Effects of Vaping in Periodontal Disease: A Systematic Review

Objectives: While regular tobacco smoking has been proven to be a risk factor for periodontitis, limited information is available about to what extent vaping, a new alternative to smoking that has been branded as less harmful, influences in the progression of the periodontal disease. Therefore, our aim was to systematically review the impact of vaping in periodontal disease.

Methods: The researchable question was created using PICOs format. A systematic search of the following electronic databases was performed up to October 2018: Medline, Embase, Pubmed, Cochrane, and Google Scholar. Human studies that assessed periodontal status (plaque index [PI], bleeding of probing [BOP], clinical attachment loss [CAL], marginal bone loss [MBL], probing depth [PD]) in e-cigarette users compared to control groups were selected for risk of bias assessment.

Results: After duplicates were removed, 1,513 studies were screened and 4 case-control studies that investigated the relation between vaping and periodontal parameters in humans were selected after the risk of bias assessment. BOP was 35.3(±5.6) in control compared to 17.4 (±9.1) in e-cig users; PI was 31.2(±12.3) vs 39.2(±15.2); CAL 0.5(±0.3) vs 0.8(±0.3); MBL mesial 1.2(±0.6) and distal 1.4(±0.6) vs 1.9(±0.3) and 2.1 (±0.1). Levels of proinflammatory cytokines obtained from two of the studies were TNF-α 6.7(±8.1) in control versus 24.3(±32.4) in e-cig users and IL-1β 19.7(±22.3) versus 205.2(±230.7).

Conclusions: Within the limitations of our study, we found that vaping groups had reduced BOP compared to never smokers. Also, no significant difference in PI, CAL, and MBL between the two groups was observed. Reports of levels of proinflammatory cytokines TNF-α and IL-1β from two of the studies were not significantly different between the two groups. However, included human studies were limited by multiple factors. In vitro studies results support that vaping induces inflammation responses, DNA damage, and reduces wound healing by affecting fibroblasts.