has actually improved since I started using e-cigarettes.”

You might see reports like these in a lot of online forums.

That’s because nicotine can hide the symptoms of gum disease from your dentist, making it harder to be diagnosed.

When you have gum disease, it’s the increased blood flow to the gums that tips you off or tips off your dentist to the fact that you have gum disease. The gums are irritated and swell with blood, and when you floss or even brush, they bleed.

This fools everyone — both the dentist and yourself — into thinking that things are going well in your mouth.

If the progression of gum disease can’t be observed or diagnosed, then things go south without treatment.

Even longterm chewing of nicotine gum can cause these problems.

Nicotine Causes Bad Breath

As a vasoconstrictor, nicotine also inhibits your body’s ability to produce saliva. Not enough saliva can leave you susceptible to bacteria buildup, dry mouth, and tooth decay.

Nicotine Intensifies Grinding

Nicotine is also a stimulant that fires up the muscles, making you grind your teeth more intensely if you’re already a grinder — and might even prompt you to start grinding your teeth even if you weren’t a grinder before.

My Recommendation

If you’re thinking about using e-cigarettes or you already use them, you’ve got to watch out for the signs of gum disease.

But how are you going to watch out for the tell-tale sign of gum disease — bleeding gums — if nicotine masks bleeding gums via vasoconstriction?

Since nicotine masks the symptoms of gum disease from both you and your dentist, you’ll have to be extra vigilant about gum disease prevention.

To diagnose gum disease, as well as measure its progression, your dentist will take something called a pocket reading.

“Pockets” are like the “moat” around each of your teeth, which is naturally present. It’s the space between the gum line (where you see your gums and teeth meet when you look in the mirror) and where the tooth and gum attach a little further down (see the illustration below). Deeper pockets indicate a breakdown of the attachment of the gums to the teeth.

pocket reading
Image via healthsnap.ca

Visit your dentist every three months to monitor your pocket readings. Your likelihood of having gum disease is greater as long as you’re using nicotine and because nicotine masks the tell-tale signs, a frequency of every three months is necessary in order to prevent tooth loss, bone loss, and gum recession.

The best and most convenient option here, and I know it’s hard to hear, is to eliminate the nicotine habit.

Mark Burhenne DDS

Sources

Nicotine and periodontal issues
Effects of E-cigarette aerosol mixtures on oral and periodontal epithelia

read next: Hospitals Are Fighting Pneumonia With Brushing and Flossing (And Winning)

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Dr. Mark Burhenne DDS

33 Comments

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  1. Hi,
    You make a number of claims for adverse effects of Nicotene separate from tobacco smoke, could
    You help me with links to the research that demonstrates any of your claims. All I can find is smoking
    Studies.
    As far as I can determine you are drawing your own conclusions without any way to substantiate.

    • Mark, thanks for taking the time to leave a comment. Just in case you missed them, there are links to the studies are listed in the “Sources” section of this article. There’s also an additional article you should take a look at here: http://clincancerres.aacrjournals.org/content/early/2015/01/08/1078-0432.CCR-14-2544.full.pdf+html

      Essentially, if you look at an e-cigarette as a way to stop smoking over a limited period of time, then there’s nothing wrong with it, but you’re still being exposed to many of the same chemicals as smoking and many experienced users can actually get the same amounts that they do from smoking. In addition, they may be getting new chemicals and the new research that’s in process is just beginning to get a handle on this. I think you may find that in 5-10 years from now, they will find that e-cigarettes are as harmful in perhaps the same or different ways.

      Hope that helps.

      • holy cow, i can’t believe you just stated that nonsense. nicotine (if used) is about the only chemical found that is the same in cigarettes and “e-cigs”. that you spouted that nonsense brings your other statements so far into question, that i will laugh at anyone who cites you for information.

        • I’m afraid Mark is probably correct, I’ve been vaping for about 12 months since giving up smoking and recently felt I have more gum a tooth problems recently, however the jury is still out! On a plus side, I service haematology regularly for my employer and use my own blood to verify service work. I have seen a dramatic shift down in my white cell count since giving up cigarettes from typically being around 13 (high side of normal) to 8 (midish range). White cells generally fight infection so my conclusion in changing to vaping is I have less infection to fight 🙂

      • Can e cigarettes cause thrush as I have bin doin it for a few weeks now nicotine free and looks like thrush on my tongue

        • yes, but it could be something else, a reaction to the chemicals in vaping devices like propylene glycol

          drb

          Dr. Mark Burhenne | AsktheDentist.com Read reviews for The 8-Hour Sleep Paradox Facebook | Twitter | YouTube (408) 737-2100

          Schedule a Skype or phone consultation with me

  2. One main thing I have discovered since vaping and doing research about the side effects of vaping, is that “vapers” avoid admitting to certain side effects. Hereby a list of my own experiences.
    1) Burning throat.
    2) Inside of my mouth feels dried out and irritated.
    3) Sinuses run all the time (sniffing permanently)
    4) 2 months later: Bleeding gums started
    5) Where I was smoking cigarettes at a packet a day, I now vape constantly.. Never ending.
    I fully support mark in his accurate comment: “I think you may find that in 5-10 years from now, they will find that e-cigarettes are as harmful in perhaps the same or different ways.”

