Smokers have a reputation for having bad teeth. They get “nicotine stains,” people often say, which turn their white teeth dull or yellow-brown.
Most vapers faced with comments like this would rightly point out that nicotine in its pure form is actually colorless. It seems obvious that, just as with the health risks, nicotine is not the source of the problem for the teeth when smoking; it is the tar.
But are we really right? New studies on the subject have flagged vaping as a potential problem, and although the results are far from being linked to dental problems in real-life vapers, it is a sign that dental issues may arise in the future.
So here is a brief summary of what we know about vaping and how it affects the teeth, nicotine’s role, and what we can do to minimize the risk.
How does smoking affect the teeth?
To understand the potential risks to the teeth from vaping, it is reasonable to learn a little about how smoking causes oral health problems. Although there are many differences between the two— inhaling tar-containing smoke is very different from inhaling droplets of liquid—vapers and smokers are exposed to nicotine and other chemicals in a similar way.
Smokers are at greater risk of developing dental problems than people who have never smoked or former smokers. For example, current smokers are four times more likely to have poor oral health compared with people who have never smoked, and they are twice as likely to have three or more oral health problems.
Smoking affects your oral health in many different ways; it can cause everything from yellow-brown discoloration and bad breath to more serious oral health problems such as gum disease (technically called periodontal disease) and oral cancer. Smokers also tend to have more tartar than non-smokers, which is a form of hardened buildup, also known as plaque.
There are other effects of smoking that also cause dental problems. For example, smoking affects your immune system and interferes with the mouth’s ability to heal, both of which can worsen other problems caused by smoking.
Smoking and gum disease
Gum disease is one of the most common dental problems in Sweden and around the world, and smokers are approximately twice as likely to develop it compared with non-smokers. It involves infection in the gums and the bone surrounding the teeth, which over time causes the tissue and bone to break down and can result in tooth loss.
The disease is caused by plaque, which is the name for a mixture of saliva and bacteria in the mouth. In addition to causing the irritation and inflammation of the gums that characterize gum disease, plaque also directly affects the teeth, leading to cavities.
When you consume foods that contain a lot of sugar or starch, bacteria break down the carbohydrates in the food into glucose, which is used as energy. This process creates acid as a by-product. If you do not keep your teeth clean, this acid eventually affects the surface of the teeth and causes cavities. But plaque contains many different bacteria, and some of these are also direct causes of gum irritation.
So while one of the consequences of plaque formation is more relevant to gum disease, both lead to dental problems, and smokers are at greater risk of experiencing both consequences than non-smokers. The effects smoking has on the immune system mean that if a smoker develops a gum infection caused by plaque buildup, his or her body is less able to fight it. In addition, when damage occurs as a result of plaque buildup, the effect of smoking on wound healing makes it more difficult for the gums to heal.
Over time, if gum disease is not treated, pockets can form between the gums and the teeth. This problem worsens as more tissue breaks down, and eventually it can cause the teeth to loosen or even fall out.
Overall, smokers are twice as likely to develop periodontal disease compared with non-smokers, and the risk is greater for people who smoke heavily and who smoke for longer periods. In addition, the chances of achieving positive results when the problem is treated are lower.
Smoking and gum disease: Is nicotine the culprit?
Among vapers investigating the connection between smoking and gum disease, the following question arises: is it the nicotine or the tar in tobacco that causes the problems? Naturally, as vapers we would be inclined to blame the smoke and tar rather than nicotine, but would that be right?
There are several theories about the connection between smoking and gum disease:
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Toxins in smoke can directly damage gum tissue.
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Smoke can alter the specific microbes found in plaque or affect how the immune system responds to it.
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Nicotine causes blood vessels to constrict, and this can make it difficult to detect the early warning signs (such as bleeding gums).
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Nicotine’s effect on blood vessels can lead to “hypoxia”—low levels of oxygen in the tissues—and this can make the gums susceptible to infections and reduce their ability to heal.
Unfortunately, it is not entirely clear which explanation or combination of explanations causes the problems in smokers. For vapers, however, this brings obvious potential benefits. There are far fewer toxins in vapor, so any problems caused by these will be less serious in vapers than in smokers.
