The risk profile of electronic nicotine delivery systems, compared to traditional cigarettes, on oral disease: a review.

Introduction
Electronic nicotine delivery systems (ENDS) have rapidly increased in popularity and are often marketed as a safer alternative to traditional cigarettes.
While the systemic risks of smoking are well known, the oral health effects of ENDS remain less clearly defined.
This review evaluates and compares the oral disease risk profiles of ENDS versus conventional cigarette smoking.
Key Points
Scope of review: Systematic review of English-language clinical and public health studies (2012–2022) assessing ENDS effects on oral health.
Relative harm: ENDS generally expose users to fewer toxicants and carcinogens than combustible cigarettes but are not risk-free.
Dental caries: ENDS aerosols increase bacterial adhesion and biofilm formation, raising susceptibility to tooth decay, especially with flavored e-liquids.
Tooth discoloration: ENDS may cause enamel and restoration discoloration; effects are typically less severe than cigarettes but increase with long-term use.
Periodontal disease: ENDS users show altered oral microbiomes and higher odds of self-reported periodontal disease compared with non-users.
Implant health: ENDS appear less harmful than cigarettes for dental implants, though evidence remains limited and mixed.
Oral mucosa: ENDS use is associated with dry mouth, irritation, and transient mucosal changes, generally milder than those caused by smoking.
Carcinogenic potential: ENDS aerosols contain tobacco-specific nitrosamines and aldehydes, suggesting a potential oral cancer risk, albeit lower than smoking.
Behavioral risk: Harm from ENDS may be underestimated due to ease of access, appealing flavors, and lack of use restrictions, especially among youth.
Conclusion
Current evidence suggests that ENDS are less harmful to oral health than traditional cigarettes, but they still pose meaningful risks.
Most oral effects associated with ENDS are milder and more temporary than those from smoking, yet long-term safety is not established.
Further high-quality, long-term clinical studies are needed to clarify the oral health consequences of sustained ENDS use.

Zhang, Qing, and Cai Wen. “The Risk Profile of Electronic Nicotine Delivery Systems, Compared to Traditional Cigarettes, on Oral Disease: A Review.” Frontiers in Public Health, vol. 11, 2023, doi:10.3389/fpubh.2023.1146949.