The next time you see a plume of vapor, remember: the impact on oral health is more than just a cloud of uncertainty.
When we think of tobacco and oral health, the image that often comes to mind is the classic smoker's smile—teeth stained yellow-brown from years of cigarette use. But as traditional cigarettes are increasingly joined by e-cigarettes and heated tobacco products on store shelves, dental professionals and researchers are facing a new, complex landscape of oral health challenges. The emergence of these novel nicotine delivery systems has sparked urgent scientific inquiry into their effects on everything from tooth decay and gum disease to the very microbial ecosystems that call our mouths home.
For decades, the conversation about tobacco and oral health was relatively straightforward. Now, new products are reshaping the landscape.
For decades, the conversation about tobacco and oral health was relatively straightforward. Traditional cigarettes, with their thousands of chemicals and carcinogens, were known to contribute to periodontal disease, oral cancers, tooth staining, and bad breath. The mechanism was well-understood: nicotine constricted blood vessels, reducing blood flow to gums and hiding the early warning sign of bleeding, while tobacco smoke created an environment where harmful bacteria could thrive.
The introduction of electronic cigarettes in the early 2000s promised a safer alternative. These devices, known formally as Electronic Nicotine Delivery Systems (ENDS), heat a liquid typically containing nicotine, flavor additives, and chemical bases like propylene glycol and vegetable glycerol to create an inhalable aerosol 1 . Heated tobacco products (HTPs), which warm tobacco without burning it, emerged as another alternative, marketed as generating fewer harmful compounds than combustible cigarettes.
The rapid adoption of these products, particularly among youth, has left dental researchers racing to understand their specific impacts on oral health. By 2024, e-cigarettes had become the most commonly used nicotine product among middle and high school students in the United States, with 1.63 million students currently using them . This trend has significant implications for dental professionals, who are now seeing a new generation of patients with exposure profiles different from traditional smokers.
The relationship between e-cigarettes and tooth decay represents one of the most concerning areas of emerging research.
When it comes to gum health, the distinction between traditional and novel tobacco products becomes particularly striking.
A 2025 systematic review found that traditional cigarette smokers experience worse periodontal conditions than both vapers and non-smokers 5 .
This discrepancy arises partly from nicotine's effects on gum vasculature. Traditional smokers often display deceptive gingival appearances—while their gums may look pink and healthy due to reduced blood flow, they can harbor significant inflammation and infection beneath the surface 5 .
Our mouths contain complex ecosystems of bacteria, fungi, and viruses that maintain oral health when in balance.
Traditional cigarettes create an environment favorable to pathogens responsible for periodontal disease while diminishing beneficial species .
E-cigarettes also contribute to oral dysbiosis, with users showing shifts in microbial composition toward more acid-producing and inflammatory species .
| Parameter | Traditional Smokers | E-cigarette Users | Non-smokers |
|---|---|---|---|
| Gingival Index | Higher | Moderate | Lower |
| Plaque Index | Higher | Elevated compared to non-smokers | Lower |
| Bleeding on Probing | Lower (masked by vasoconstriction) | More typical response | Normal |
| Clinical Attachment Loss | Greater | Less than traditional smokers | Least |
| Pocket Depth | Often >3mm | Moderate | Typically ≤3mm |
While much research has focused on biological tissues, a 2025 study investigated how cigarette smoke and heated tobacco affect the very materials used in dental restorations 2 .
The research team prepared 120 disc-shaped samples made of four different denture base materials: conventional heat-cured acrylic resin, flexible acrylic resin, titanium nanoparticle-reinforced acrylic resin, and 3D-printed acrylic resin. Additionally, they created 60 samples of artificial and 3D-printed teeth to assess color changes 2 .
The experimental groups were divided as follows:
The researchers developed a custom-made smoking device to simulate real-world exposure, using 600 cigarettes/heets representing 30 days of medium smoking behavior (20 cigarettes/day) 2 .
They measured surface roughness before and after exposure using a precision roughness tester and assessed color parameters with a dental shade scanner.
Increased significantly in all denture base materials after exposure to both conventional cigarette smoke and heated tobacco. Rough surfaces create more areas for plaque accumulation and bacterial adhesion, potentially compromising oral health even beyond the natural teeth 2 .
Notably higher in the heated tobacco group across all four denture base materials compared to conventional cigarettes 2 . This surprising finding suggests that the aerosol from heated tobacco products may create a more favorable environment for microbial adhesion to dental materials.
Showed a different pattern—conventional smoking caused more significant discoloration of both conventional and 3D-printed artificial teeth than heated tobacco 2 . This aligns with the familiar observation of tar-induced staining in traditional smokers.
| Material Type | Surface Roughness Change | Bacterial Accumulation | Color Change |
|---|---|---|---|
| Conventional Acrylic | Significant increase with both CS & HT | Greatest with HT | Greatest with CS |
| Flexible Acrylic | Significant increase with both CS & HT | Greater with HT | Greater with CS |
| Titanium-Reinforced Acrylic | Significant increase with both CS & HT | Greater with HT | Moderate with CS |
| 3D-Printed Acrylic | Significant increase with both CS & HT | Greater with HT | Moderate with CS |
These findings carry important clinical implications. The increased bacterial accumulation associated with heated tobacco products on dental materials suggests that patients using these products may require more frequent maintenance of dentures and other dental appliances. Meanwhile, the significant surface roughness caused by both traditional and heated tobacco products could shorten the functional lifespan of dental work.
Essential Materials and Methods in Dental Tobacco Research
| Research Material | Function/Application |
|---|---|
| In vitro smoking devices | Simulate human smoking patterns for standardized testing |
| Surface roughness testers | Measure microscopic changes in dental material surfaces |
| Colorimetric spectrophotometers | Quantify tooth and material discoloration with high precision |
| Microbial culture systems | Grow and analyze oral bacteria exposed to tobacco aerosols |
| Dental plaque indices | Standardize assessment of plaque accumulation (e.g., PI) |
| Gingival indices | Quantify gum inflammation and bleeding (e.g., GI) |
| Biofilm growth assays | Measure bacterial adhesion and biofilm formation on materials |
| Oral microbiome sequencing | Identify microbial community changes in response to exposures |
The scientific evidence makes clear that while novel tobacco products like e-cigarettes and heated tobacco systems may present different risk profiles than traditional cigarettes, they are far from harmless in the context of oral health.
The dental implications span from increased caries risk associated with vaping to significant effects on dental materials from both conventional and heated tobacco products.
What emerges is a complex picture in which the harm reduction narrative often used to market alternative nicotine products requires careful nuance when applied to oral health. While traditional cigarette smokers switching to e-cigarettes may reduce their exposure to many carcinogens and tar, they may still face significant risks for specific oral conditions, particularly if they perceive these products as completely safe.
These findings underscore the importance of comprehensive tobacco use screening that includes questions about both traditional and novel products.
They also highlight the need for targeted patient education about the specific oral health risks associated with different nicotine delivery systems.
As research continues to evolve, one thing remains certain: maintaining oral health requires looking beyond the smoke and mirrors of product marketing to understand the actual scientific evidence—evidence that increasingly shows all tobacco and nicotine products come with significant trade-offs for our teeth, gums, and mouths.