Art-5-Gyorkos
ORAL MEDICINE www.stomaeduj.com
THE ORAL EFFECTS OF E-CIGARETTES – A LITERATURE REVIEW
Review Articles
Áron Imre Györkös1a , Norbert Kulcsár2b , Péter Hermann2c , Barbara Kispélyi2d
¹Szép és Ép Fog Kft., Budapest, Hungary
²Department of Prosthodontics, Faculty of Dentistry, Semmelweis University, Szentkirályi utca 47, HU-1088 Budapest, Hungary
a
Private Dentist; e-mail: aron.gyorkos@gmail.com; ORCiD ID: https://orcid.org/0000-0002-9657-6156
b
Dental Student; e-mail:kulcsar.norbert@stud.semmelweis.hu; ORCiD ID: https://orcid.org/0000-0003-3070-970X
c
DMD, MSc, PhD, Professor and Head; e-mail:hermann.peter@dent.semmelweis-univ.hu; ORCiD ID: https://orcid.org/0000-0002-9148-0139
d
DMD, PhD, Associate Professor; e-mail:kispelyi.barbara@dent.semmelweis-univ.hu; ORCiD ID: https://orcid.org/0000-0002-0530-0905
https://doi.org/10.25241/stomaeduj.2022.9(3-4).art.5
ABSTRACT
Background Because of regulations made against smoking, and the rising popularity of a healthy lifestyle
there has been a visible change in the smoking habit of the population in the last 15 years. The negative
impact on the attitude toward smoking forced the industry to develop new ways to satisfy the consumer’s
nicotine need. That is how heated tobacco products and a variety of ENDS (Electronic Nicotine Delivery
System), such as electronic cigarettes) have been invented.
Objective This literature review aims to summarise the oral effects of consuming e-cigarettes which have
been proven and publicised.
Data Sources The main source of the study has been the publications found through PubMed and NBCI
(National Center for Biotechnology Information).
Study Selection Articles have been selected from the international literature if they had any information on
the oral effects of e-cigarettes.
Data Extraction The information from the articles has been categorised based on the tissue and the time
they last.
Data Synthesis Electronic cigarettes cause a change in saliva flow and its composition, a decrease in the
blood supply of soft tissues and an immunosuppressed state in the said area, therefore the incidence of
some diseases are higher among the users. Components of the e-liquid may cause damage to both soft and
hard tissues, such as cancerous lesions, inflammation, chronic periodontitis and neurodegeneration. Nicotine
may be absorbed by the surface of the teeth, causing patches, and some ingredients may be beneficial to the
bacterial flora of the oral cavity.
KEYWORDS
E-Cigarette; Electronic Nicotine Delivery Systems; Oral Health; Nicotine; Smoking
1. INTRODUCTION smoking in the population; however, when it comes
Over the last few years, electronic cigarettes to e-cigarettes, no similar action has been underway,
(e-cigarettes) have gained greater and greater allowing their popularity to increase on and on. Over
popularity. According to a 2011 survey by the the last years worldwide, countless research studies
WHO (World Health Organisation), 7 million people have aimed to describe the health effects of electronic
used e-cigarettes regularly worldwide at the time, cigarettes, which indicates that there are many
and this number increased to 41 million by 2018 questions without answers. For this reason, this article
[1]. Some forecasts indicate that the popularity of aims to summarize present knowledge concerning
e-cigarettes will not change; furthermore, as of the oral effects of using electronic cigarettes.
2021, there are an estimated 55 million daily users
[1]. Concerning the health effects of e-cigarettes, 2. CHANGES IN THE SALIVA FLOW AND ITS
they are thought to be a healthy alternative to CONSEQUENCES
smoking, a notion rooted in the marketing strategy
and other factors of the tobacco industry. Another Traditional cigarettes burn at almost 1000 degrees
problem is that these products are accessible to a Celsius and produce quite toxic by-products at this
younger demographic: in 2020 alone in the USA, high temperature, for instance, tar. In contrast, during
19.6% of surveyed secondary school students used the use of electronic cigarettes, there is no burning;
e-cigarettes, and 22.5% used them as a daily routine instead, they vaporize liquid content at a much lower
[2]. The harmful effects of traditional cigarettes are temperature, so the exhaled vapour is assumed to
already established knowledge in people’s awareness, contain fewer toxic components [3]. The temperature
thanks to widespread effort to combat the habit of of the vapour emitted by the e-cigarette depends on
OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license.
