To Vape or Not to Vape: Oral Health in the Age of Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems

100 million adults and 15 million adolescents currently use e-cigarettes, a type of Electronic Nicotine Delivery System (ENDS) or Electronic Non-Nicotine Delivery System (ENNDS). While they were introduced as smoking cessation aids, they are currently marketed as consumer products rather than prescription-based cessation tools. According to the WHO, as of 2025, 88 countries do not have minimum age restrictions, and 74 countries have no regulations. The growing popularity of ENDS and ENNDS has introduced a new and complex set of behaviours and exposures that might impact oral and overall health. E-cigarette aerosols are reported to impact cardiovascular health, heighten airway inflammation and increase risk of upper respiratory infections. In the oral cavity, a high caries risk, greater staining of teeth and restorations, higher incidence of xerostomia, gingival inflammation and a greater prevalence periodontal and peri-implant diseases when compared to non-users. Oral mucosal lesions such are nicotine stomatitis, hairy tongue, and angular cheilitis are more prevalent when compared to former smokers. Thus, evidence is emerging to indicate that ENDS and ENNDS impact both oral and systemic health, albeit in ways different from conventional cigarettes. However, high-certainty evidence also supports e-cigarettes as effective smoking cessation tools, with four additional quitters per 100 individuals. Therefore, it behooves oral health professionals to play a crucial role in counselling and support patients with evidence-based data. More evidence is needed to understand the long-term health impacts of e-cigarettes.