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Clinical Resources

Vaping and E-Cigarettes

Vapes and e-cigarettes have become a popular alternative to regular cigarettes due to the perception that vaping and e-cigarettes are safer substitutes to cigarettes and can provide an easier transition to quitting tobacco use. Vaping is still too new for researchers to understand every potential risk, but early studies show that vaping can have negative effects on the oral cavity and overall health.

What are e-cigarettes and vapes?

E-cigarettes and vapes are classified as electronic nicotine delivery systems (ENDS) by the Food and Drug Administration. These battery-powered devices heat a cartridge of liquid containing various chemicals. Once heated, the liquid becomes aerosolized and inhaled. The base ingredients of e-liquid include water, nicotine, propylene glycol, vegetable glycerin and flavor additives.

The chemicals used to add flavor to the e-liquids have been recognized as being safe to ingest, but very little is known about the health effects of inhaling these different chemicals. In addition to the thousands of flavor combinations and formulas, the composition of the chemicals changes once vaporized, which makes studying the health effects very difficult.

How does vaping affect our health?

An Ohio State University study found that vaping stresses the oral environment in such a way that it changed the bacterial composition in the mouth to favor pathogenic bacteria. After just three months of use, people who were periodontally healthy had a change in the types of bacteria in their mouth. The bacterial profile of people who vape resemble that of people with periodontal disease even if there is no current active disease. The presence of pathogenic bacteria can exponentially increase the likelihood of disease.

Nicotine, whether it comes from traditional cigarettes or e-cigarettes, is a major contributor to periodontal disease. While vaping is considered a low- to no-nicotine alternative, a CDC study has shown that 99% of e-cigarettes sold in the United States contain nicotine, even though some are marketed as 0% nicotine.

The propylene glycol and glycerin in the liquid comes in direct contact with teeth when vaporized. As a result, it adheres to hard and soft tissues of the mouth, which can promote bacteria adhesion and biofilm formation, leading to increased risk of caries.

Sugar alcohols used to enhance flavor in vapes have been shown to decrease enamel hardness compared to unflavored e-liquid. Because of the many possible combinations in flavorings, the interactions with teeth can vary from one liquid to another.

Xerostomia is the most common side effect among people who vape due to the propylene glycol. Without proper saliva production to buffer the acidic oral environment after eating and drinking, people suffering from xerostomia are at high risk of cavity formation.


Vaping or e-cigarettes can have an adverse effect to oral health. Additional long-term studies will be needed to understand their full affects; however, the available literature suggest that vaping is not as safe as once believed.