Gingivitis with a Hint of Strawberry: How Vaping Can Affect Oral Health
- Katie Lin
- Jun 1
- 8 min read
Sooyun Christina Kim, Amreet Minhas, Beatrice Sixt
Project Smile Global
April 22, 2025
It is well known that vapes have become the primary alternative to traditional cigarettes. The use of these electronic cigarettes is prevalent among teenagers and young adults worldwide (Besaratinia & Tommasi 1). Similar to smoking traditional cigarettes, numerous health issues have been associated with vaping. This is usually due to the presence of nicotine in the liquid component of an electronic cigarette (Alkattan et al. 2). Nicotine consumption can put individuals at risk for numerous health issues, such as periodontal disease, various types of cancers, and dry socket. Regular exposure to nicotine in cigarette smoke or vapour is known to impede the function of key immune cells that maintain healthy gums structurally and aid in the inflammatory response (Shabil et al. 2). Additionally, vasoconstriction may occur in affected tissues, which is the restriction of blood flow (Kubota et al. 10). This is due in part to the interaction between nicotine and acetylcholine receptors (Brunzell et al. 1). The presence of nicotine at these sites has been associated with the inhibition of nitric oxide and prostacyclin, which are responsible for vasodilation in endothelial cells (Whitehead et al. 19). Decreased levels of these regulatory compounds allows vasoconstriction to persist in the skin (Black et al. 1102). This can also inhibit proper wound healing, as the localization of immune cells is disrupted (Shabil et al. 2).
Besides the direct impact on tissue, consistent vaping and/or smoking can be detrimental to the function of saliva (Iacob et al. 2). Saliva is essential in maintaining an antibacterial environment in the mouth, which in turn prevents caries (Kumar et al. 5). Notably, saliva contains lysozymes, which are responsible for breakdown of bacteria that can prevent infections (Kumar et al. 5). Saliva also allows for the circulation of ions such as calcium and phosphorus, which contributes to mineralization and overall strength of the teeth (Kumar et al. 6). According to a 2024 review by Zięba and colleagues, use of electronic cigarettes can result in disruption of salivary homeostasis, in which more bacteria than usual is present in the saliva. Additionally, the level of lysozymes found in the saliva tends to decrease, which justifies the increased level of bacteria found in the mouth (Zięba et al. 139).
Another concern that has been raised is the effect of flavour additives in vapes. It is common for the liquid component of a vape to mirror the taste of a fruit or dessert, which is meant to enhance its appeal (Xu et al. 2). It has been found that flavoured vape use is associated with increased bacteria growth in the mouth as compared to unflavoured versions (Xu et al. 3). The exact cause requires further investigation. Research has also shown that individuals who use flavoured vapes feel more satisfied and perceive vaping as more rewarding compared to using unflavoured counterparts (Audrain-McGovern et al. 264). In terms of young adults specifically, a 2019 study suggests that this particular age group tends to view flavoured vapes as less harmful than traditional cigarettes and unflavoured vapes (Landry et al. 2). This could be due to the sensory factors involved in using a flavoured vape, such as taste and smell (Landry et al. 6).
The perception of vaping as a healthier alternative to traditional smoking has been a major contributor to the popularity of e-cigarettes. Some distinctions between the two may support this claim. In theory, e-cigarettes administer nicotine without the addition of the four thousand toxic substances found in cigarette smoke, including acrolein, carbon monoxide, acetaldehyde and cyanide (Mohammad Z et al.). Because of this, the percentage of youth who have tried vaping, particularly those ages fifteen to nineteen, has risen to 20% in comparison to the 11% who smoke traditional cigarettes within the same age group (Thatcher).
Socioeconomic factors modulate vape usage and exposure on multiple levels. Social class includes objective factors such as familial education, occupation, and income (Mello et al. 1). In contrast, subjective factors can be perceived societal positions – both affect how vaping is perceived by adolescents, affecting vape usage (Mello et al. 1). While there has been extensive research into how socioeconomic status (SES) affects adolescent usage of conventional smoking, investigations as to whether the effects are similar for e-cigarettes have been limited and conflicting. For instance, a previous study found that education and income gradients for exclusive traditional cigarette use are strongly and negatively associated (Friedman & Horn. 1363). However the association between the two were insignificant for e-cigarettes (Friedman & Horn. 1363). The same conflicting results held for the relationship between e-cigarette use and advertising. While low SES was associated with greater exposure to traditional cigarette advertising and use, higher SES was correlated with greater advertising of e-cigarettes, which led to a higher frequency of e-cigarette use (Simon et al.). Both of these findings suggest that high SES is associated with e-cigarette use while the reverse is true for conventional tobacco use. An explanation for these results may be that vaping has been perceived by the general public to be less harmful than smoking, and therefore has increasingly become a popular smoking cessation aid (Hardie & Green. 165). Perhaps individuals with higher SES, and therefore higher educational attainment, believe that if they are to smoke, then e-cigarettes would be the best option.
These conflicting findings call for further research into what factors affect the relationship between SES and adolescent e-cigarette use. A study assessed the cumulative impacts of health risks in disadvantaged neighbourhoods, which included poor air quality (Venugopaul et al. 132). They found that specialty vape shops are disproportionately present in underserved neighbourhoods with poor air quality, highlighting the cumulative effects of social and environmental disparities in contributing to vape use (Venugopaul et al. 132). Their findings are further supported by a study comparing vape shop density in urban vs non-urban areas (Dai et al. 1338). In both urban and non-urban areas, higher vape shop density was correlated with larger proportions of non-White individuals, higher poverty rates, and lower rates of homeownership; conversely, a decrease in vape shops was correlated with higher education (Dai et al., 1338). All of these studies imply that on a national level, there are disparities in vape shop density that exploit socioeconomic differences between different areas, which call for a need for further regulations and research to prevent minorities and other socially disadvantaged groups from being targeted by these companies, whether it be through physical shop presence or advertising (Dai et al. 1338).
Overall, while vapes have been marketed to be a “healthier” alternative to traditional smoking, we have to be cognizant of the fact that they still contain nicotine, which have a range of detrimental effects on our bodies. Furthermore, socioeconomic factors modulate vape exposure, affecting potential or current usage. While research has been limited and conflicting, there is emerging evidence to suggest that socioeconomic differences can contribute to differences in vape usage, highlighting the need for more robust regulations and research.
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