Peer-Reviewed Article
Citation: Györkös ÁI, Kulcsár N, Hermann P, Kispélyi B. The oral effects of e-cigarettes – a literature review. Stoma Edu J. 2022;9(3-4):109-114.
Received: July 19, 2022; Revised: September 29, 2022; Accepted: October 21, 2022; Published: November 03, 2022.
*Corresponding author: Norbert Kulcsar, Faculty of Dentistry, Semmelweis University, Szentkirályi utca 47, HU-1088 Budapest, Hungary
Tel: +36 70633 3583; Fax: +36 1317 5270; e-mail: kulcsar.norbert@stud.semmelweis.hu
Copyright: © 2022 the Editorial Council for the Stomatology Edu Journal.
Stoma Edu J. 2022;9(3-4):109-114 pISSN 2360-2406; eISSN 2502-0285 109
Györkös ÁI, et al.
www.stomaeduj.com
several factors such as battery voltage, resistance, the extra quantity may be considered an indicator of
Review Articles oral inflammation [10].
atomiser condition, mouthpiece size, and e-liquid
composition (mainly the level of propylene glycol (PG)
and glycerine content); furthermore, some devices 3. CHANGES CAUSED BY VACUUM
have adjustable voltage, so the temperature can
vary quite widely. Generally, it can be stated that the During the use of an electronic cigarette, there is
average temperature of vaporizing is about 157 to 266 suction in the oral cavity, the size of which depends on
degrees Celsius [3]. The result of the extremely high- the type of equipment, and its duration on the user’s
temperature vapour (mainly of PG-based liquids) may habits. The suction power is produced by the mimic
be the formation of substances containing a carbonyl muscles, and its consequence is a relative vacuum
group such as formaldehyde or acetaldehyde, which in the oral cavity. In a University of California 2010
cause inflammation in the oral mucosa [4,5]. The most study, the researchers ran tests on the most popular
common and important condition that the vapour- e-cigarettes of that time, assessing the level of effort
induced temperature increase causes is xerostomia. needed to use an e-cigarette and the health effects
The change in the saliva flow is assessed by measuring of the arising vacuum. They measured the pressure
the resting and stimulated saliva flow. Symptoms of by a manometer attached to a machine mimicking
xerostomia may be a sticky or burning sensation in smoking and found that the user needed to generate
the oral cavity, increased thirst, difficulties in talking, greater suction power with any type of e-cigarette
swallowing, and tasting, and halitosis. Furthermore, than with traditional ones. In the first ten suction
the dried-out mucosa has a greater risk to develop cycles, the density of the vapour did not change;
oral infections such as oral candidiasis, which can after the tenth suction cycle, however, it started to
recur from time to time. Besides these, the user’s oral decrease continuously. The longer the e-cigarette
hygiene deteriorates [6], and the saliva’s washing had been used the greater effort was needed for the
same amount of vapour. The generated vacuum, the
effect is compromised, therefore the incidence of
density of the vapour and the required effort varied
caries rises [7]. Using an electronic cigarette changes
across device types [11]. There is no unified medical
not just the quantity of saliva but the quality as well.
position yet on the health effects caused by the
Oral pH is driven into the acidic range by nicotine;
vacuum; further studies are needed, but the presumed
however, nicotine-free liquids move oral pH into the
consequences are the overload of the tongue and
basic range and the saliva’s buffer capacity is not
mimic muscles. The result of the greater suction
affected [8]. Changes to the saliva’s composition are
power is that the vapour travels to the distal parts of
also notable: the amount of secretory IgA, lysozyme,
the lung, reaching deeper regions, with all associated
and lactoferrin is different from the physiologic level.
disadvantageous consequences [12].
