E-Smoking and Periodontal Diseases: Current Insights and Future Directions

Periodontal diseases are long-term inflammatory diseases of the gingiva and alveolar bone that can result in the loss of teeth in the case of untreated conditions. Despite the fact that conventional smoking is an established risk factor, the widespread adoption of electronic cigarettes (e-cigarettes) has raised new concerns about periodontal health.

PubMed, Scopus, and Google Scholar were utilized for carrying out this narrative review. Keywords were e-cigarettes, vaping, electronic nicotine delivery systems, periodontal disease, periodontitis, oral microbiome, gingival inflammation, and oxidative stress. Publications up to February 2026 were considered, with systematic reviews and meta-analyses (2023–2025) prioritized. Evidence on clinical periodontal parameters, inflammatory biomarkers, and changes in the microbiome was synthesized.

E-cigarette smoking is linked to elevated levels of gingival inflammation, oxidative stress, immune dysregulation, enrichment of inflammatory pathogens like Porphyromonas gingivalis and compromised tissue repair. Periodontal parameters tend to be poorer than in non-smokers but better than in traditional smokers, which demonstrates a moderate risk profile.

E-cigarettes seem to be an intermediate risk factor of periodontal disease. The mechanisms involved are oxidative stress, cytotoxicity, neutrophil dysfunction and microbial dysbiosis, though usually at reduced intensity compared to traditional smoking. Nevertheless, the existing evidence is constrained by cross-sectional designs, brief follow-ups, and confounding variables, including multiple uses or prior smoking, which makes it challenging to reach logical conclusions regarding long-term effects.

Current evidence suggests that e-cigarette use is associated with adverse changes in periodontal health and should not be assumed to be biologically inert for oral tissues. Its long-term periodontal effects are not well understood, although it is not as harmful as combustible tobacco. More longitudinal research is required, and dental practitioners are advised to counsel patients on the dangers of vaping and ways of quitting.