Vaping, a relatively new human habit, poses its own oral health risk.

Nearly half of Americans over the age of 30 suffer from gum disease. While smoking cigarettes is a well-established risk factor for gum disease, little is known about the impact of e-cigarettes—which vaporize nicotine and other chemicals—on oral health, particularly the long-term effects of vaping.

Researchers at NYU College of Dentistry have published a series of new studies that show how e-cigarettes affect oral health and may contribute to gum disease. The latest study, published in mBio, discovers that e-cigarette users have a distinct oral microbiome—a community of bacteria and other microorganisms—that is less healthy than that of nonsmokers but potentially healthier than that of cigarette smokers, and it also tracks the progression of gum disease over time.

The researchers looked at the dental health of 84 persons from three different groups: smokers, e-cigarette users, and non-smokers. Two dental exams, six months apart, were used to assess gum disease, with plaque samples taken to test the bacteria present.

Gum health changes

At the outset of the trial, all of the individuals had some form of gum disease, with cigarette smokers having the most severe illness, followed by e-cigarette users. Gum disease had worsened in several patients in each group after six months, including numerous e-cigarette users, according to the study.

Clinical attachment loss, which is measured by gum ligament and tissue detaching from a tooth’s surface, causing the gum to recede and produce pockets, is a key symptom of gum disease. Bacteria thrive in these pockets, which can lead to more serious gum disease. In a study of the same patients published in Frontiers in Oral Health, the research team discovered that clinical attachment loss was much worse only in e-cigarette smokers—not non-smokers or cigarette smokers after six months.

A distinct microbiota

The researchers next looked at the bacteria present in the plaque samples and discovered that e-cigarette users have a different oral microbiome than smokers and nonsmokers, confirming findings published in iScience and Molecular Oral Microbiology earlier.

While all groups shared around a fifth of the types of bacteria, e-cigarette users’ bacterial makeup was noticeably more similar to that of cigarette smokers than that of nonsmokers. In comparison to nonsmokers, both smokers and vapers have higher levels of bacteria such as Selenomonas, Leptotrichia, and Saccharibacteria. Other bacteria, such as Fusobacterium and Bacteroidales, which have been linked to gum disease, were notably prevalent in e-cigarette users’ mouths.

The researchers discovered higher diversity in bacteria for all groups evaluated in the six-month follow-up when plaque samples were collected and analyzed, but each group maintained its own distinct microbiome.

“Vaping appears to be driving unique patterns in bacteria and influencing the growth of some bacteria in a manner akin to cigarette smoking, but with its own profile and risks to oral health,” says Fangxi Xu, the study’s co-first author.

Changes in the immune response

The researchers discovered that e-cigarette users’ microbiomes were linked to clinical markers of gum disease and changes in the host immunological environment. Vaping was linked to varied levels of cytokines, which are proteins that help control the immune system. Certain cytokines have been related to a bacterial imbalance in the mouth, and they can exacerbate gum disease by making people more susceptible to inflammation and infection.

TNFα, an inflammatory cytokine, was shown to be considerably higher in e-cigarette users. IL-4 and IL-1, on the other hand, were found to be lower in e-cigarette users; IL-4 is lowered in patients with gum disease and increases following treatment, suggesting that particular bacteria in e-cigarette users’ lips may be actively suppressing immune responses.

The researchers found that e-cigarette users’ unique oral microbiome causes altered immune responses, which, in combination with clinical signs for gum disease, demonstrate how vaping poses its own oral health risk.

Source: 10.1128/mBio.00075-22

Image Credit: Getty

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