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Vaping May Set the Stage for Tooth Decay

Man holding a vape pen, exhaling visible vapor.
Credit: Ethan Parsa on Pixabay

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A new study has found that dental patients who reported using e-cigarettes, also known as vapes, have a significantly higher risk of developing cavities than those who don’t. The study is published in the Journal of the American Dental Association.

The potential dangers of vaping

Vapes and e-cigarettes were first developed as an alternative to smoking and as a tool to quit smoking altogether. The handheld devices heat liquid-filled cartridges that contain various flavors and compounds such as nicotine or tetrahydrocannabinol (THC) – the psychoactive chemical found in cannabis – producing an aerosol vapor that is inhaled by the user.


An estimated 9.1 million US adults – as well as 2 million teenagers – are reported to use tobacco-based vaping products, according to the CDC. However, these products are not as benign as once thought – the CDC reported that 68 deaths and 2,807 hospitalizations occurred due to vape-associated lung injuries in the US by February 18, 2020.


Evidence has also emerged suggesting that vaping is bad not only for our lungs but also for our oral health. The authors of one article documented three cases of patients seeking treatment for unusual patterns of dental cavities (also known as caries), in which all three patients reported using vaping liquids containing THC. Another study showed that participants who smoked e-cigarettes as well as dual smokers (those who smoked conventional and e-cigarettes) were more likely to have untreated caries than both non-smokers and non-dual smokers.


Nevertheless, conclusive evidence regarding the possible risks to dental health from vaping remains limited. In the current study, the researchers aimed to take a closer look at the association between vaping and the risk of developing dental caries.

How does vaping affect caries risk?

The study was led by Dr. Karina Irusa, assistant professor of comprehensive care at Tufts University School of Dental Medicine. Irusa and colleagues examined data from over 13,000 patients that attended Tufts dental clinics between 2019 and 2022. Patients included in the study were over 16 years of age, had been diagnosed with caries, had a caries risk assessment on record and had also indicated whether or not they used vapes or e-cigarettes on a patient history questionnaire.


Of these patients, 13,080 (99.3%) responded “no” to vape use and 136 (0.69%) responded “yes”. The researchers found that vape users were at a significantly increased risk of developing caries – as much as 79% of vaping patients were classified as high-risk compared to approximately 60% of the control group.


Vaping may affect the environment within the mouth in several ways that lead to caries. “The current hypothesis is that vaping may cause dry mouth, depriving the oral cavity of its ability to self-cleanse through saliva,” Irusa explains.


The authors also suggest the increased risk of caries could also be caused by the high sugar content of the vape liquid which can stick to the teeth, causing decay. Additionally, bacteria resident in the mouth – known as the oral microbiome – could also be affected by vaping, as it may encourage the growth of cavity-causing bacteria.


Despite gathering information on how often and how much these patients vaped, the authors state that they could not draw any valid conclusions regarding how these may affect risk levels due to the small number of patients in the vaping group.

Recommendations for caries risk management

Now, the researchers are sourcing funding to investigate exactly how vaping influences tooth decay by studying the bacteria found in dental plaque and saliva.


Irusa also expands on the preliminary nature of this study and its implications: “I would just like to reiterate that the results of this study are preliminary and that this snapshot is aimed at raising a red flag to the general public/healthcare practitioners and to serve as the foundation for further research,” she adds.


The authors recommend that information on vape use should be included in routine dental-medical history questionnaires, in addition to being considered as a factor that may increase the risk of developing cavities.


Reference: Irusa KF, Finkelman M, Magnuson B, Donovan T, Eisen SE. A comparison of the caries risk between patients who use vapes or electronic cigarettes and those who do not. JADA. 2022;153(12):1179-1183. doi: 10.1016/j.adaj.2022.09.013


Dr. Karina Irusa was speaking to Sarah Whelan, Science Writer for Technology Networks.

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