    • Thanks for taking the time to share your experiences, Andre. I think it’s important to be aware of the scientific research, but also aware of your own body’s response. Every body reacts differently!

  3. Not many know that by just taking care of your
    caffeine intake you can reduce your cholesterol level to a greater extent.
    Electronic cigarettes aree without harmful components which do
    not cause lungs cancer, heardt stroke issues oor aany of the respiratory trract problems.
    I think it really depends on each individual, soo in order
    too find out what the best ways to stop smoking are, one needs to consider each method for
    its advantages annd disadvantages.

  4. causes completely no dangewr for passive smoking, also.
    Electronic cigarettes are without harmful components which do not
    cause lungs cancer, heart stroke issues or any of
    the respiratory tract problems. While there are lots of methods that aim to
    help people quit smoking like nicotine lozenges, chewing gum, counselling, patches and other cessation methods,
    one significant alternative is hyponosis or hypnotherapy.

  5. All of your comments are about how nicotine affects you, what I want to know is what about zero mg nicotine liquid? are they bad for you too? At the moment I vape 9mg nicotine and I ddefinitely suffer from dry mouth, runny nose and sensitive teeth. I was wondering if these symptoms would continue if I used a zero nicotine liquid. Only one way to find out I guess!

  6. I smoked for 15 years then switched to vaping, after a month of vaping I can honestly say from my personal usage of the devices and juices something just was not right. I had a few teeth start to act up. Almost like the juice was causing the enamel to erode away. And I couldn’t agree with the statement more, we don’t know enough to make a call on weather or not it’s causing certain things to our bodies to happen. And anything you do too much of and not try to do in moderation I think can be harmful in some way or another.

    • Same here. My front tooth that needs a root canal is acting up since switching to a bigger mod. As Well as discomfort on the tips of my teeth. Wondering if its from the sucktion of constantly vaping or the fact that I’m getting much bigger vape intake now.

  7. Hi
    I am smoking from last 15 year and now start e liquid vaping 4 month ago. i have just two problem with it.
    1. Gums Bleeding
    2. Bad Smell start after 2 month

    I start this due to NHS review from website. They wrote E-cigarettes ‘95% less harmful than smoking’ says report. Click on below link for further information

    http://www.nhs.uk/news/2015/08August/Pages/E-cigarettes-95-per-cent-less-harmful-than-smoking-says-report.aspx

    I am also confused what’s the truth but still searching. Thanks
    Ashraf

  8. 2yr smoker, stopped to 4 months vaping. 12mg nicotine. Front tooth implant, now noticing gum recession in front and back of implant, moreso than other teeth. Recently the back of my implant, extreme sensitivity it hurts when touched. Feeling, now recognize the gums in the back are now exposing the inner parts of the implant. Scary as shit, now googling to blame the nicotine. Finding that a key target to blame. Also I usually exhale through my nose because I enjoy the prolonged feeling. This has also caused constant sniffling, and even more so my right nostril interior is extremely sensitive. I’m a 29 yr old male, healthy eater, excercize 5 days/week. I’ve noticed nose is getting better if I just exhale through my mouth only. I will now only buy organic liquid @ 0mg nicotine. If your reading this, don’t be stupid, drop the nicotine, cuz I love my vaping, just have to find the balance in the activity.

  9. Electronic cigarettes use a premium e liquid mix of nicotine, distilled water, flavoring ingredients, and a few other chemicals that turn into vapor when inhaled. These liquid ingredients will not cause any teeth discoloration, plaque buildup, or bad breath.

    • I would imagine that “flavoring ingredients” would include acids, especially in fruit-flavored juices. Acidic compounds do cause enamel erosion and tooth decay, and possibly the irritation in the nose/sinuses that people are describing. I quit smoking and have been vaping for 2 years and have had numerous issues with sensitivity and tooth decay in the last few years. Dentist says its acid erosion of my enamel. Never had issues before. So I have to deduce that the vaping has at least contributed.

  10. As a normal peripheral care dentist and a beginner vaper, i am truly in the limelight of this fight. In truth however, any food ingestion, drug or non-toxic will have its adverse effects. For instance, nicotine is indeed a vasoconstrictor. This is the key term here where nothing else really matter in tgis argument.

