Problems with your teeth or gums continue to be some of the most common health issues you can have, affecting 3.5 billion people worldwide.
The introduction of e-cigarettes probably didn’t help, according to the dentists we talked to, who say they can often tell you vape just by looking in your mouth.
If you’re someone who vapes, dentists may be able to see physical changes in your teeth, tongue, and gums. Some experts have made their way to social media platforms like TikTok to share how they can tell their patients are using e-cigarettes.
Because so many people vape, it’s a common problem; more than 2.5 million middle school and high school students reported vaping in 2022. Some vapes can deliver nicotine more quickly than cigarette smoking. Although it varies by brand, one pod from an e-cigarette can be equivalent to the nicotine from smoking 20 cigarettes.
Compared to nonsmokers, smokers are 10 times more likely to develop oral cancer and diseases from tobacco products, including nicotine.
Of course smoking isn’t the same as vaping; cigarette smoke has toxic chemicals that e-liquid does not and there’s no link (yet) between vaping and a greater risk of mouth cancer. (Although vape liquids can contain substances that are known carcinogens.)
However, the evidence is accumulating that vaping may have a negative impact on your oral health.
In a 2021 study of more than 100 people, researchers found that those who smoked or used e-cigarettes were more likely than non-smokers to have clinical attachment loss, which is a sign of destructive gum disease. (The CAL was 3.5 mm in smokers, 2.8 mm in e-cigarette users, and 2.2 in non-smokers.) During the six-month study, about 44% of smokers, 29% of e-cigarette smokers, and 18% of non-smokers had gum disease progression.
“There is not enough data or studies on the length of time it takes for the changes to occur and there is still much to learn on the effects of vaping,” said Avalene Roberts, a New York–based dental hygienist and a spokesperson for the American Dental Hygienists’ Association. “However, if vaping becomes habitual, your dentist will notice immediately as you may develop dryness of the mouth and tongue and you may develop staining of the teeth if nicotine is used.”
People who use e-cigarettes also might be at greater risk of cavities.
There are more than 10,000 e-liquid formulations, with different basic components including nicotine and flavors that can mimic baked goods, sweets, beverages, and fruits. Flavored vapes are popular, with a 2022 CDC survey suggesting that 85% of students who vape use flavored e-cigarettes, with the most commonly used flavors being fruit (69% of people); candy, desserts, or other sweets (38%); mint (29%); and menthol (17%).
Vapes get their sweet taste because manufacturers sometimes add sucrose (table sugar) and sugar alcohol (sweet-tasting sugar substitutes) to e-liquids, which can affect your teeth.
In fact, vape flavors may have physical and chemical properties similar to sugary food and drinks, according to some research.
In a 2018 study conducted in a lab, cavity-causing bacteria called Streptococcus mutans were four times more likely to stick to tooth enamel when vape aerosols were present, and flavored aerosols resulted in a twofold increase in biofilm formation.
A biofilm is a community of bacteria that can’t be easily rinsed away. Biofilms can form when microorganisms attach and grow on a wet surface, in this case, your teeth. Biofilms are known to cause oral problems like gum disease. The aerosols generated by e-cigarettes may encourage the growth of biofilms made of S. mutans to the detriment of healthier mouth bacteria, the study suggested.
In essence, vaping could alter your microbiome, or the mix of organisms in your body, according to Roberts.
“Dental professionals are trained to spot changes in the mouth and aid patients in smoking cessation,” Roberts said. “Some of the immediate giveaways that a patient has been [vaping] nicotine is dryness of the mouth and tongue, increase in cavities and gum disease, stained teeth, and mouth odor. Nicotine restricts blood flow to the gums, which can speed up the progression of periodontal disease.”
In a 2022 study in the Journal of the American Dental Association that included 13,000 people, about 80% of participants who said they vaped were at a high risk of cavities compared with about 60% of those who didn't.
Vaping can also give you bad breath, according to Dr. Vivian A. Roknian, a dentist and dental implantologist based in California.
“Unfortunately, even when wearing a mask, it's hard to disguise a smoker's breath,” she said. “Dentists can smell it almost immediately.”
What you can do to maintain dental health
Dentists generally recommend that you quit vaping to reverse any of the negative changes in the mouth. Although that can be a challenge, your dentist can help you find ways to kick the nicotine habit.
“Tooth staining can be addressed with cleanings and whitening procedures. With time, the changes to the gums and other soft tissues in the mouth can be healed by the body,” Roknian said. “With regards to overall healing, the ability to bounce back to health depends on the length of time and volume of smoking or vaping that was done.”
If you are vaping, it’s best to continue protecting and maintaining oral hygiene. Practicing good oral hygiene includes brushing your teeth thoroughly and flossing daily. According to the CDC, you should try not to use any tobacco products, try to limit alcoholic drinks, and visit your dentist at least once a year.
“Get regular dental checkups, dental cleanings, and oral cancer screenings,” Roberts said. “Also, to repair any cavities and treat any other oral diseases you may have to control the oral microbiome and maintain optimum oral health. One important thing to also note is that support while quitting is very helpful and patients should avoid things that trigger oral habits. There are patches, gum, and tobacco cessation programs that can help.”