E-cigarettes and vapes tied to higher risk of tooth decay and cavities, study finds

78 percent of the vaping patients were categorized as having high-caries risk.
Deena Theresa
Vaping damages microbiome health.
Vaping damages microbiome health.


Vaping, once seen as a harmless habit, is being increasingly studied over the years and found to be damaging to health.

The latest research by faculty from the Tufts University School of Dental Medicine has revealed that patients using vaping devices were more likely to have a higher risk of developing cavities. And with the number of vapers increasing — CDC surveys reported that 9.1 million American adults and two million teenagers use tobacco-based vaping products — that can only mean a lot of "vulnerable" teeth. 

"Public awareness has increased about the dangers of vaping - especially after the activity was tied to lung disease. Though some dental research has shown a link between e-cigarette use and gum disease, less emphasis has been placed on the 'intersection between e-cigarette use and oral health, even by dentists," Karina Irusa, assistant professor of comprehensive care and lead author on the paper, said in a statement.

The first study to link vaping with increasing risk of developing cavities

According to Irusa, this study is the first known to "specifically" investigate the association of vaping and e-cigarettes with the likelihood of getting cavities. More than 13,000 patients older than 16 who were treated at Tufts dental clinics from 2019-2022 were analyzed. 

The scientists found a "statistically significant" difference in dental caries risk levels between the e-cigarette/vaping group and the control group. Seventy-nine percent of the vaping patients were categorized as having high-caries risk, compared to just about 60 percent of the control group. 

It has to be noted that vaping users were not asked if their devices contained nicotine or THC.

"It's important to understand this is preliminary data," Irusa said. "This is not 100 percent conclusive, but people do need to be aware of what we're seeing." 

Sugary content in vaping liquid to be blamed

How can e-cigarette use contribute to cavities?

The sugary content and viscosity of vaping liquid, when aerosolized and inhaled through the mouth, stick to the teeth. A study published earlier this year did reveal that vaping affected the oral microbiome in the user's mouth. 

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This study also observed that vaping encouraged decay in areas like the bottom edges of front teeth. "It takes an esthetic toll," said Irusa.

What can be done?

Dentists must routinely enquire about e-cigarette use as part of a patient's medical history.

The Tufts 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 rinse, in-office fluoride applications, and checkups more often than twice a year, according to the release. 

"It takes a lot of investment of time and money to manage dental caries, depending on how bad it gets," Irusa said, "Once you've started the habit, even if you get fillings, as long as you continue, you're still at risk of secondary caries. It's a vicious cycle that will not stop."

The study was published in The Journal of the American Dental Association on November 23.

Study Abstract:

Background: Evidence on the potential oral health effects of vaping is scarce and there are limited data on possible links to both caries and periodontal disease. The authors assessed the association between electronic cigarette (e-cigarette) or vape use and caries risk level. The Caries Management by Risk Assessment tool was used.

Methods: A cross-sectional study of patient records was conducted; 13,098 patients who attended the dental school clinics from January 1, 2019, through January 1, 2022, were included in the study. Mann-Whitney U test and multivariable ordinal logistic regression were used to assess the relationship between use of e-cigarettes or vapes and caries risk level.

Results: Data from 13,216 patients were included in the data set initially; 13,080 responded "no" when asked whether they used e-cigarettes or vapes (99.3%), and 136 responded "yes" (0.69%). There was a statistically significant difference (P < .001) in caries risk levels between the e-cigarette or vape group and the control group; 14.5%, 25.9%, and 59.6% of the control group were in the low, moderate, and high caries risk categories, respectively, and 6.6%, 14.3%, and 79.1% of the e-cigarette or vape group were in the low, moderate, and high caries risk categories, respectively.

Conclusions: In this study population, there was an association between use of e-cigarettes or vapes and caries risk level of patients; vaping patients had a higher risk of developing caries.

Practical Implications: Within the study limitations, it was recommended that use of e-cigarettes or vapes should not only be included in the routine dental-medical history questionnaire, but also among the risk factors that increase a patient's caries risk level.

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