Electronic Cigarette Use and Risk of Gingivitis and Periodontitis: A Systematic Review and Meta-analysis

Objectives: The relationship between electronic cigarettes (e-cigarettes) and gingivitis and periodontitis is not currently established, although some studies have analyzed a possible association. The aim of this study is to identify and describe studies that assess the relationship between the use of e-cigarettes and gingivitis and periodontitis. Methods: A literature search was conducted in PubMed, Embase, Cochrane, CINAHL, Scopus, and Biotechnology Source until January 2024. Observational studies evaluating the risk of exclusive e-cigarette use on gingivitis and periodontitis were included. Studies that showed the presence of gingivitis or periodontitis on a clinical and/or self-reported basis were included. Studies with a clinical diagnosis were described qualitatively. In self-reported studies, the odds ratio (OR) was meta-analyzed using a random effects model. Results: Nineteen studies were included. Eight were based on clinical assessment, nine were self-reported and two included both clinical and self-reported assesments. In studies with clinical assessment, e-cigarette users showed poorer outcomes in the parameters of plaque index (ranging from 2.1% to 40.1%), marginal bone loss (mesial, ranging from 0.8 to 4.4 mm; distal, ranging from 0.7 to 4.4 mm), and periodontal disease (ranging from 0.2% to 3.6%). In the self-reported studies, e-cigarette use was identified as increasing the risk of gingivitis (OR: 1.71, 95% CI : 1.13–2.59), periodontitis (OR: 1.46, 95% CI : 1.17–1.83), and bone loss (OR: 1.44, 95% CI : 1.19–1.75). Conclusions: The findings have key implications for dental practice and public health. Evidence suggests exclusive e-cigarette use is associated with increased risk of indicators of gingivitis and periodontitis, indicating these devices are not risk-free alternatives to smoking. Clinicians should be aware of these associations when advising patients.