Updated: Feb 17, 2020
This is a question that I get asked by patients and have often pondered myself. We all know of the harm that cigarette/cigar/pipe smoking cause. Fewer young people take up the smoking habit and older smokers are looking for safer ways to enjoy their nicotine fix. The tobacco industry needs to recruit new addicts and is looking at ways to deliver nicotine in a safer way. And so, electronic (e-cigarettes) have been developed with the promise of being safer than tobacco smoking. Even Public Health England's (PHE) 2015 report stated that "E-cigarettes are 95% less harmful than tobacco."
At first glance, vaping looks like a better option. There is no tar or myriad other chemicals that are known to cause cancer. The carrier for the nicotine is propylene glycol (PG) which is used in the food industry. It is a viscous, colourless liquid that possesses a faintly sweet taste and is one of the major ingredients of the e-liquid used in e-cigarettes. This creates the billowing clouds of white smoke that vapers exhale. PG breaks down into lactic acid, acetic acid and propionaldehyde all of which are harmful to the teeth and soft tissues. The acids soften the teeth and provide an environment which bacteria favour. Additionally, PG dehydrates the mouth (saliva is absorbed by it) and this promotes proliferation of bacteria which can cause gum disease and tooth decay.
Other major ingredients in e-cigarettes include glycerin and flavourings. Vegetable glycerin (VG) is a colorless, odourless, viscous, and sweet-tasting liquid. It has a myriad of applications and is used in medical, pharmaceutical and personal care. Although VG is not used for energy by bacteria like ordinary sugar, it appears to increase plaque formation and makes it more likely to stick to the teeth. This will make conditions more favourable for bacteria that cause tooth decay and can lead to a greater chance of tooth decay and thus the need for fillings.
The final major ingredient found in e-cigarettes is nicotine, providing the addictive high that smokers crave. Although each puff of an e-cigarette contains less nicotine than a tobacco cigarette, its ready availability and frequent use can add up to the equivalent of 40-60 cigarettes over the course of a day. Unlike a regular cigarette which is smoked over a course of a few minutes, use of an e-cigarette can become continuous. Nicotine is known to impair the healing process and the immune response as it constricts blood vessels. Healthy blood flow is particularly important for healthy gums. If blood flow is restricted then nutrients and white blood cells cannot rebuild and protect the gum tissues. Nicotine also reduces the amount of saliva produced and saliva is a very important in providing mineral replenishment of the tooth surface and it is also antibacterial.
In summary, it seems that vaping may actually be worse for your oral health than smoking tobacco. It can increase the amount of tooth decay as well as gum disease; the only thing that it does not do is stain the teeth! The adverse effects on other organs are possibly less harmful but the best advice would be not to start either habit.