Is vaping harmful to oral health?

Many patients ask their dental professional if vaping is harmful to their oral health. It can often be confusing to follow the evidence and guidance on e-cigarettes.
BSP is grateful to Dr Richard Holliday, from Newcastle University School of Dental Sciences, who has prepared a brief updated summary of current evidence on e-cigarettes and periodontal health for dental professionals. The summary has been reviewed and contributed to by BSP Council and we hope that you find it helpful. This summary has been updated in March 2025. 
 
Dr Richard Holliday is a Senior Lecturer/ Honorary Consultant in Restorative Dentistry and Specialist in Periodontics at Newcastle University. His research interests are translational in nature, spanning fundamental research to pragmatic clinical trials and public health research. He has a particular focus on tobacco and novel nicotine products and is currently conducting a large national multi-centre randomised controlled trial on smoking cessation interventions in primary dental care (The ENHANCE-D trial).
 
An evidence summary on e-cigarettes and periodontal health (2025)
There are often  alarming media articles and press releases about vaping and oral health. Some  state that vaping is as damaging, or more damaging, for oral health than smoking; that e-cigarettes cause cancer and that they should not be advised as a transition from tobacco smoking. Often no supporting evidence is provided for these claims. This evidence summary aims to provide a simple and clear overview of the current UK recommendations and the evidence base surrounding e-cigarette use.
The Chief Medical Officer for England, Professor Sir Chris Whitty, said in 2023 "The key points about vaping (e-cigarettes) can be easily summarised. If you smoke, vaping is much safer; if you don’t smoke, don’t vape".

What are the general health effects of vaping?
Many large reviews from expert groups have reviewed the health effects of e-cigarette use. A famous US report, published in 2018 by the National Academies of Science, Engineering and Medicine (NASEM), concluded that ‘Laboratory tests of e-cigarette ingredients, in vitro toxicological tests, and short-term human studies suggest that e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes. However, the absolute risks of the products cannot be unambiguously determined at this time. Long-term health effects, of particular concern for youth who become dependent on such products, are not yet clear.’1 The Office for Health Improvement and Disparities, (OHID) 2022 report completed a systematic review on the health risks of vaping and concluded that ‘vaping poses only a small fraction of the risk of smoking…. This does not mean vaping is risk-free, particularly for people who have never smoked.’
It is particularly noteworthy that this magnitude of relative risk between vaping and smoking is not reflected in current public perceptions. In 2023, 39% of adult smokers reported that they thought that e-cigarettes were either a lot more, more or equally harmful as cigarettes (the opposite of the evidence reviews and expert opinion).3 This is up from 7% in 2013.3 

What is the evidence for vaping effects on periodontal health?
Tobacco smoking is well known as one of the most important risk factors for periodontal disease development and progression. It is little surprise that much attention is being focused on the potential effects of e-cigarettes on periodontal health.
Individual studies can be found to support different viewpoints on e-cigarettes (e.g. showing periodontal damage or not) and it is important to look at the evidence base as a whole. A recent systematic review and meta-analysis pulled together evidence from 40 studies and compared e-cigarette users to both tobacco smokers and non-smokers (or former smokers).4 The study made the following findings: 

• The studies conducted within this field were at high risk of bias (usually due to cofounding factors) so caution must be applied to the conclusions generated. The biggest issue was that the e-cigarette groups being investigated were often confounded by tobacco smoking i.e. e-cigarette users were also smoking, making it hard to identify the effect of e-cigarettes alone. The review explored this in some detail with subgroup analysis (see full paper for details). 
• There was evidence to suggest that e-cigarette use had some impacts on periodontal parameters compared to non-smokers/former smokers. Tobacco smokers had consistently worst outcomes.
• There was no evidence of a difference between e-cigarette users and non-smokers/former smokers in markers of periodontal destruction (pocket probing depths/marginal bone loss). 
• There was evidence that e-cigarette users had lower bleeding and gingival indices that non-smokers/former smokers. Similar effects were seen between e-cigarette users and smokers. These suppression effects are well known with smoking, but this finding suggests e-cigarette use has similar effects on gingival vasculature (probably through the effects of nicotine). 
• The was evidence that plaque levels were higher in e-cigarette users compared to non-smokers/former smokers and higher again in smokers. 
• Epidemiological studies generally found higher odds of poor periodontal health in e-cigarette users (compared to non-users). However, issues with  self-reporting and confounding from smoking are a problem in this field. 
• Studies also indicated that ENDS use leads to unique microbial changes compared to tobacco smokers and higher pro-inflammatory markers compared to non-smokers/former smokers.

