Xerostomia among users of electronic nicotine delivery systems in a multinational web-based cross-sectional study

The use of electronic nicotine delivery systems (ENDS) has increased globally. Evidence of the association between xerostomia and ENDS remains limited. We evaluated the association between nicotine product use and xerostomia severity in a multinational sample from the Middle East and North Africa (MENA) region. In this cross-sectional study, adults aged 18-40 years from 18 MENA countries were recruited via convenience sampling through social media platforms between December 2023 and March 2024. Xerostomia symptoms were assessed using the xerostomia Inventory (XI). Directed acyclic graphs guided confounder selection. Regression models examined the association between nicotine product use and xerostomia symptom scores. Among 11,451 participants (6975 [60.9%] non-users, 1913 [16.7%] exclusive ENDS users, 1778 [15.5%] exclusive combustible tobacco users, and 785 [6.9%] dual users), all current-use categories were associated with higher XI scores than non-use after adjustment for age, sex, and exercise frequency: exclusive ENDS users (standardised β = 0.385; p < 0.001), exclusive combustible tobacco users (β = 0.201; p < 0.001), and dual users (β = 0.324; p < 0.001). Current use of any nicotine product was associated with higher xerostomia scores than non-use, with the strongest associations observed among exclusive ENDS users and dual users.

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Journal
Scientific Reports
Published
2026-06-24
DOI
https://doi.org/10.1038/s41598-026-55899-7
Primary Topic
Salivary Gland Disorders and Functions
Type
article
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article

Xerostomia among users of electronic nicotine delivery systems in a multinational web-based cross-sectional study

Saadi M. Saleh, Saifaleslam Elsahli, Ali Malik Tiryag, Samah Fageer et al.
Scientific Reports
Salivary Gland Disorders and Functions
article

Xerostomia among users of electronic nicotine delivery systems in a multinational web-based cross-sectional study

Saadi M. Saleh, Saifaleslam Elsahli, Ali Malik Tiryag, Samah Fageer, Mohamad Ali Assaf, Rana H. Shembesh, Khaledah Aladwan, Rawan Abujudeh, Alaa Aljamala, Ata Al-howaity, Yousef Almahmoud, Islam Khadmi, M Ahmed, Jawad Alqedra, Hawwa Abdullah Albishari, Arwa Alstif, Mahmoud Abushmaah, Hiba Kabab, Weam Aldiban, Remon Khalaf, Ahmed Elawad, Khalid Sallam, Ibrahim Alhadi, Yasameen Magdy, Sami Alsalous, Ghufran Abdalgadir, Tiba Ahmed, Ahmad M. A. Okour, Safia Abdi, Amgad Al-Maliki, Hamza Yousef, Alloulu Alghardaq, Mohamedelamin Mohamedbakheet, Nermin Adly Hassan, Manhal Sirelkhatem, Zeina Wahbeh, Merfat Albasi, Aisha Makahleh, Ismail Amaty, Mohamed Zehni Khairallah, Rayan Taha, Farhan Alnoaimi
article en

Abstract

The use of electronic nicotine delivery systems (ENDS) has increased globally. Evidence of the association between xerostomia and ENDS remains limited. We evaluated the association between nicotine product use and xerostomia severity in a multinational sample from the Middle East and North Africa (MENA) region. In this cross-sectional study, adults aged 18-40 years from 18 MENA countries were recruited via convenience sampling through social media platforms between December 2023 and March 2024. Xerostomia symptoms were assessed using the xerostomia Inventory (XI). Directed acyclic graphs guided confounder selection. Regression models examined the association between nicotine product use and xerostomia symptom scores. Among 11,451 participants (6975 [60.9%] non-users, 1913 [16.7%] exclusive ENDS users, 1778 [15.5%] exclusive combustible tobacco users, and 785 [6.9%] dual users), all current-use categories were associated with higher XI scores than non-use after adjustment for age, sex, and exercise frequency: exclusive ENDS users (standardised β = 0.385; p < 0.001), exclusive combustible tobacco users (β = 0.201; p < 0.001), and dual users (β = 0.324; p < 0.001). Current use of any nicotine product was associated with higher xerostomia scores than non-use, with the strongest associations observed among exclusive ENDS users and dual users.

Scientific Reports
University of Aleppo (SY), Ain Shams University (EG), Latakia University (SY), University of Jordan (JO), University of Science and Technology (YE), Cadi Ayyad University (MA), University of Basrah (IQ), Qatar Airways (Qatar) (QA), Cairo University (EG), Misurata University (LY), Jordan University of Science and Technology (JO), Hashemite University (JO), Benha University (EG), Al Yarmouk University College (IQ), University of Anbar (IQ), Tripoli Central Hospital (LY), Damascus Hospital (SY), University of Bakhtalruda (SD), University of Dongola (SD), Omdurman Islamic University (SD), University of Abuja Teaching Hospital (NG), Al Assad University Hospital (SY), International University for Science and Technology (SY), University of Bahri (SD), Libyan International Medical University (LY), University of Science and Technology, Sana’a (YE), Hamad Medical Corporation (QA), University of Gezira (SD), Tbilisi State Medical University (GE), University of Pecs (HU), Alexandria University (EG)
Openalex Percentile: Top 8%
Salivary Gland Disorders and Functions
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