Secretory IgA is a specialized antibody for the oral
cavity containing saliva. The lysozyme content of saliva 4. EFFECTS ON DIFFERENT ORAL TISSUES
is detrimental to the immune processes: because of
its proteolytic function, it breaks down antibodies. 4.1 Soft Tissues: Acute Changes
B-lymphocytes that have met antibodies migrate As an effect of e-cigarette vapour, the blood supply of
to one of the salivary glands and transform into the soft tissues decreases, which can be traced back
plasma cells. In addition to monomer IgA, these cells to two reasons. On the one hand, the chronic nicotine
produce a protein called J-protein, which connects supply has a vasoconstrictor effect; on the other, the
IgA molecules by their Fc regions to form a dimer; this use of nicotine-free e-cigarettes decreases the blood
way, the lysozyme recognising the Fc regions becomes supply as well. This is explained by glycerine and
ineffective against these IgA dimers [9]. After the use propylene-glycol inducing endothelial inflammation,
of an electronic cigarette, it is proved by ELISA testing which decreases the ability of veins to dilate so they
that the amount of IgA is decreased, which leads to stay constricted [13]. A decrease in blood flow can
a weakened oral immune response [10]. Lysozyme have numerous consequences such as decreased
is responsible for breaking the bond between tissue defence and a hypoxic milieu, which can
N-Acetylglucosamine and N-Acetylmuramic acid; cause changes in the bacterial microbiome, leading
these being the components of the bacterial cell walls, to the proliferation of anaerobic species. Periodontal
the action causes the lysis of bacteria. The substance index values become higher, and the tendency to
also has antiviral and antifungal functions. As an regenerate decreases, which leads to slow or failed
effect of using e-cigarettes, the amount of lysozyme wound healing [8].
decreases, causing a downturn in oral protection Propionaldehyde, which appears in the aerosol
[10]. Lactoferrin is an iron-binding glycoprotein, a during the decomposition of propylene-glycol, leads
multifunctional molecule participating in numerous to the irritation of the oral cavity and the throat,
physiological processes. Concerning the oral cavity, it is with sensitivity, redness, and dry cough [14]. The
produced by the serous cells of the salivary glands; like symptoms of irritation tend to alleviate with continued
lysozyme, it has antibacterial, antiviral, and antifungal use. Nicotine can cause a burning sensation by the
effects, and is also an important immunomodulator. activation of the TRPA1 (transient receptor potential
As an effect of using e-cigarettes, its level increases; ankyrin) channel [15].
110 Stoma Edu J. 2022;9(3-4):109-114 pISSN 2360-2406; eISSN 2502-0285
The Oral Effects of E-cigarettes
www.stomaeduj.com
As a result of the immunosuppressed state in the oral include the lack of long-term experiments and
Review Articles
cavity, the incidence of infectious mucosal diseases, participant recruitment challenges since the ideal
mainly candidiasis caused by Candida albicans, subject would be a person who has never smoked and
increases among e-cigarette users. It has been proved does not have any risk factors. Despite the shortage
by in vitro experiments that in candida cells exposed of clinical proof, current medical opinion states that
to e-cigarette vapour, the expression of chitin and because there are carcinogenic components and
SAP-2,3,9 (secreted aspartic protease) increases, and adverse changes induced in cells, using an e-cigarette
a change takes place in the phenotype: the hyphae could have a carcinogenic effect [20].
become longer. These changes help the adhesion of
candida to the oral mucosa [16]. 4.3 Hard Tissues: Teeth
Upon exposure to some components of the vapour Nicotine can be absorbed by the surface of the teeth,
such as carbonyls, reactive oxygen radicals, and causing yellowish-brown patches [21]. During the
different types of aldehydes, the cytokine secretion of degradation of propylene-glycol, which is one of
epithelial cells increases, which causes inflammation the components of the e-liquid, acidic substances
[17]. The components of e-liquid may cause an allergic such as acetic acid or lactic acid are produced, which
reaction depending on one’s immune system. can directly damage the enamel [22]. Furthermore,
The prevalence of some mucosal diseases is higher propylene-glycol is a quite hygroscopic substance: it
among e-cigarette users. One such disease is binds the water from saliva and soft tissues, further
stomatitis nicotina palati; induced by nicotine, the increasing the rate of xerostomia already developed,
lesion mainly occurs on the hard palate, appearing along with all the adverse consequences [22]. During
as hyperkeratotic patches. Another disease occurring a 2018 research, enamel was incubated in flavoured
more often is lingua villosa nigra (black hairy tongue), and non-flavoured e-cigarette vapour; measuring
causing the enlargement of the tongue’s papillae and their hardness, the researchers found that the enamel
a change in colour to black. The risk of the disease treated with flavoured vapour was 27% softer than the
cheilitis angularis also increases; this is a state other preparation. Considering these results, flavours
associated with the bilateral drying and cracking of may promote the demineralisation of enamel. The
the anguli oris, which can be superinfected by some pathomechanism of this process is that triacetin
candida species [18]. (traditional tobacco flavour), hexyl acetate (apple
flavour), and ethyl butyrate (pineapple flavour) are
4.2 Soft Tissues: Chronic Changes all esters, sources of nutrients for cariogenic bacteria,
Several components of e-liquids may damage the manly for Streptococcus mutans. They facilitate the
epithelial cells, which can cause the death of these extracellular polymer formation of bacteria, which
cells, leading to ulcerative areas and wounds. During is the main process of biofilm generation, and they
the use of an e-cigarette, metal particles may get into promote bacterial growth. During the degradation
the aerosol from the atomiser or the cotton wool, of carbohydrates, acids are generated, mainly lactic
including cadmium, nickel, and arsenic. Metal particles acid, decreasing pH and causing the demineralisation
cause cancerous lesions, inflammation, chronic of teeth [23].
