The impact of electronic and conventional cigarettes on periodontal health-a systematic review and meta-analysis

Abstract

Objectives: This systematic review and meta-analysis examined the effects of electronic cigarettes on periodontal health compared to conventional cigarette smoke and a non-smoking population.

Materials and methods: MEDLINE, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov were screened for literature. Eligibility criteria included clinical studies published between 2006 and 2022 that compare e-cigarettes and conventional cigarettes on periodontal health (bleeding on probing (BoP), plaque index (PI), probing depth (PD), attachment loss (AL), marginal bone loss (MBL), tooth loss, molecular inflammation markers, salivary flow rate). Meta-regression analysis was used to examine the influence of moderator variables.

Results: Sixteen studies were found to be eligible for qualitative synthesis. Individual analyses showed that cigarette smokers had significantly higher PI, PD, AL, and MBL and increased concentrations of proinflammatory mediators than e-cigarette users and non-smokers. Meta-analysis revealed a 0.33-fold lower chance for BoP in e-cigarette users compared to smokers (p = 0.03), whereby meta-regression failed to detect any effects regarding the age of users and frequency of smoking. A 0.01-fold decreased chance for positive BoP in e-cigarette users compared with non-smokers was seen (p < 0.01).

Conclusions: The current findings suggest that that e-cigarette use might be considered a healthier alternative to cigarette smoking concerning periodontal health. Even so, harmful effects of electronic nicotine delivery system (ENDS) usage on periodontal health were seen as well. However, a definitive decision on this research question remains elusive due to the absence of randomized controlled trials.

Clinical relevance: Electronic cigarettes, marketed as a safer alternative to traditional cigarettes, are becoming increasingly popular. Evidence on the use of electronic cigarettes as a cessation aid and its beneficial impact compared to cigarette smoke remains inconclusive, so the analysis conducted in this review addresses a recent question of high clinical relevance.

Keywords: Bleeding on probing; Electronic cigarettes; Oral health; Periodontal health; Smoke; Smoking; Vaporizer.

Fig. 1

Flowchart of studies screened, retrieved, included, and analyzed in the systematic review and subsequent meta-analyses according to the PRISMA guidelines [28, 30]

Fig. 2

Forest plot for meta-analysis of BoP in e-cigarette users compared to cigarette smokers in three case–control, three cross-sectional, and one cohort studies (n = 7 studies, association measure: odds ratio, CI confidence interval)

Fig. 3

Funnel plot for included studies in this meta-analysis. Each plotted point represents the standard error and standardized odds ratio between e-cigarette users and smokers

Fig. 4

Forest plot for meta-analysis of BoP in e-cigarette users compared to non-smokers in three case–control, three cross-sectional, and one cohort studies (n = 7 studies, association measure: odds ratio, CI confidence interval)

Fig. 5

Funnel plot of the meta-analysis of published studies. Each plotted point represents the standard error and standardized odds ratio between e-cigarette users and non-smokers

Fig. 6

Forest plot illustrating the odds ratio for a positive BoP test comparing e-cigarette users and non-smokers after applying the trim-and-fill method (CI confidence interval, OR odds ratio)