The final two possible explanations are directly linked to nicotine, but there are a couple of things worth noting.
Regarding the idea that nicotine reduces blood flow and that this causes the problems, there are some issues. Studies that directly examined its effect on the gums (here ) found either no change in blood flow or small increases. One bonus study is this one, which also addresses the subject.
Even if nicotine really does cause blood vessels to constrict, the effect smoking has on blood pressure is generally stronger, and blood flow to the gums increases overall. This is the opposite of what would be expected if the explanation were correct, and at least suggests that it is not the most important factor overall. Vaping has less effect on blood pressure, however, so the result may be different in vapers.
The other idea is that gum tissues receive less oxygen, causing the problem. Although studies have shown that the hypoxia caused by smoking parallels how nicotine acts in the body, nicotine is not the only thing in smoke that can have this effect. Carbon monoxide in particular is a component of smoke (but not vapor) that has exactly the same effect, and hydrogen cyanide is another.
It is not entirely clear which is to blame, but since wound healing (a closely related problem) is impaired in smokers but not in users of nicotine replacement products, it is unlikely that nicotine alone causes all or even most of the damage.
It is not surprising that much of the discussion on the subject confuses nicotine with smoke, making it difficult to determine how large a role nicotine really plays. There is not much research examining this by specifically relating it to vaping, as one might expect, but there is not much research on nicotine without smoke in general.
Research on vaping and the teeth
First of all, some studies have specifically examined how vaping affects the teeth. However, these studies have all taken the form of cell culture studies. These are known as “in vitro” studies (literally “in glass”), and although they are useful for understanding the biological mechanisms underlying the potential health effects of vaping (and other exposures, medications, and almost everything else), they are a limited form of research. Just because something affects a large number of cells in a culture does not mean that it will have the same effect in a real human body.
With this in mind, research on vaping and the teeth is summarized in a review from March 2017. The authors examine research on gum diseases, including cell culture studies showing that e-liquids have harmful effects on ligament cells and connective tissue in the gums. Aldehydes in e-cigarette vapor can affect proteins and cause DNA damage. All of these effects could theoretically lead to periodontal disease in vapers.
Nicotine also has the potential to cause dental problems, although this too is based on cell studies and studies of people who smoke tobacco. The authors argue that vaping may lead to impaired healing.
But the truth is that at present we do not have much research specifically examining vaping, and much of the above is ultimately speculation. It is speculation based on mechanistic studies of how nicotine interacts with cells in the mouth, so it cannot be completely ignored, but the evidence we have so far does not really say much about what will happen to real-life vapers in practice.
Research on snus and gums
So how should we respond to the current questions about vaping’s potential effects on the teeth? Like the authors of the article discussed above, we are also largely limited to speculation. But not entirely.
If it is nicotine that causes the dental problems smokers experience—or at least contributes to these problems—then we should see signs of the problems in others who use nicotine without smoking. Snus—the Swedish form of smokeless tobacco in a kind of tiny teabag—and nicotine chewing gum provide two excellent sources of research that we can use to investigate the question in more detail.
Overall, the research does not seem to point to nicotine. One study reviewed 20 years of research in Sweden, with a total of more than 1,600 participants, and found that while serious gum diseases were more common among smokers, snus users did not seem to be at increased risk. There is evidence that gum recession and loss of tooth attachment are more common where snus is placed, but overall, the likelihood of experiencing these problems is much more closely related to smoking than snus use.
Although this has not been studied as much as you might expect, a study of nicotine gum users provides even more evidence that nicotine is not really the problem. Chewing sugar-containing gum obviously has the potential to affect the teeth even without nicotine, but a comparison between 78 people who chewed nicotine gum for 15 weeks and 79 who chewed non-nicotine gum found no difference in things such as plaque, gingivitis, tartar, and other oral health conditions. Once again, smoking increased the risk of tartar and gingivitis.
Overall, although there are some plausible explanations for how nicotine could affect oral health, the connection is not really supported by studies. This is good news for all vapers, snus users, or long-term users of nicotine replacement products, but of course it is still important for your oral health to avoid smoking and generally take care of your teeth.
Dehydration linked to the teeth: will vaping indirectly affect our teeth?