periodontitis, and neurodegeneration. As a result of The metal content of e-cigarette vapour is beneficial
heat and atomizing, flavouring substances decompose for the bacteria as well because it contains iron,
to carbonyls such as diacetyl. The main ingredients copper, and magnesium ions, which are the cofactors
(propylene glycol and glycerine) decompose because of some of the essential enzymes in Streptococcus
of the heat, and among the decomposition products mutans, and help the bacteria survive the attacks
there are molecules containing a carbonyl group of the immune system. Researchers think e-liquid
(formaldehyde, acetaldehyde) and reactive oxygen flavours are like fizzy drinks considering all things
species (ROS). These molecules are cytotoxic above, because of their cariogenic potency [23].
regardless of the nicotine content; they induce DNA E-liquids usually contain glycerine as well, which is a
damage in the oral epithelium. They decrease the desiccant like propylene-glycol. In the food industry,
cells’ defence via antioxidants, which would protect it is used as a sweetener, but cariogenic bacteria
the cell against the reactive radicals; apoptosis and cannot break it down, meaning it does not facilitate
inflammation are induced. Carbonyl compounds the development of caries this way. On the other hand,
cause protein carbonylation and oxidative stress. through its viscosity, it helps bacterial adhesion to
The consequence of all the above is a decrease in the surface of teeth; with the flavours in the e-liquid,
proliferative capacity and viability [15]. it quadruples microbial adhesion to enamel, and the
The volatile organic compounds with the potential bacterial biofilm’s size becomes twice as large [23]. The
for carcinogenicity in the e-cigarettes’ vapour have result of dental tissue weakening may be the fracture
a genotoxic effect [19]. Compared to traditional of enamel or fracture of an entire tooth. During a 2016
cigarettes, e-cigarettes have fewer carcinogenic cross-sectional study, 11.4% of young respondents
substances at lower levels, but further studies are reported such damage to their teeth, proving the
needed to find out if e-cigarettes can cause malignant scientific position that with the use of e-cigarettes, the
transformations. The difficulties to judge the situation number of cracks and fractures of teeth increases [24].
Stoma Edu J. 2022;9(3-4):109-114 pISSN 2360-2406; eISSN 2502-0285 111
Györkös ÁI, et al.
www.stomaeduj.com
4.4 Hard Tissues: Bone gingivitis, and periodontitis may develop [4]. The
Review Articles
Some ingredients of e-liquids are harmful to bone cells, symptoms of such gingivitis include pain, redness and
affecting the cells’ viability, differentiation, proliferative bleeding-while-brushing of the gingiva [17].
capacity, and matrix production. Cadmium found in It is quite interesting that according to research on the
e-liquid causes a decrease in the lifetime of osteoblasts microbiome of the saliva, done on 119 participants,
even at a small concentration; furthermore, it increases some gram-negative bacteria such as periodonto-
the risk of certain musculoskeletal diseases such as pathogenic Porphyromonas and Veillonella occur in a
rheumatoid arthritis and osteoarthritis [25,26]. greater quantity in e-cigarette users’ saliva than in that
In a 2019 experiment series, the effect of different of traditional smokers, showing e-cigarettes’ potential
flavouring substances of e-liquids on bone cells was harm leading to periodontitis [29].
