Crosstalk between oral and general health status in e-smokers

Crosstalk between oral and general health status in e-smokers

Authors:  Marco Tatullo, PhD, Stefano Gentile, PhD Francesco Paduano, PhD, Luigi Santacroce, MD, and Massimo Marrelli, MD

PMC, The US National Public Library of Medicine, National Institute of Health

Source DOI: 10.1097/MD.0000000000005589

  • T0 is baseline (Day 0)
  • T1 after 60 day
  • T2 after 120 days


Electronic cigarette (e-cigarette) simulates the act of tobacco smoking by vaporizing a mixture of propylene glycol, nicotine, and flavoring agents. e-cigarette has been proposed as a product able to aid to stop smoking. The aim of the study is to verify the clinical variations of periodontal health induced by e-cigarettes use and, moreover, to investigate about the awareness of the e-smokers about their health variations and about their hypothetical need to turn back to smoke combustible cigarettes.

This clinical observational pilot study involved 110 out of 350 smokers, who switched to e-cigarette. Patients were subjected to oral examinations. A questionnaire to self-assess the variations of some parameters of general health, and to self-assess the need to smoke combustible cigarettes, was distributed to such subjects involved in the study.

At the end of the study, we registered a progressive improvement in the periodontal indexes, as well as in the general health perception. Finally, many patients reported an interesting reduction in the need to smoke.

In the light of this pilot study, the e-cigarette can be considered as a valuable alternative to tobacco cigarettes, but with a positive impact on periodontal and general health status.


The clinical observations highlighted in this research work were aimed to assess the improvements of periodontal health in smokers that switched to e-cigarettes. A clinical approach was used for the evaluation of general health status and, more in detail, of oral health status.

Systemic diseases induced by tobacco smoking are well known and widely documented in the scientific literature. Furthermore, several studies assess that tobacco smoking entails an overall increase of the risk to develop severe periodontal diseases.

Our observations revealed an interesting growing trend, relating to PI, BI, and PBI in the 110 subjects considered in this study. To our knowledge, there are no data in literature related to the variations of such periodontal indexes in subjects that dropped the tobacco cigarette, and started to use the e-cigarette instead.

We observed a constant reduction of bacterial plaque on teeth surfaces, from baseline at T0 to the end of the observational period at T2. More precisely, subjects of group 1 showed a homogeneous presence of a thin film of plaque at T0, which visibly decreased toward T1 until it completely disappeared in all subjects of group 1 at T2. Interestingly, this result was more marked in subjects of group 2 characterized by a huge presence of plaque at T0.

Epidemiological studies have clearly demonstrated that tobacco smokers have a worse oral hygiene than nonsmokers. There are some evidences that smoking habit increases the mineralizing potential of saliva. Moreover, recent studies have demonstrated that the plaque quantity, the plaque architecture, and its bacterial composition are rather similar between smokers and nonsmokers patients; instead, smokers show a nicotine-related vasoconstriction of the gingival tissue, leading to a slight decrease of the crevicular fluid flow: such flow reduction is able to impair the immunological reply to bacterial growth on dental tissues; moreover, the gingival vasoconstriction inhibits the early signs of gingivitis. In conclusion, since PI is mainly related to plaque control and to a proper flow of crevicular fluid, and since heavy smokers were found to have worse oral hygiene and worse crevicular fluid flow than nonsmokers: the PI variation, reported in this study, could be related to the difference in the crevicular fluid flow and to the different ability of e-smokers to manage their oral hygiene.

Appreciable improvements were likewise observed for gingival bleeding. Although there might be some controversy regarding the effect of tobacco consumption on the gingival vasculature, there is a clear clinical evidence that nicotine induces vasoconstriction of peripheral blood vessels, thus reducing bleeding.

On the other hand, as shown in literature, nicotine represents a contributing cause to periodontal degradation by affecting the fibroblasts attachment ability, collagen production, and integrin production. Moreover, nicotine increases the amount of proinflammatory cytokines in cultured gingival keratinocytes and fibroblasts.

The results observed in our study could be explained by the fact that the combined harmful effects of tobacco and nicotine on periodontal health are now limited only to the amount of nicotine in the e-cigarettes thus contributing to the reduction of the typical side effects of smoking habit, and of the severity of smoke-related oral diseases.

In our study, we analyzed for the first time the changes of the status of periodontal health in individuals who have dropped the common cigarette and started to use e-cigarette.

A first relevant take-home message deriving from our observational/clinical study is that many subjects showed a reduction of the need to smoke combustible cigarettes, even if this only a limited pilot study that must be enlarged and confirmed by other more numerous RCTs. This major result has a high relevance as it implies the reduction of the addiction to the chemical component of the combustible cigarettes, and to the psycho-social aspect that characterizes the typical smoker.

Nevertheless, although e-cigarette represents a valuable alternative to traditional cigarettes, thus a concrete aid for all the smokers needing to quit smoking; however, many respectable studies suggested that the main components of e-cigarette liquids could be potentially harmful, because of the still poorly known effects of such substances on the human organism.

In our role of highly experienced physicians in the field of oral medicine, we want to highlight how the switching from combustible to e-cigarette can represent a valid support toward a clear improvement in some specific oral health parameters, leading also to overall benefits toward patients’ wellbeing.

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