    Since I myself was drawn into this shitty habit, a result of being thrown alone overseas for 5 years, I decided to vape and came here curious if studies were done, but all i receive were information i already know about nicotine.

    First fact: Nicotine causes gume recession IN ADDITION TO THE CALCULUS YOU HAVE! Withou calculus build up however, nicotine effect on gums ia debatable. So to trick this nicotine side effect, you attend scaling sessions with the dentist more regularly. If u do it once a year, do it twice a year. If you do it twice a year, do it four times a year, etc. As long as calculus isnt there to keep the nicotine ever present around the areaa of the gums, the effect becomes extremely milder than if u do not do scaling on your teeth at all.

    Second fact: Nicotine is a vasoconstrictor, so everywhere it is exposed to your smooth mucosa/internal mucosa, it will diminish its blood supply. Now if it is in the nose, your nose cells will get dry, less blood, irritable and often catch yourself running because it you were already used to it being dry in the first place

    Third fact: Implants will definitely be the worse affected by nicotine because implants are foreign objects that do not resupply the area. If an object is already taking space in a living microhabitat that is diminishing in blood supply, but do nothing but take up space which could have been taken up by new blood vessels and gingiva cells, then it is all the more affected by diminishing and receding mucosa.

    Fourth Fact: Nicotine main causes are vasoconstriction. That same affect reduced saliva secretion, healthy bleeding and wound healing, and reduced saliva causes bad breath. If your blood supply is active, even if it is thinned out, if you are healthy, you drink a lot of water, you exercise on a personal can do basis, you scale your teeth as per the dentist recommendation, brush your teeth twice a day, check your diet and medicament intake, floss, and tongue scrape with no bad oral habit, you are most likely doing better than a cigarette smoker

    Fact 5: The last ultimate fact is my own personal research in vape and has nothing to do with dentistry. It is the use of propylene glycol or vegetable glycol as a vehicle for atomizing in vape. This one is simple if you understand basic pathology. Every atom on the planet has a chance to cause hypersensitivity and allergic reaction. VGhowever is known to be less biotoxic even in allergic circumstances since its organic rather than synthetic like propylene glycol. Check with your doctor to see if you are allergic to propylene glycol or vegetable glycol. Try chging to see the effect and if you are allergic to both, it means you are literally allergic to smoke in every way, including burning trash in you backyard. One can only wonder how u went thru smoking without an allergic reaction or has been tolerated silently

  11. Makes a lot of sense to me because I have vaped for years now and for a long time I had no apparent gum problems, however I began in steps to reduce my nicotine and THAT is when my gums started bleeding whenever I flossed…I asked my dentist about the bleeding but he only accused me of not flossing enough…now I think I have the mystery solved. My gums were being damaged by the nicotine but I used high enough strength nicotine apparently to keep my gums from bleeding the evidence. But when I reduced down to a low level nicotine there is just enough to inflame the damaged gums but not enough to constrict the blood vessels…dang it I have to quit now or risk my flippin teeth! FIgures I have a huge supply of DIY vape juice makings including a large bottle of nicotine liquid! Have to just dump it or find someone that wants it I guess…

    • Yesterday after reading about nicotine and gums, I decided to quit. Well easier said than done! By the evening I just keep reaching for my vape “mech mod” which is not there cause I removed it from the coffee table. I finally dug it back out for a bunch of puffs. Will stash it again and try to see if I can go longer tomorrow …I DID last all the way to the evening so I vaped a whole lot less. I can also use the dilution route and taper off if need be. I was already down to about 5mg strength (per ml) so if I give in tomorrow I will drop that to 2.5mg and try not to simply do more puffs to make up for the drop…I just need to keep reminding myself that “nicotine is destroying my oral health and who knows what else” and just keep pushing myself to QUIT! It was SO easy to quit smoking by vaping instead, but I guess there is no totally magic bullet. Got rid of the cancer threat it is true, that was good except vaping STILL sucks for me…

  12. I stopped smoking a few years ago I didn’t have stained teeth and after a few months my gums swelled up and was really sore I started smoking again they recovered but my gums had receeded , but had started to smoke too much and was getting allot of calculus build up so I’ve gone on to a ecig and just smoking less than 10 day and the calcolous build up has reduced allot but I’ve only been using it for a couple of weeks so far

  13. The only people who seem to have anything good to say about vaping are people who do it. It’s almost like e-juice contains one of the most addictive chemicals known to man or something.

