The impact of e-cigarette use on periodontal health: a systematic review and meta-analysis

Abstract

Background

Electronic Nicotine Delivery Systems (ENDS, e-cigarettes) are a popular alternative to traditional tobacco smoking. Objective: To evaluate the effect of ENDS use on periodontal health.

Methods

A protocol was published in accordance with PRISMA standards. Subjects with periodontal health, gingivitis and periodontitis were included. Reviews, case reports, letters, abstracts, narratives and expert opinions were excluded. Databases searched included PubMed, Embase, Web of Science, CINAHL Plus, and Dentistry & Oral Sciences Source up until February 2024. Risk of bias was evaluated using the Newcastle-Ottawa Scale, ROBINS-I and the RoB 2 tools.

Results

40 eligible studies were included. Smokers had poorer clinical outcomes than ENDS users and non-smokers/former smokers, apart from bleeding on probing and gingival indices. There was no difference between ENDS users and non-smokers/former smokers in markers of periodontal destruction (pocket probing depths/marginal bone loss). ENDS users had higher plaque scores than non-smokers/former smokers. ENDS use leads to unique microbial changes compared to tobacco smokers and higher pro-inflammatory markers compared to non-smokers/former smokers.

Conclusion

Within the limitations of the included studies which are at high risk of bias, we found evidence that ENDS use had some impact on periodontal parameters compared to non-smokers/former smokers. Tobacco smokers had consistently worst outcomes.

Registration PROSPERO 2024

CRD42024496560.

Metadata

Item Type:	Article
Authors/Creators:	Tattar, R. Jackson, J. https://orcid.org/0000-0002-8599-9065 Holliday, R. https://orcid.org/0000-0002-9072-8083
Copyright, Publisher and Additional Information:	© The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Keywords:	Periodontics; Periodontitis
Dates:	Accepted: 20 January 2025 Published (online): 13 February 2025 Published: June 2025
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Clinical Dentistry (Sheffield)
Depositing User:	Symplectic Sheffield
Date Deposited:	01 Jul 2025 08:17
Last Modified:	01 Jul 2025 08:17
Status:	Published
Publisher:	Springer Science and Business Media LLC
Refereed:	Yes
Identification Number:	10.1038/s41432-025-01119-6
Related URLs:	PubMed URL Dataset
Sustainable Development Goals:
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:228549