assessed: osteoblasts were exposed to the most Furthermore, nicotine is antiproliferative to
popular flavoured e-liquids, both nicotine-containing fibroblasts: as a result of prostaglandins and matrix
and nicotine-free, for 48 hours, then the cells’ viability metalloproteases released upon exposure to
and their main osteoblast markers were evaluated. nicotine, myofibroblast and mesenchymal stem cell
Results showed an increase in the expression of type differentiation are blocked, holding back wound
I collagen, and the conclusion was that e-cigarettes healing. Osteoblast functions and new vessel growth
are osteotoxic: all e-liquids decreased the viability of are similarly suppressed, negatively impacting the
the cells, which was explained by oxidative stress and success rate of implant dentures, osteointegration,
a higher level of reactive oxygen radicals. The rate and the regeneration of papillae. Decreased
of osteotoxicity was determined by the dosage and osseointegration has been confirmed by animal
the flavour but was unrelated to nicotine content. experiments: around implants in rats getting a nicotine
Considering these findings, flavourless e-liquid is the injection, the size of BIC (Bone Implant Contact), i.e.,
least harmful, and cinnamon flavoured is the most the contact surface between bones and implants, was
cytotoxic [25]. lower than in the control group [27].
The negative effects of e-cigarettes cause a change The components of the periodontium – gingival
in the bone’s features, and a decrease in its density fibroblasts, periodontal ligaments, and epithelial cells
and mineral content, which is dangerous mainly in – develop and maintain inflammation as a response to
childhood because this period is crucial in proper specific stimuli or stress caused mainly by cytokines.
bone growth and development, this being the time Some components of the vapour of e-cigarettes
when 90% of the bone mass develops. A long-time such as reactive oxygen substances, aldehydes
consequence of the change in the bones’ condition and compounds containing a carbonyl group, are
might be osteoporosis [25], thus bone fractures among the triggers of inflammation. The potential
might occur more frequently; furthermore, as an inflammatory effects of carbonyl compounds include
effect of nicotine, the regeneration of bone fractures carbonylation of proteins, leading to autoantibody
is disturbed as well [27]. The changes in the bone’s production and periodontal destruction [30].
condition start in about two months of e-cigarette Furthermore, the stress caused by these compounds
use; upon quitting, the alveolar bone recovers to its gives rise to DNA damage, which translates to early
original, healthy state [28]. cell ageing. In vitro experiments have proved that
gingival fibroblasts exposed to e-cigarette vapour
4.5 Effects on the Periodontium face a greater risk of necrosis and apoptosis [30].
The duty of the periodontium is anchoring, and fixing Periodontitis is a multifactorial disease where the
the teeth in the tooth ridge. The inflammation of presence of bacteria is a necessary but not sufficient
periodontal tissues may lead to losing all the teeth, condition; the effects of e-cigarette vapour provide
meaning that a healthy periodontium is necessary to a favourable medium for the development of this
keep and maintain one’s teeth. Traditional cigarettes disease. The depth of an e-cigarette user’s periodontal
are well known for leading to periodontitis; the sac increases, the developed gingivitis may cause
question here is if e-cigarettes have this consequence, sensitivity and bleeding, and the plaque index
too. Because of the vasoconstrictor effect of nicotine, increases.[17] The risk of periodontitis increases, which
the gingiva’s oxygen and nutrition supply decrease. leads to tissue and bone destruction, tooth mobility
The consequence is a decrease in local white blood and, in the worst case, tooth loss.
cell count, followed by these cells’ inability to fulfil
their defensive role, reinforced by low levels of 5. CONCLUSION
lysozyme as a result of reduced saliva flow. On the
other hand, there are consequential changes to The main purpose of inventing e-cigarettes was to
the microbiome of the oral cavity, creating perfect find a less harmful alternative to traditional cigarettes;
circumstances for anaerobic periodonto-pathogenic it is therefore useful to compare the health effects
bacteria to multiply, such as Porphyromonas of these two harmful habits. In numerous cases, the
gingivalis, Aggregatibacter actinomycetemcomitans e-cigarettes’ harmful effects on the oral cavity are
and Prevotella intermedia. As a result of weakened milder than those of traditional cigarettes; however,
defence and bacterial colonisation, inflammation, they have several adverse effects and may cause
112 Stoma Edu J. 2022;9(3-4):109-114 pISSN 2360-2406; eISSN 2502-0285
The Oral Effects of E-cigarettes
www.stomaeduj.com
severe diseases. A further danger of e-cigarettes is on e-cigarettes’ health effects are clear: they may be
Review Articles
that there are various types of devices and e-liquids, a useful assistive device while quitting traditional
making the uniformity of regulations and medical cigarettes, but they are unadvised to use in other cases
research more difficult. Even though much research due to their negative effects on oral tissues.
