Introduction

Undoubtedly, E-cigarettes popularly known as vape - use can be double-edged. Previously, it was considered as a possibility for quitting smoking but recent studies show that there is a development of newer addiction esp. for those who never used nicotine in the younger population in particular. E-cigarettes operate by heating a liquid solution, containing nicotine, flavorings, and humectants like propylene glycol and glycerol, to generate an aerosol for inhalation. The mechanism involves the activation of a heating element triggered by airflow, which vapourizes the liquid solution contained in a cartridge, producing an aerosol that mimics smoke when inhaled. 

Impact on dental and periodontal health

Glycerol and other flavouring agents might increase biofilm formation causing demineralisation and caries formation. Calcium, iron, and copper found in e-cigarette aerosols are involved in the mineralization and demineralization of enamel. Sweet-flavored e-liquids might promote the adherence of carcinogenic bacteria to the tooth surface.

Similar to the traditional tobacco smoking, the e-cigarettes also significantly lower the gingival bleeding leading to delayed diagnosis, higher clinical attachment loss, increased bone loss. 

Impact on oral mucosa

Traditional tobacco smoking is associated with the development of various oral mucosa lesions like leukoplakia, nicotinic stomatitis, necrotizing gingivitis, black hairy tongue, melanosis, epithelial dysplasia, and squamous-cell carcinoma. E-cigarettes also have similar effects.

Oral mucosa melanosis, nicotine stomatitis, hairy tongue, and hyperplastic candidiasis were the most common oral mucosa disorders in e-cigarette users. Median rhomboid glossitis, oral erythematous candidiasis are also observed. pH alteration induced by the chemical compounds in e-cigarette vapour favouring acidic pH becomes ground for candida growth. 

Mucosal dryness, high oral temperature, acidic pH caused by e-cigarettes can lead to hairy tongue. The discontinuation of e-cigarette use resulted in spontaneous resolution.

Oral lichenoid reaction as white reticular patterned striae on the oral mucosa and lower lip is also observed in e-cigarette usage.

Long-term e-cigarette usage might also lead to oral carcinoma development.

Impact on saliva

The chemical compounds in e-cigarette vapor dissolve in saliva and impact its biochemical composition and function. 

Recent studies show that e-cigarette users have highest salivary LDH levels compared with cigarette smokers and non-smokers indicating higher cell death and oral epithelial cell breakdown.

Antibacterial properties of saliva are also significantly affected. A study shows that the salivary IgA and lysozymes are reduced in e-cigarette users compared with non-smokers.

The level of myeloperoxidase - oxidative stress marker, was significantly reduced in e-cigarette users compared with non-smokers and cigarette smokers, associated with the development of chronic systemic and oral disease

It is observed that IL-6 and IL-1β in the saliva of e-cigarette users were highly elevated in comparison to non-smokers.