Vaping and oral health: established risks

A narrative review published in 2026 in the Dentistry Journal examines studies on the effects of e-cigarettes on the mouth. Its author, Mahmoud Rouabhia, from Laval University in Quebec, concludes that inhaled vapor poses risks to oral tissues, while emphasizing that some long-term risks have yet to be rigorously documented.[1]

An alternative that has become a mass-produced product

Introduced in the early 2000s as a solution for smokers trying to quit, the electronic cigarette has rapidly diversified. The first models, known as «cigalikes,» gave way to rechargeable devices, then to adjustable devices and compact pods, often more powerful and more efficient in delivering nicotine, not to mention single-use and semi-disposable devices.

This technological development has broadened its use far beyond smoking cessation. The review notes that e-cigarettes are now widely used not only by young smokers but also by non-smokers, fueling concerns among healthcare professionals.

The mouth is directly exposed

With each inhalation, the aerosol comes into direct contact with saliva, gums, tongue, teeth, mucous membranes, and dental restoration materials. According to the studies reviewed, this exposure can reduce saliva flow, dry out the mouth, make saliva more acidic and viscous, and decrease its antioxidant and antimicrobial properties.

The review of scientific findings also mentions an imbalance in the oral microbiota: a decrease in certain bacteria associated with good oral health and, conversely, an increase in periodontopathogenic bacteria. This imbalance could promote cavities, chronic inflammation, candidiasis, or periodontal disease.

The teeth themselves could be affected, with enamel demineralization, a risk of erosion, and discoloration. The materials used for fillings or prostheses (composites, glass ionomer cements, ceramics) can also change in color, surface roughness, and hardness due to repeated exposure.

Gums, tongue and mucous membranes under surveillance

The gums are among the most studied areas. The studies cited report an increase in inflammatory mediators, an alteration of gingival microcirculation, and a decrease in the ability of gingival cells to adhere, proliferate, and produce extracellular matrix.

This inflammation could remain subtle: the decrease in gingival bleeding due to reduced blood flow may give a false impression of periodontal health, even as the tissues deteriorate. The authors of this study see this as a factor likely to slow healing and promote the silent progression of periodontal disease.

The tongue can also be affected: irritation, burning sensations, taste disturbances, tongue coating, bad breath, and reported cases of black hairy tongue are among the symptoms associated with vaping. Lesions of the buccal and palatal mucosa, including ulcerations or white patches, have also been described in clinical studies and case reports.

Chemical compounds under high temperature

The aerosol does not only contain nicotine. By heating propylene glycol, vegetable glycerin, nicotine and flavorings, the devices can produce formaldehyde, acetaldehyde, acrolein, methylglyoxal, hydroxyacetone, hemictals or even tobacco-specific nitrosamines, such as NNK and NNN.

The heating temperature varies considerably between different generations of devices, ranging from approximately 100°C to over 400°C under certain conditions. High temperatures, especially during a «dry hit» when the wick is no longer sufficiently saturated with liquid, increase the formation of potentially toxic carbonyl compounds.

According to the review, these substances can induce oxidative stress, DNA damage, cell death, and chronic inflammation of oral tissues. The author specifies, however, that there is still no direct clinical evidence linking e-cigarettes to oral cancer: the available data mainly concerns biological mechanisms observed in vitro or early markers observed in users.

These cautious conclusions nevertheless suggest limiting vaping.

The study emphasizes the limitations of the literature: much of the research is conducted in laboratories, exposure conditions are not standardized, and human studies often involve short durations or individuals who also smoke conventional cigarettes. Cohorts followed for several decades, with comparable groups and control for confounding factors, would be necessary to determine the true level of risk. Nevertheless, the conclusions remain clear: the available data suggest that vaping, in itself, can disrupt the balance of the oral cavity and should not be considered harmless. The review recommends that oral health professionals routinely ask their patients about vaping, monitor for dry mouth, irritation, gingival inflammation, and bad breath, and encourage rigorous oral hygiene and the earliest possible cessation of vaping.

These results are consistent with a growing number of warnings issued. for the attention of users of these products. They remind you that vaping aerosols are not simply «water vapor»: they can contain nicotine, fine particles, carbonyl compounds and certain metals.

This review on oral health reinforces a message of caution already being promoted by public health professionals: while e-cigarettes may represent an alternative for adult smokers seeking to quit, they should not be presented as harmless, and quitting vaping after smoking cessation is strongly recommended. Public health professionals also warn against the appeal of many e-cigarettes, such as the puffs and numerous flavors of these products targeting young people. They remind us that nicotine addiction can develop rapidly and that the brains of young people are still developing. The observed effects on gums, saliva, enamel, and the oral microbiota provide further support for the need to prescribe validated and safe smoking cessation treatments first, to clearly inform users of these products about the risks involved, to regulate access to these products, and to prevent their use among non-smokers.

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[1]Rouabhia M., The Adverse Effects of Electronic Cigarettes on Oral Health: Where Do We Stand?, Dentistry Journal, published October 8, 2026, accessed November 4, 2026

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