has been done in this area, there are still numerous AUTHOR CONTRIBUTIONS
unanswered questions and statements awaiting
proof. Despite our lack of knowledge, the opinion All authors agree to be accountable for the content of the work.
REFERENCES
1. Jones L. Vaping: how popular are e-cigarettes. BBC News. 2019 14. Callahan-Lyon P. Electronic cigarettes: human health
Sep;14. effects. Tob Control. 2014 May;23 Suppl 2(Suppl 2):ii36-40. doi:
Available from: https://www.bbc.com/news/business-44295336, 10.1136/tobaccocontrol-2013-051470. PMID: 24732161; PMCID:
Sep. 13, 2019. PMC3995250.
Fulltextlinks CrossRef Free PMC Article PubMed Google Scholar
2. Wang TW, Neff LJ, Park-Lee E, et al. E-cigarette use among 15. Ebersole J, Samburova V, Son Y, et al. Harmful chemicals
middle and high school students - United States, 2020. emitted from electronic cigarettes and potential deleterious
MMWR Morb Mortal Wkly Rep. 2020 Sep 18;69(37):1310-1312. effects in the oral cavity. Tob Induc Dis. 2020 May 8;18:41. doi:
doi: 10.15585/mmwr.mm6937e1. PMID: 32941408; PMCID: 10.18332/tid/116988. PMID: 32435175; PMCID: PMC7233525.
PMC7498174. CrossRef Free PMC Article PubMed Google Scholar Scopus
CrossRef Free PMC Article PubMed Google Scholar 16. Alanazi H, Semlali A, Chmielewski W, Rouabhia M. E-cigarettes
3. Li Y, Burns AE, Tran LN, et al. Impact of e-liquid composition, increase Candida albicans growth and modulate its interaction
coil temperature, and puff topography on the aerosol with gingival epithelial cells. Int J Environ Res Public Health. 2019
chemistry of electronic cigarettes. Chem Res Toxicol. 2021 Jun Jan 21;16(2):294. doi: 10.3390/ijerph16020294. PMID: 30669681;
21;34(6):1640-1654. doi: 10.1021/acs.chemrestox.1c00070. Epub PMCID: PMC6352080.
2021 May 5. PMID: 33949191. CrossRef Free PMC Article PubMed Google Scholar Scopus
CrossRef PubMed Google Scholar Scopus 17. Rouabhia M. Impact of electronic cigarettes on oral health: a
4. Rajhans N, Sabale D, Patil T, et al. Can vaping affect the pe- review. J Can Dent Assoc. 2020 Mar;86:k7. PMID: 32543367.
riodontal health? A review. Int. J. of Sci. and Res. vol. 2018 Nov. Full text links PubMed Google Scholar Scopus
7(11):1491-1492. 18. Bardellini E, Amadori F, Conti G, Majorana A. Oral
Full text link mucosal lesions in electronic cigarettes consumers versus
5. Zhou Y, Irshad H, Dye WW, et al. Voltage and e-liquid com- former smokers. Acta Odontol Scand. 2018 Apr;76(3):226-228.
position affect nicotine deposition within the oral cavity and doi: 10.1080/00016357.2017.1406613. Epub 2017 Nov 21. PMID:
carbonyl formation. Tob Control. 2021 Sep;30(5):485-491. doi: 29161938.
10.1136/tobaccocontrol-2020-055619. Epub 2020 Jun 25. PMID: CrossRef PubMed Google Scholar Scopus
32587113. 19. Ganapathy V, Manyanga J, Brame L, et al. Electronic
CrossRef PubMed Google Scholar Scopus cigarette aerosols suppress cellular antioxidant defenses and
6. Kaán R, Pénzes M, Abafalvi L, et al. Oral hygiene practices of induce significant oxidative DNA damage. PLoS One. 2017 May
hungarian adult E-cigarette-only and dual users. Oral Health Prev 18;12(5):e0177780. doi: 10.1371/journal.pone.0177780. PMID:
Dent. 2020 Nov 20;18(1):991-998. doi: 10.3290/j.ohpd.a45520. 28542301; PMCID: PMC5436899.