  14. I been smoking for almost 35 years, during that time i have very less issue with my teeth and gums. I stop smoking 5 month ago and switch to vaping. I was happy because my stamina improved a lot, but After 3 months of vaping my gums start to bleed and few of my teeth start aching like hell. 2 week ago I’ve just loss my one of my teeth and might loose 2 more in the next few days.
    Starting today I will use 0mg nocotine and see what happen. If there are no improvement on my gums and teeth then I really need to quit vaping before I loose all of my teeth :(.

  15. Nicotine, from any source, acts as a vasoconstrictor in the body. This means, in the gums, that there is lower oxygen tension. The bacteria that cause periodontitis (gum disease) are anaerobic (they don’t like oxygen).
    This is like putting out a welcome mat for these bacteria to invade the tissue. Inflammation of the gums is masked by the effect of the nicotine – the gums don’t bleed as much because the capillaries (smallest vessels) are smaller. The breakdown of tissue is still going on. Any potential for healing is reduced by the reduced blood flow to the damaged tissue.
    As supporting bone is lost, teeth can become loose. As gums recede, sensitive root surfaces are more exposed. Can we agree this is not good?
    Nicotine users are lulled into a false sense of security. Things seem okay until nicotine use is stopped and the real situation is evident.
    Does this make sense to you?
    Do you suppose nicotine is having negative effects on other parts of the body that need oxygen?
    Would it be worth it to you to find something healthier?

  16. Could it be possible that near the 2mo mark of not smoking the crusty build up from regular tobacco has been brushed clear away, thus leaving the problem of gums exposed? So now Vaping may not “the” problem it may be aggravating the existing from what smoking was hiding all along?
    Just a thought? I’m to Vaping & having concerns with gums & bleeding.
    — I am aware of Vape mouth that is dry mouth from too much nicotine.
    Dry mouth equals decay, alot of medications lead to dry mouth & decay teeth. Bioteen works as a quick fix —

  17. Well the author of this article might be the type of person that assumes one source is completely correct.

    I think it’s safe to say that while electronic cigarettes may not be the best thing in the world for us, it’s a hell of a lot better than tobacco ones, especially when used temporarily to aid in cessation.

    I do think that I’d agree that the pro-vaping crowd (especially ex-smokers who are still using nicotine liquids years later) seems to think that all facts that put their hobby/habit in a negative light are all wrong… anti-vapers are just as bad. Because it looks like smoking they assume it’s just as deadly.

    It’s going to take awhile before different studies allow unbiased (key word) scientists and groups to draw accurate conclusions about the health risks (or lack thereof) associated with vaping.

  18. Judging by your title, you are referencing the mods that have exploded on some people, but that is not only a quite rare occurrence, but also caused by a lack of education, and failure to ensure their vape is safe, and most often a cheap, unregulated mod. If one puts the batteries in backwards, the mod will still try to fire, causing the battery to vent, and if use continues the battery will explode. Battery safety is unfortunately a lesson some people learn the hard way, Which is why I use my regulated mod with battery protection, meaning if i put the batteries in backwards, my mod won’t turn on. The people that had their mod/batteries explode also wrongly place blame on their RDA(rebuildable dripping/drip atomizer) Which works by using the power from the batteries to heat the coils, which heat the juice on the cotton to release the vapour, they used it wrong and suffered the consequences. The end

    • hi kyle, was referring to the controversy over vaping when writing “plenty of fire”.

      i don’t think it’s (the battery issue) a big issue and did not mention it in my article.

      thanks for being a reader

      drb

      Dr. Mark Burhenne | AsktheDentist.com Read reviews for The 8-Hour Sleep Paradox Facebook | Twitter | YouTube (408) 737-2100

      Schedule a Skype or phone consultation with me

  19. What about the e cigarettes they have brought our now that contain all natural products and have Zero nicotine? Ingradirtnd are deionised water, flavourinf, vegetable glycerine USP grade, propylene Glycol USP grade . Would these be far safer on the gums and mouth?

  20. This conversation has convinced me to quite vaping while I still have a few teeth left. I smoked for 35 years and quit 2 years ago. Vaping made it easy. And while everyone in here seems to be focused on nicotine as the cause for degrading gum health, I keep thinking about the effect of 350*f steam in my mouth. Even a few seconds at a time would slowly cook your mouth. I’ll just be drinking water now!

  21. Gotta say I suffer from a lot of these symptoms but I vape THC oil (I’m in Colorado, so it’s legal) from Necterbee. So I’m thinking that nicotine is not the cause. Maybe someone should compare the added ingredients and see if there is a common chemical and study that.

  22. Propylene glycol and glycerin both are compounds that might be left in your mouth that could be digested by bacteria; deriving acids which ultimately lead to cavities etc. They are both sugar derivatives. Not sure I know any more than that.

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