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Meta-Analysis
. 2025 Jun;75(3):2014-2024.
doi: 10.1016/j.identj.2024.12.036. Epub 2025 Jan 24.

Effects of Electronic Cigarettes on Periodontal Health: A Systematic Review and Meta-Analysis

Reem Alkattan  1 , Nada Tashkandi  2 , Amani Mirdad  1 , Hossam Tharwat Ali  3 , Nouf Alshibani  1 , Eman Allam  4
Affiliations
Meta-Analysis

Effects of Electronic Cigarettes on Periodontal Health: A Systematic Review and Meta-Analysis

Reem Alkattan et al. Int Dent J. 2025 Jun.

Abstract

Objectives: The use of electronic cigarettes "e-cigarettes," or vaping is growing in popularity, especially among adolescents and young adults. While the effects of cigarette smoking on oral health are well-established, the exact impact that e-cigarettes may have on dental tissues is still uncertain. The aim of the current review was to summarize evidence related to the effect of vaping on the periodontal health status of e-cigarette users.

Methods: A comprehensive electronic search was performed using PubMed, Web of Science, and Scopus databases, until January 31st, 2024. Two independent reviewers participated in the screening of studies, data extraction, and assessment of the included studies. Any disagreements were resolved by a third reviewer the quality assessment was done using the Newcastle-Ottawa Scale to assess the risk of bias. A frequentist meta-analysis was performed using R Statistical Software. The random effects model was adopted. Data were described as mean difference (MD) and 95% confidence interval (CI). A p-value of ≤ .05 was deemed statistically significant.

Results: Ten studies met the eligibility criteria. Overall, the findings were consistent, with most studies showing that e-cigarette users are at greater risk of periodontal disease than nonsmokers, but that they have a lower risk than cigarette smokers. Pooling results showed lower mean probing depth (PD) among nonsmokers than e-smokers (MD: -1.91; 95% CI: [-3.36: -0.47]; p-value = .01) while it was higher among cigarette smokers in participants with periodontitis (MD:0.43; 95%CI: [0.08:0.79]; p-value = .02). Compared to e-smoking, nonsmokers had lower PI (MD: -20.63; 95%CI: [-28.04: -13.21]; p-value < .001) while cigarette smokers had higher PI (MD: 4.88; 95% CI: [-1.52:11.29]; p-value = .135). Among participants with periodontitis, only cigarette smokers had significantly higher PI (MD: 4.53; 95%CI: [1.94:7.13]; p-value < .001).

Conclusion: Based on the current analysis, conventional cigarette smoking is the most detrimental to periodontal health among the groups compared in all included studies. This indicates that traditional cigarettes have a more severe impact on periodontal tissues than do e-cigarettes. The data suggest a gradient of risk where nonsmokers have the lowest risk, e-cigarette users have a moderate risk, and cigarette smokers have the highest risk for periodontal health issues.

Keywords: Cigarette; Periodontal health; Periodontitis; Smoking; Vaping.

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Conflict of interest statement

Conflict of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1:
Fig. 1
Summary of the search and process of the study selection.
Fig 2:
Fig. 2
Network meta-analysis – plaque index: Forest plots with corresponding network graphs.
Fig 3:
Fig. 3
Network meta-analysis – bleeding on probing: Forest plots with corresponding network graphs.
Fig 4:
Fig. 4
Network meta-analysis – probing depth: Forest plots with corresponding network graphs.
Fig 5:
Fig. 5
Network meta-analysis – clinical attachment loss: Forest plots with corresponding network graphs.
Fig 6:
Fig. 6
Network meta-analysis – marginal bone loss: Forest plot with corresponding network graph.
See this image and copyright information in PMC

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