Vaping, heated tobacco, and periodontal health: a systematic review of their effects on inflammation, microbiota, and non-surgical therapy response

Background: The increasing use of electronic cigarettes and heated tobacco products has raised concerns regarding their potential effects on periodontal health. The objective of this systematic review was to assess the impact of these alternative nicotine delivery systems on periodontal inflammation, oral microbiota, and outcomes of non-surgical periodontal therapy. Methods: A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus, in accordance with PRISMA guidelines. Results: The findings indicate that although electronic cigarettes and heated tobacco products may reduce exposure to certain harmful constituents compared with conventional cigarettes, they are not free of adverse effects. Their use has been associated with increased levels of pro-inflammatory cytokines, reduced anti-inflammatory mediators, delayed periodontal healing, and alterations in oral microbiota composition, which may contribute to the progression of periodontal disease. These biological changes may negatively influence the response to non-surgical periodontal therapy. Discussion: From a clinical perspective, individuals using electronic cigarettes or heated tobacco products tend to exhibit less favorable treatment outcomes, often comparable to those observed in conventional cigarette smokers. Despite being promoted as harm-reduction alternatives, current evidence suggests that electronic cigarettes and heated tobacco products still pose significant risks to periodontal tissues. Overall, the available biological and clinical evidence supports the need for further investigation into the underlying mechanisms of tissue damage and reinforces the importance of promoting complete smoking cessation, including avoidance of electronic cigarettes and heated tobacco products, to preserve long-term oral health.