The Impact of electronic cigarettes on the oral microbiome

Background: Electronic cigarettes are battery-powered devices. Since their introduction, it has evolved through four generations. The oral cavity, being the initial point of contact for e-cigarette aerosol, is particularly vulnerable to its effects. This review aims to synthesize existing evidence on the impact of e-cigarette aerosols on the oral microbiome and their implications for oral health. Methods: This article reviews the effects of electronic cigarettes on the oral microbiome by analyzing the most recent studies. A systematic search was conducted using keywords such as "e-cigarette," "vaping,"and"oral microbiome,". Relevant studies were selected, critically evaluated, and synthesized to identify consensus findings and gaps in current knowledge. Results: Current research indicates that electronic-cigarette aerosols disrupt the complex ecosystem of the oral microbiome, leading to a significant reduction in beneficial commensal bacteria (e.g., S. sanguinis and S. gordonii) and an increase in opportunistic bacteria (e.g., S. mutans). This dysbiosis alters biofilm architecture and creating an environment conducive to oral diseases such as dental caries, periodontitis, and oral candidiasis. Studies also highlight the role of nicotine, propylene glycol, and flavoring additives in driving microbial imbalances. Conclusions: Despite being marketed as a safer alternative to traditional smoking, e-cigarette use poses significant risks to oral health by destabilizing the oral microbiome and fostering pathogenic dominance. The observed dysbiosis and associated inflammatory processes underscore the need for long-term studies to elucidate the full clinical implications. Regulatory measures and public health strategies should address these risks to mitigate the growing burden of e-cigarette-related oral diseases.