Evidence grows for vaping’s role in gum disease

vaping gum disease
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A series of new studies by US researchers highlights how e-cigarettes alter oral health and may be contributing to gum disease. 

The latest, published in mBio, finds that e-cigarette users have a unique oral microbiome that is less healthy than non-smokers but potentially healthier than cigarette smokers, and measures worsening gum disease over time.

Smoking cigarettes is a known risk factor for developing gum disease, but less is known about the impact of e-cigarettes on oral health, especially the long-term consequences of vaping.

Researchers at NYU College of Dentistry studied the oral health of 84 adults from three groups: cigarette smokers, e-cigarette users, and people who have never smoked. Gum disease was assessed through two dental exams six months apart.

All participants had some gum disease at the start of the study, with cigarette smokers having the most severe disease, followed by e-cigarette users. After six months, the researchers observed that gum disease had worsened in some participants in each group, including several e-cigarette users.

A key indicator of gum disease is clinical attachment loss, measured by gum ligament and tissue separating from a tooth’s surface, leading the gum to recede and form pockets. These pockets are breeding grounds for bacteria and can lead to more severe gum disease. In a study of the same participants published in Frontiers in Oral Health, the research team found that clinical attachment loss was significantly worse only in the e-cigarette smokers—not non-smokers and cigarette smokers—after six months.

The researchers then analysed the bacteria found in the plaque samples and determined that e-cigarette users have a different oral microbiome from smokers and non-smokers—building on findings the team previously reported in iScience and Molecular Oral Microbiology.

While all groups shared roughly a fifth of the types of bacteria, the bacterial make-up for e-cigarette users had strikingly more in common with cigarette smokers than non-smokers. Several types of bacteria were abundant in both smokers and vapers compared to non-smokers. Several other bacteria which are known to be associated with gum disease were particularly dominant in the mouths of e-cigarette users.

When plaque samples were gathered and analysed in the six-month follow-up, the researchers found greater diversity in bacteria for all groups studied, yet 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,” co-first author Fangxi Xu said.

The researchers found that the distinct microbiome in e-cigarette users was correlated with clinical measures of gum disease and changes to the host immune environment. In particular, vaping was associated with different levels of cytokines. Certain cytokines are linked to an imbalance in oral bacteria and can worsen gum disease by making people prone to inflammation and infection.

The researchers concluded that the distinct oral microbiome of e-cigarette users elicits altered immune responses, which along with clinical markers for gum disease illustrate how vaping presents its own challenge to oral health.

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