No Smoke, But Plenty of Fire: How Do E-Cigarettes Affect Oral Health?

I was never really a smoker, but I’ve used an e-cigarette for about two years, although I hardly put any nicotine in it these days. (Dropping from 18 mg to probably 4-6 mg the past year). I’ve always had healthy teeth, but recently realized that my gums are receding, especially on the side where I “vape” from. Using an e-cigarette hasn’t seemed to impact my teeth at all, but is it unhealthy for gums? Is there anything I should be doing aside from flossing and delicate brushing that could help keep my gums healthy or stop the recession?

It’s easy to see why e-cigarettes seem like a fantastic alternative to regular cigarettes. E-cigarettes don’t contain tobacco, although they do contain nicotine derived from the tobacco plant, and they don’t produce smoke — instead they are battery-powered and work by producing an aerosol that you “vape” — so you can use them anywhere.

The problem is, e-cigarettes have not been fully studied.

In 2014, the US Food and Drug Administration (FDA) concluded that “e-cigarettes have not been fully studied, so consumers currently don’t know the potential risks of e-cigarettes when used as intended, how much nicotine or other potentially harmful chemicals are being inhaled during use, or whether there are any benefits associated with using these products.”

Clinical studies are in progress at the moment to understand e-cigarettes’ impact on health — so until these are out, there’s a lack of definitive research on the health effects and still much we can’t know for sure.

I can say that e-cigarettes can still cause gum recession and other oral health problems because they still deliver nicotine, even if it’s in smaller doses than traditional cigarettes.

What Are the Effects of Nicotine on Gum Health?

Studies have shown that nicotine — whether delivered via traditional cigarette or other means — does harm to the mouth, gums and tongue.

A report published in the Journal of the Indian Society of Periodontology has stated that nicotine may contribute significantly to the development of gingivitis and periodontitis, which can cause bad breath and inflammation throughout the body.

Here’s how nicotine can impact your oral health:

Nicotine Causes Gum Recession
Nicotine is a vasoconstrictor, meaning it reduces the amount of blood that can flow through your veins.

Without sufficient blood flow, the gums do not get the oxygen and nutrients they need to stay healthy. Nicotine chokes tissues in the mouth from the blood it needs to survive, causing death of the gum tissues.

Nicotine Masks Symptoms of Gum Disease
“Almost two years vaping and my gum disease has dramatically improved.”

“I just got back from the dentist and he said my gum health has actually improved since I started using e-cigarettes.”

You might see reports like these in a lot of online forums.

That’s because nicotine can hide the symptoms of gum disease from your dentist, making it harder to be diagnosed.

When you have gum disease, it’s the increased blood flow to the gums that tips you off or tips off your dentist to the fact that you have gum disease. The gums are irritated and swell with blood, and when you floss or even brush, they bleed.

This fools everyone — both the dentist and yourself — into thinking that things are going well in your mouth.

If the progression of gum disease can’t be observed or diagnosed, then things go south without treatment.

Even longterm chewing of nicotine gum can cause these problems.

Nicotine Causes Bad Breath
As a vasoconstrictor, nicotine also inhibits your body’s ability to produce saliva. Not enough saliva can leave you susceptible to bacteria buildup, dry mouth, and tooth decay.

Nicotine Intensifies Grinding
Nicotine is also a stimulant that fires up the muscles, making you grind your teeth more intensely if you’re already a grinder — and might even prompt you to start grinding your teeth even if you weren’t a grinder before.

My Recommendation

If you’re thinking about using e-cigarettes or you already use them, you’ve got to watch out for the signs of gum disease.

But how are you going to watch out for the tell-tale sign of gum disease — bleeding gums — if nicotine masks bleeding gums via vasoconstriction?

Since nicotine masks the symptoms of gum disease from both you and your dentist, you’ll have to be extra vigilant about gum disease prevention.

To diagnose gum disease, as well as measure its progression, your dentist will take something called a pocket reading.

“Pockets” are like the “moat” around each of your teeth, which is naturally present. It’s the space between the gum line (where you see your gums and teeth meet when you look in the mirror) and where the tooth and gum attach a little further down (see the illustration below). Deeper pockets indicate a breakdown of the attachment of the gums to the teeth.

Visit your dentist every three months to monitor your pocket readings. Your likelihood of having gum disease is greater as long as you’re using nicotine and because nicotine masks the tell-tale signs, a frequency of every three months is necessary in order to prevent tooth loss, bone loss, and gum recession.

The best and most convenient option here, and I know it’s hard to hear, is to eliminate the nicotine habit.

Mark Burhenne DDS
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