From Vape to Disease: Evaluating the Oral Health Threat of Electronic Nicotine Delivery Systems (ENDS) Products. A Review of the Literature

The global rise in electronic cigarette (e-cigarette) use, particularly among youth and young adults, has prompted growing concern regarding their implications for oral health. This comprehensive review synthesizes findings from six peer-reviewed studies published between 2020 and 2025, including systematic reviews and meta- analyses. The evidence indicates that while e-cigarettes may pose fewer oral health risks than traditional combustible tobacco products, they are far from benign. Commonly reported effects include mouth and throat irritation, increased plaque accumulation, gingival inflammation, periodontal tissue breakdown, reduced salivary antioxidant capacity, and disturbances in the oral microbiome. Additionally, in vitro and clinical studies reveal cytotoxic, genotoxic, and pro-inflammatory responses in oral tissues exposed to e-cigarette aerosols, which often contain harmful substances such as heavy metals, aldehydes, and volatile organic compounds. Although some data suggest that switching from conventional cigarettes to e- cigarettes may confer limited periodontal benefits, the use of e-cigarettes is still associated with significantly poorer oral health outcomes compared to non-smoking controls. The reviewed literature consistently concludes that e-cigarettes should not be recommended as a harm-free alternative or a cessation aid without further long-term evidence. These findings underscore the need for enhanced public awareness, regulatory oversight, and robust longitudinal research to clarify the full extent of oral health risks associated with vaping