Comparative Evaluation of Periodontal Health among E-cigarette Users, Conventional Smokers, and Nonsmokers: A Cross-sectional Clinical Study

Background and aim: Electronic cigarettes (e-cigarettes) are often promoted as a safer alternative to conventional tobacco products; however, their effects on periodontal health remain relatively underexplored.This study aimed to compare clinical periodontal parameters among exclusive e-cigarette users, traditional cigarette smokers, and nonsmokers.Methods: A cross-sectional comparative study was conducted involving 99 systemically healthy adults aged 18-45 years, equally distributed into three groups (n = 33 each): E-cigarette users, cigarette smokers, and nonsmokers.Clinical parameters recorded included plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment loss (CAL).Information regarding smoking habits and awareness of periodontal health was gathered through a structured questionnaire.Statistical analyses included one-way analysis of variance (ANOVA), Tukey's post-hoc test, Chi-square test, and Pearson correlation.Results: Significant differences were observed among all study groups in all clinical parameters (p < 0.001).Cigarette smokers exhibited the highest mean scores for PI (1.95 0.39), GI (1.82 0.41), PPD (3.91 0.56 mm), and CAL (3.62 0.51 mm), followed by e-cigarette users and nonsmokers.Duration and frequency of use positively correlated with PPD and CAL in both conventional smokers and the e-cigarette group (p < 0.01).Awareness scores were significantly lower in smokers compared to other groups (p < 0.001).Conclusion: E-cigarette use is linked to moderate periodontal deterioration, greater than that observed in nonsmokers but less severe than in conventional smokers.Clinical significance: E-cigarette use should not be considered risk-free in the context of periodontal health.