The Prevalence of Periodontal Disease Among Electronic Cigarette Users

Objectives: Use of Electronic Nicotine Devices (ENDs), also known as electronic cigarettes, is a popular alternative to conventional cigarette use. While smoking tobacco is well established as a major risk factor of periodontitis, the effects of ENDs on the periodontium are largely unknown. The aim of this study was to investigate whether an association exists between use of ENDs and periodontal disease.
Methods: A total of 633 patient records, screened between June 1^st 2017 and April 23^rd 2018, were reviewed from the University of Oklahoma Health Sciences Center College of Dentistry. All patients were aged 18-50 years. Demographic information (age, race/ethnicity, and gender) and diagnosis (health, gingivitis, or mild, moderate or severe chronic periodontal disease) was collected, as well as data regarding use of ENDs and other types of tobacco. Data were analyzed using Pearson chi-squared tests of cross-tabulations and multivariate logistic regression.
Results: The majority of patients indicated no tobacco use (64.3%); 31.3% reported using cigarettes; only 5.5% reported using ENDs. Smokers were more likely to use ENDs (10.6%) than non-smokers (3.2%). Smokers were more likely to have periodontal disease than non-smokers (p = 0.0024). END users were more likely to have periodontal disease than non-End users (p = 0.046), even among END users who were not smokers (p=0.042). Smokers, who also used ENDs, were more likely to have gingivitis (p = 0.0002) or severe periodontal disease (p = 0.11) compared to those who did not use ENDs.
Conclusions: This study suggests that using ENDs as a "healthier" alternative to smoking is misguided when it comes to dental health. Use of ENDs is associated with increased prevalence of gingivitis and periodontitis independent of the effects of smoking. The results must be considered with caution, however, due to the small number of END users.