Effects of Electronic Cigarettes on Oral Cavity: A Systematic Review

Ana Ralho; Ana Coelho; Manuela Ribeiro; Anabela Paula; Inês Amaro; José Sousa; Carlos Marto; Manuel Ferreira; Eunice Carrilho

doi:10.1016/j.jebdp.2019.04.002

Effects of Electronic Cigarettes on Oral Cavity: A Systematic Review

J Evid Based Dent Pract. 2019 Dec;19(4):101318. doi: 10.1016/j.jebdp.2019.04.002. Epub 2019 Apr 8.

Authors

Ana Ralho¹, Ana Coelho², Manuela Ribeiro¹, Anabela Paula³, Inês Amaro¹, José Sousa¹, Carlos Marto⁴, Manuel Ferreira³, Eunice Carrilho³

Affiliations

¹ Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
² Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research (iCBR) Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Electronic address: anasofiacoelho@gmail.com.
³ Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research (iCBR) Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
⁴ Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Institute for Clinical and Biomedical Research (iCBR) Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

PMID: 31843181
DOI: 10.1016/j.jebdp.2019.04.002

Abstract

Introduction: The increase in the use of electronic cigarettes (e-cigs) in young people and the lack of knowledge of the health effects of smoking in the short and long term are worrying. Although the oral cavity is the first to interact directly with the e-cig aerosol, studies on potential oral cavity lesions are still limited and there is some controversy about safety.

Objective: To perform a systematic review to evaluate the adverse effects of e-cigs on oral health.

Materials and methods: The research was conducted using Cochrane Library, Embase, PubMed, and Web of Science. The research was limited to articles in English, Portuguese, and Spanish, published between January 2003 and November 2018. The research question was formulated according to the population, intervention, comparison, outcome (PICO) strategy. The quality of the methodology of each study was evaluated following the guidelines described in the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool.

Results: The initial search resulted in 432 articles, of which only eight were included for analysis. Periodontal and peri-implant clinical and radiographic parameters (plaque index, clinical attachment loss, probing depth, peri-implant bone loss, and radiographic bone level) are worse, and proinflammatory cytokine levels are higher among electronic and conventional cigarette smokers than among nonsmokers. Bleeding on probing was higher in nonsmokers than in conventional cigarette smokers and e-cig users. Nine different lesions of the oral mucosa were detected, with nicotinic stomatitis, hairy tongue, and angular cheilitis being more prevalent in e-cig consumers.

Conclusion: The results suggest that e-cigs are less harmful than conventional cigarettes. However, there is also a greater susceptibility of e-cig consumers to developing alterations in oral biological tissues than ex-smokers or nonsmokers. There is still a clear need for the development of new studies.

Keywords: Electronic cigarette; Oral health; Oral mucosal lesions; Smoker.

Publication types

Review
Systematic Review

MeSH terms

Adolescent
Dental Plaque Index
Electronic Nicotine Delivery Systems*
Humans
Mouth
Oral Health