Abstract
Introduction: Tobacco use is one of the main causes of periodontitis. E-cigarette are gaining in popularity, and studies are needed to better understand the impact of e-cigarettes on oral health.Objective: To perform a longitudinal study to evaluate the adverse effects of e-cigarettes on periodontal health.Methods: Naïve E-cigarette users, cigarette smokers, and non-smokers were recruited using newspaper and social media. Age, gender, and ethnicity, were recorded. Participants were scheduled for two visits 6 months apart. At each visit, we collected data on the frequency and magnitude of e-cigarette and cigarette use, and alcohol consumption. Carbon monoxide (CO) levels, cotinine levels, salivary flow rate, periodontal probing depth (PD), bleeding on probing (BoP), and clinical attachment loss (CAL) were also determined at both baseline and follow-up visits and compared between groups with two-way repeated measures ANOVA. Periodontal diagnosis and other categorical variables were compared between groups with the chi-square statistic and logistic regression.Results: We screened 159 subjects and recruited 119 subjects. One-hundred-one subjects (31 cigarette smokers, 32 e-cigarette smokers, and 38 non-smokers) completed every assessment in both visits. The retention and compliance rate of subjects was 84.9%. The use of social media and craigslist was significant in recruiting e-cigarette subjects. Ethnicity and race differed between groups, as did average age in the male subjects. Carbon monoxide and salivary cotinine levels were highest among cigarette smokers. Bleeding on probing and average PDs similarly increased over time in all three groups, but CAL uniquely increased in e-cigarette smokers. Rates of severe periodontal disease were higher in cigarette smokers and e-cigarette users than non-smokers, but interpretation is confounded by the older age of the cigarette smokers.Conclusion: Among the recruited participants, CAL after 6 months was significantly worse only in the e-cigarette smokers. This study design and protocol will assist in future larger studies on e-cigarette and oral health.
Highlights
Tobacco use is one of the main causes of periodontitis
Non-smokers were significantly younger than e-cigarette smokers, and e-cigarette smokers were significantly younger than cigarette smokers
A great deal of literature is available on conventional tobacco products, but limited data is available on the effects of e-cigarette on oral health
Summary
Tobacco use is one of the main causes of periodontitis. E-cigarette are gaining in popularity, and studies are needed to better understand the impact of e-cigarettes on oral health. Previous studies have demonstrated that the use of tobacco-containing products could potentially lead to oral manifestations, such as mucosal lesions (e.g., leukoplakia, candidiasis, nicotine stomatitis), plaque formation, teeth staining, gingivitis, periodontitis, tooth loss, failure of prosthetic and surgical treatments, and increased risk of oral cancer [3,4,5]. The CDC recently reported 2,668 hospitalized e-cigarettes use-associated lung injury cases or deaths [14]. Among those cases, 15% of patients were under 18 years old, and 37% of patients were 18–24 years old [14]. As the popularity of e-cigarettes use increases, and the potential for damage exists, it is necessary to investigate the impact of e-cigarette use on oral health
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