The impact of electronic cigarette use on periodontitis and periodontal outcomes: a systematic review and meta-analysis

Abstract

Background: Periodontitis, a prevalent inflammatory disease affecting tooth-supporting structures, leads to significant oral health and systemic complications if untreated. While traditional smoking is a well-known risk factor for periodontitis, the impact of electronic cigarettes (e-cigarettes) on periodontal health remains unclear. This systematic review and meta-analysis aim to synthesize existing evidence on the effects of e-cigarette use on periodontitis and other periodontal outcomes.

Methods: A literature search was conducted across PubMed, EMBASE, and Web of Science from their inception up to June 15 2024. Eligible studies included those assessing the impact of e-cigarette use on periodontal outcomes such as bleeding on probing (BOP), plaque index, probing depth, clinical attachment loss, and marginal bone loss. Data were extracted and analyzed using random-effect models to calculate pooled mean differences. R statistical software was used to perform meta-analyses.

Results: Twelve studies were included in the meta-analysis. E-cigarette users showed a significantly lower mean BOP score compared to non-users (pooled mean difference: -14.233; 95% CI: -20.424 to -8.043; I² = 99%). For other periodontal outcomes, the findings were as follows: Plaque Index (MD: -0.160; 95% CI: -0.680 to 0.360; I² = 95%), Clinical Attachment Loss (MD: 0.120; 95% CI: -0.045 to 0.285; I² = 90%), Probing Depth (MD: 0.056; 95% CI: -0.070 to 0.182; I² = 85%), and Marginal Bone Loss (MD: -0.052; 95% CI: -0.168 to 0.064; I² = 88%).

Conclusion: Present studies have not identified a significant link between e-cigarette use and adverse effects on periodontal health, but the available research is limited. Further longitudinal research is necessary to evaluate the long-term effects of e-cigarette use on periodontal health and to clarify any associated risks.

Keywords: Dental health; E-cigarette; Meta-analysis; Oral health; Periodontitis.

Fig. 1

PRISMA flowchart depicting article selection and screening process

Fig. 2

Meta-analysis showing the pooled mean difference in BOP of E-cigarettes versus non-smokers

Fig. 3

Meta-analysis showing the pooled mean difference in clinical attachment loss of E-cigarettes users versus non-smokers

Fig. 4

Meta-analysis showing the pooled mean difference in plaque index of E-cigarettes users versus non-smokers

Fig. 5

Meta-analysis showing the pooled mean difference in probing depth of E-cigarettes users versus non-smokers

Fig. 6

Meta-analysis showing the pooled mean difference in distal marginal bone loss of e-cigarette users versus non-smokers

Fig. 7

Meta-analysis showing the pooled mean difference in mesial marginal bone loss of e-cigarette users versus non-smokers