Vaping, also known as using e-cigarettes or electronic nicotine delivery systems (ENDS), has become a widely adopted practice, prompting scientists to take a closer look at the potential health impacts. Its rise in popularity may be attributed to its convenient and discreet usability, extensive variety of flavor options, targeted marketing, and the widespread misconception of its safety. Due to the relative novelty of vaping devices, long-term health studies are limited, but current research does not support the idea that they are safe.  

The mouth is the first part of the body to come into contact with vaping emissions, making it a key area to study the effects of exposure. The clouds may seem harmless, but each puff contains a complex mixture of chemicals, metals, and ultrafine particles that interact with the body in ways that scientists are only beginning to understand. Recent research has found that vaping can disrupt the balance of bacteria in the mouth, trigger inflammation, and introduce harmful metals and chemicals into saliva. These discoveries have deepened scientific understanding of vaping’s impact on oral health and uncovered biological changes in the mouth that potentially point to broader health outcomes.

Your mouth is home to a diverse community of bacteria, also known as the oral microbiome, that helps protect your teeth and gums. In a healthy state, these bacteria work together to defend against disease, but vaping appears to disrupt this balance. A recent study examining the subgingival microbiome, which is the bacteria living beneath the gumline, discovered significant alterations of these microbial communities in vape users. Harmful bacteria associated with gum disease became more dominant, while beneficial species declined. Researchers also found that vaping affected microbial behavior, and these shifts appeared to encourage disease-associated bacteria to become more active and potentially aggressive. 

These changes were particularly pronounced in users who had more intense vaping behaviors, specifically those with higher puff volumes, demonstrating how personal vaping behaviors may play a role in biological outcomes. Changes like these may increase the risk of gum inflammation, bleeding, and even bone loss around the teeth, which can eventually lead to tooth loosening or loss. Even without noticeable symptoms, users may be reshaping the bacterial landscape of their mouth and laying the groundwork for oral disease.

Saliva contains proteins and other substances that aid in defending dental health, and changes in its composition reflect how the body responds to exposures. In one study, researchers used advanced techniques that analyze multiple types of biological data like genes, proteins, and chemical signals at once, also known as multi-omics, to compare saliva from vape users and non-users. They found that vaping introduces metals like nickel, cadmium, and cobalt into saliva, with elevated levels observed in users with higher puff volumes. Results indicated a strong correlation between the levels of these metals and changes in biomarkers, which are biological indicators of health or disease, associated with inflammation and DNA damage, suggesting that vaping may accelerate cellular stress and weaken oral defenses.  

Additional investigations demonstrate that personal vaping behaviors are only one indication of increased risk. In another study, findings suggested that African Americans may be at greater risk for vaping-related oral health effects compared to users from other racial groups. This included higher levels of cell damage, inflammation, and gum disease, as well as disrupted oral defense mechanisms. Together, these studies highlight how saliva is a powerful tool for detecting the effects of vaping on oral health and can also be applied to examine broader biological impacts.

The oral health risks associated with vaping don’t stop at the gums and teeth. What happens in the mouth can offer important insights into what’s happening elsewhere in the body and even impact other systems. Studies analyzing saliva from vape users have identified biomarkers linked to conditions like asthma, Alzheimer’s disease, and cancer. While these findings don’t confirm that vaping can cause these diseases, they suggest that the biological changes triggered in the mouth may reflect, or even contribute to, broader health risks. As researchers continue to explore these connections, the mouth is emerging as a critical site for understanding vaping’s full impact.

Vaping is often seen as a safer alternative to smoking, but the research tells a more complex story. From shifts in the oral microbiome to the presence of metals and inflammatory biomarkers in saliva, the evidence shows that vaping can undermine oral health. What happens in the mouth isn’t isolated and should be looked at as part of a larger picture of overall health.  

As researchers continue to discover these links, it’s becoming clear that the effects of vaping are not limited to what we can see or feel right away. For those who vape or are considering it, understanding these impacts is essential. Protecting your smile could be the first step in protecting your health.

• The impact of vaping behavior on functional changes within the subgingival microbiome
• Beyond the puff: health consequences of vaping
• Unveiling Oral Health Impacts of Vaping in African Americans through Untargeted Metabolomics and Proteomics
• Multi-Omics Assessment of Puff Volume-Mediated Salivary Biomarkers of Metal Exposure and Oxidative Injury Associated with Electronic Nicotine Delivery Systems
• UL 200D Guidance Document: Science Education and Research on Vaping and Interventions for Community Engagement (SERVICE)

Principal investigator: Christa Wright, Ph.D.
NIH Award Numer: 1R56DE031814-01