The full article is available open access in the Evidence-based Dentistry journal here: https://doi.org/10.1038/s41432-025-01119-6.   

What is the evidence for e-cigarettes helping smokers to quit?
A regularly updated Cochrane Systematic Review and Meta-analysis includes 90 studies and 29,044 participants and looks at several comparisons.5
When comparing e-cigarettes to traditional nicotine replacement therapies (NRT; patches and gum; our usual standard of care), it finds high certainty evidence that e-cigarettes are more effective. In absolute terms, this translates to 6/100 people quitting with NRT compared to 8-10/100 with e-cigarettes. This comparison is based upon 7 randomized controlled trials with 2544 participants. Arguably this evidence base is as strong, or stronger, than anything else we do in dentistry.
With respect to dental settings in particular, a separate Cochrane review looked at all cessation options but included only one small trial with e-cigarettes.6 In the UK there is an ongoing national trial investigating smoking cessation in dental settings, which includes e-cigarettes. The findings are due to be reported in 2025 (ENHANCE-D trial, NIHR funded).    

What is the current guidance on e-cigarettes for smoking cessation?
There is comprehensive guidance for UK healthcare professionals:
•    NHS websites provide useful information to users (and healthcare professionals) on using e-cigarettes to stop smoking, Vaping myths and youth vaping.
•    NICE guidance includes e-cigarettes, recommending that health and social care professionals should offer advice on using nicotine-containing products on general sale, including over-the-counter NRT and nicotine-containing e-cigarettes. Items for discussion include ensuring that users use them long enough to ensure they don’t return to smoking and the importance of getting enough nicotine to overcome withdrawal symptoms. The guidance also discusses that there is not enough evidence to know the long-term harms from e-cigarette use, but that it is likely to be substantially less harmful than smoking and that smoking tobacco should be stopped completely.
•    Annual expert independent evidence reviews commissioned by Public Health England (now the OHID).
•    Delivering better oral health: an evidence-based toolkit for prevention. Chapter 11: Smoking and tobacco use.
•    National Centre for Smoking Cessation training – vaping: a guide for healthcare professionals.

Young people and ‘disposables’
Vaping is not for children or young people. Worryingly, we have recently seen a large increase in young people using e-cigarettes and this has principally been attributed to the popularity of disposable products and marketing practices. Further restrictions are likely to be introduced imminently  within the UK under the ‘UK Tobacco and Vapes Bill’.

The bottom line
In summary, the oral health evidence is consistent with the public health messages and guidance on e-cigarettes. E-cigarette use is far less harmful than tobacco cigarettes, although not risk free – we will likely see oral health consequences of long-term vaping (but less than from tobacco smoking). E-cigarettes are not recommended for non-users, especially young people. For existing smokers, e-cigarettes can be an effective quit aid and dental professionals should support patients who choose to use this method of cessation.
1st March 2025
 
References
1.    National Academies of Sciences, Engineering, and Medicine. 2018. Public Health Consequences of E-Cigarettes. Washington, DC: The National Academies Press. https://doi.org/10.17226/24952.
2.    McNeill A, Simonavicius E, Brose L, Taylor E, East K, Zuikova E. Nicotine vaping in England: an evidence update including health risks and perceptions 2022. A report commissioned by the Office for Health Improvement and Disparities. 2022. Available from: https://www.gov.uk/government/publications/nicotine-vaping-in-england-2022-evidence-update
3.    Action on Smoking and Health. Use of e-cigarettes (vapes) among adults in Great Britain. 2023. Available from: https://ash.org.uk/uploads/Use-of-e-cigarettes-among-adults-in-Great-Britain-2023.pdf
4.    Tattar, R., Jackson, J. & Holliday, R. The impact of e-cigarette use on periodontal health: a systematic review and meta-analysis. Evid Based Dent (2025). https://doi.org/10.1038/s41432-025-01119-6 
5.    Lindson N, Butler AR, McRobbie H, Bullen C, Hajek P, Wu AD, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Livingstone-Banks J, Morris T, Hartmann-Boyce J. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2025, Issue 1. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub9.
6.    Holliday R, Hong B, McColl E, Livingstone-Banks J, Preshaw PM. Interventions for tobacco cessation delivered by dental professionals. Cochrane Database Syst Rev. 2021;2(2):CD005084. DOI: 10.1002/14651858.CD005084.pub4