Oral Health Perceptions and Self-reported Oral Problems among E-cigarette, Conventional, and Dual Smokers in Riyadh, Saudi Arabia

Abstract Background: Although the use of e-cigarettes has increased worldwide, their effects on oral health compared to conventional and dual tobacco use remain insufficient. Understanding behavioral, sociodemographic, and environmental factors that predict smoking type is crucial for targeted prevention programs. Aim: To assess and compare oral health perceptions, sociodemographic differences, and self-reported oral problems among e-cigarette, conventional, and dual smokers in Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted among adults aged 17 and older ( n = 705) in Riyadh, Saudi Arabia, using a validated questionnaire. Participants were classified into e-cigarette smokers ( n = 462), conventional smokers ( n = 49), and dual users ( n = 194). The questionnaire assessed sociodemographic characteristics, oral health perceptions, knowledge, and perceived oral health problems. Chi-square tests co0mpared categorical variables, whereas logistic regression models evaluated predictors of smoking type, including age, sex, income, education, and dental-visit frequency. Results: Dual smokers had the highest prevalence of dental caries (65.5%), teeth discoloration (77.8%), changes in gingival color (77.3%), and calculus/plaque accumulation (64.4%). E-cigarette smokers were significantly more likely to believe that e-cigarettes reduced passive smoking (68.18%, P < 0.001) and were less harmful than conventional cigarettes (80.74%, P < 0.001). Chi-square testing showed a significant difference in sex distribution ( P = 0.016), with e-cigarette users being proportionally more female (61.5%) than males (38.5%). Regression analysis showed that individuals with a monthly income of 3,000–10,000 SR had lower odds of being conventional smokers compared with e-cigarette smokers (odds ratio [OR] =0.30, confidence interval CI = 0.10–0.90, P = 0.033). Conclusions: Dual smokers reported the poorest oral health outcomes due to compounded risks. E-cigarette users misperceive the safety of e-cigarettes. These findings emphasize the need for targeted dental public health interventions to provide evidence-based education and tailored cessation strategies.