When it comes to nicotine, the evidence we have so far suggests that there is nothing to worry about, and the cell studies directly examining vaping are difficult to draw conclusions from without further research. But these are not the only ways vaping can affect the teeth and oral health.
One thing most vapers are aware of is that vaping can dehydrate you. Both PG and VG are hygroscopic, meaning that they absorb moisture from their immediate surroundings. This is why it is very common to get a dry mouth after vaping. Your mouth is constantly in contact with PG and VG, and most vapers quickly become accustomed to drinking more than usual to compensate. The question is: does this constant dehydration pose a risk to your teeth?
There is an interesting paper on the potential connection between mild dehydration and dental problems, and it generally emphasizes that there is no direct evidence of a connection. There is, however, plenty of indirect evidence and findings suggesting potential problems.
It is largely about saliva. By literally “washing” the teeth as it moves around the mouth, containing ions that neutralize acids from food, containing calcium and phosphate that can eliminate the effects of acids on the teeth, and containing proteins that also affect how molecules interact with the teeth, saliva appears to be an important factor in maintaining good oral health. If dehydration—due to vaping or something else—leads to reduced saliva production, this could have a devastating effect on the teeth and increase the risk of tooth loss and other problems.
The paper points out that there are many confounding factors to consider, making it difficult to draw firm conclusions, but the authors write:
“The direct connection between dehydration and dental diseases has not been proven, although there is substantial evidence suggesting that such a connection exists.”
And this is the closest we can really come to an answer to this question. There are, however, some interesting stories in the comments on this post about vaping and the teeth (although the article itself only speculates about the risk of gum disease).
One commenter, “Skwurl,” reports that after vaping exclusively for a year, dry mouth is common, which can lead to bad breath and appears to increase the risk of cavities. The commenter claims to be careful about good oral hygiene, but of course it is impossible to determine this or know what condition his or her teeth were in before switching to vaping.
But this is not the only story in the comments, and although everything is just speculation, including the research discussed above, it is certainly plausible that vaping can lead to dehydration-related dental problems.
Tips on how to take care of your teeth as a vaper
The risk is far from obvious, but it is clear that there are a few simple steps you can follow to reduce the risk of dental problems from vaping.
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Stay hydrated. This is important for all vapers anyway, but given the potential dehydration-related risks, it is particularly important for the teeth. I carry a bottle of water with me all the time, but however you do it, make sure to combat dry mouth with plenty of fluids.
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Vape less often with higher-nicotine juice. An idea originally proposed by Dr. Farsalinos (largely regarding reducing the risks of vaping) is that vaping less often with higher-nicotine juice is safer than vaping more often with lower-nicotine juice. The same advice applies to the teeth—dehydration is linked to PG and VG, so the less you inhale, the smaller the effect. Technically speaking, if the theories about nicotine’s role in gum disease are true, increasing your intake would not be beneficial, but overall it appears that nicotine is not the important factor.
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Take the best possible care of your teeth and keep brushing. Although some vapers may have dental problems, it is obvious that most of us have not experienced any issues. The explanation for this is probably that many vapers generally take care of their teeth. Brush at least twice a day to minimize the risk and watch out for potential problems. If you notice a problem, visit your dentist and have it treated.
The good news is that all of this is quite simple, and apart from the second suggestion, you will probably do everything you need to do anyway. But if you start noticing problems or feel that your teeth are getting worse, it is a good idea to take steps to reduce dehydration and take better care of your teeth, in addition to visiting your dentist.
Gain some perspective: teeth or lungs?
Although vaping is likely much better for your teeth than smoking, there are still potential problems linked to dehydration and possibly even nicotine. However, it is important to gain some perspective before taking any drastic measures, especially given how little research supports the concern.
If you are going to switch to a lower-risk form of nicotine use, it is unlikely to be because of your teeth. You have lungs to worry about, not to mention your heart and much else. Research so far has focused mainly on these more serious health risks. So even if vaping really did have some effect on your teeth or gums, it would not change the fact that vaping is a better idea than smoking. There are other priorities.
Take care of your teeth—as you should anyway—but do not lose perspective and forget what really matters.