PMID: 33215490. CrossRef Free PMC Article PubMed Google Scholar Scopus
CrossRef PubMed Google Scholar Scopus 20. Raj AT, Sujatha G, Muruganandhan J, et al. Reviewing the oral
7. A seemingly harmless disease, The clinic and treatment
carcinogenic potential of E-cigarettes using the Bradford Hill
options for xerostomia, MOSZ Info , Mar. 2017.
criteria of causation. Transl Cancer Res.2020 Apr;9(4):3142-
Full text link
3152. doi: 10.21037/tcr.2020.01.23. PMID: 35117678; PMCID:
8. Jones SL, Jones PK, Katz J. A nursing intervention to in-
PMC8798817.
crease compliance in otitis media patients. Appl Nurs Res. 1989
CrossRef Free PMC Article PubMed Google Scholar Scopus
May;2(2):68-73. doi: 10.1016/s0897-1897(89)80048-5. PMID:
2719485. 21. “Is Vaping Bad for Your Teeth? 7 Things to Know About Its
CrossRef PubMed Google Scholar Scopus Effects on Your Oral Health,” Available from: https://www.health-
9. Bakema JE, van Egmond M. Immunoglobulin A: A next genera- line.com/health/dental-and-oral-health/dental-and-oral-health-
tion of therapeutic antibodies? MAbs. 2011 Jul-Aug;3(4):352-361. is-vaping-bad-for-your-teeth.
doi: 10.4161/mabs.3.4.16092. Epub 2011 Jul 1. PMID: 21691145; Full text links
PMCID: PMC3218532. 22. Froum S, Neymark A. Vaping and oral health: It’s worse
CrossRef Free PMC Article PubMed Google Scholar than you think. Perio-Implant Advisory. 2019 May. Available
10. Cichońska D, Kusiak A, Kochańska B, et al. Influence of electro- from: https://www.perioimplantadvisory.com/clinical-tips/ar-
nic cigarettes on selected antibacterial properties of saliva. Int J ticle/16412201/vaping-and-oral-health-its-worse-than-you-think,
Environ Res Public Health. 2019 Nov 12;16(22):4433. doi: 10.3390/ Jan. 10, 2019.
ijerph16224433. PMID: 31726698; PMCID: PMC6888580. Full text links
CrossRef Free PMC Article PubMed Google Scholar Scopus 23. Kim SA, Smith S, Beauchamp C, et al. Cariogenic potential of
11. Trtchounian A, Williams M, Talbot P. Conventional and sweet flavors in electronic-cigarette liquids. PLoS One. 2018 Sep
electronic cigarettes (e-cigarettes) have different smoking 7;13(9):e0203717. doi: 10.1371/journal.pone.0203717. PMID:
characteristics. Nicotine Tob Res. 2010 Sep;12(9):905-912. doi: 30192874; PMCID: PMC6128655.
10.1093/ntr/ntq114. Epub 2010 Jul 19. PMID: 20644205. CrossRef Free PMC Article PubMed Google Scholar Scopus
CrossRef PubMed Google Scholar 24. Cho JH. The association between electronic-cigarette use
12. Science Daily. Electronic cigarettes require more suction than and self-reported oral symptoms including cracked or broken
conventional brands. Science News. University of California - teeth and tongue and/or inside-cheek pain among adolescents:
Riverside, Jul. 2010. Available from: https://www.sciencedaily. a cross-sectional study. PLoS One. 2017 Jul 11;12(7):e0180506.
com/releases/2010/07/100728144349.htm doi: 10.1371/journal.pone.0180506. PMID: 28700729; PMCID:
Full text link PMC5507461.
13. Caporale A, Langham MC, Guo W, et al. Acute effects of CrossRef Free PMC Article PubMed Google Scholar
electronic cigarette aerosol inhalation on vascular function 25. Fiani B, Noblett C, Nanney JM, et al. The impact of ‘
detected at quantitative MRI. Radiology. 2019 Oct;293(1):97- vaping’ electronic cigarettes on spine health. Cureus. 2020 Jun
106. doi: 10.1148/radiol.2019190562. Epub 2019 Aug 20. PMID: 29;12(6):e8907. doi: 10.7759/cureus.8907. PMID: 32742873;
31429679; PMCID: PMC6776371. PMCID: PMC7389958.
CrossRef Free PMC Article PubMed Google Scholar Scopus CrossRef Free PMC Article PubMed Google Scholar
Stoma Edu J. 2022;9(3-4):109-114 pISSN 2360-2406; eISSN 2502-0285 113
Györkös ÁI, et al.
www.stomaeduj.com
26. Reyes-Hinojosa D, Lozada-Pérez CA, Zamudio Cuevas Y, et al. 29. Pushalkar S, Paul B, Li Q, et al. Electronic cigarette aerosol
Review Articles Toxicity of cadmium in musculoskeletal diseases. modulates the oral microbiome and increases risk of infection.
Environ Toxicol Pharmacol. 2019 Nov;72:103219. doi: 10.1016/j.
etap.2019.103219. Epub 2019 Aug 15. PMID: 31494513. iScience, 2020 Mar 27;23(3):100884. doi: 10.1016/j.
CrossRef PubMed Google Scholar Scopus isci.2020.100884. Epub 2020 Feb 26. PMID: 32105635; PMCID:
27. Kazi S, Khader AA, Sheth AM, et al. Effects of vaping on PMC7113564.
periodontium - a review. J of Adv. Med. and Dental Sci. Res. 2020 CrossRef Free PMC Article PubMed Google Scholar Scopus
Feb 1;8(2):69-72.
Full text links Google Scholar 30. Javed F, Kellesarian SV, Sundar IK, Romanos GE, Rahman I.
28. César-Neto JB, Benatti BB, Sallum EA, et al. The influence of Recent updates on electronic cigarette aerosol and inhaled
cigarette smoke inhalation and its cessation on the nicotine effects on periodontal and pulmonary tissues. Oral Dis.
tooth-supporting alveolar bone: a histometric study in rats. 2017 Nov;23(8):1052-1057. doi: 10.1111/odi.12652. Epub 2017
J Periodontal Res. 2006 Apr;41(2):118-123. doi: 10.1111/j.1600-
0765.2005.00844.x. PMID: 16499714. Mar 30. PMID: 28168771; PMCID: PMC5545167.
CrossRef PubMed Google Scholar Scopus CrossRef Free PMC Article PubMed Google Scholar Scopus
Áron Imre GYÖRKÖS
DMD, Clinical Doctor
Szép és Ép fog Kft.
Érd, Hungary
CV
Dr. Áron Imre Györkös, DMD, graduated from the Faculty of Dentistry, Semmelweis University, Budapest, Hungary in 2021. He is
currently working as a dentist in Érd, next to Budapest, both in the public and private sector. The title of his research is The oral
effects of e-cigarettes - a literature review. He started exploring this topic as his thesis and tried to summarise today's knowledge
of e-cigarette health effects. He is currently working on something similar with IQOS and other heated tobacco products.
Questions
1. Generally, what temperature range do e-cigarettes vaporise the e-liquid?
qa. 57 to 66 degrees Celsius;
qb. 157 to 266 degrees Celsius;
qc. 200 to 400 degrees Celsius;
qd. 800 to 1000 degrees Celsius.
2. Which statement is true about the changes on the saliva because of e-cigarette usage?
qa. The pH of the saliva rises by the usage of nicotine-free liquids;
qb. The pH of the saliva decreases by the usage of nicotine-free liquids;
qc. The pH of the saliva rises by the usage of nicotine containing liquids;
qd. The vapour-inducted temperature rise causes more saliva secretion.
3. According to a 2011 survey by the WHO, how many people used e-cigarettes regularly
worldwide at the time?
qa. 1 million;
qb. 34 million;
qc. 7 million;
qd. 1 billion.
4. Which component of the e-liquid can cause yellowish-brownish patches on the surface
of the teeth?
qa. Propylene-glycol;
qb. Glycerine;
qc. Sweeteners;
qd. Nicotine.
114 Stoma Edu J. 2022;9(3-4):109-114 pISSN 2360-2406; eISSN 2502-0285