Electronic nicotine delivery systems (ENDS): a strategy for smoking cessation or a new risk factor for oral health?

Evid Based Dent. 2023 Dec;24(4):188-189. doi: 10.1038/s41432-023-00929-w. Epub 2023 Sep 6.


Data sources: A search was conducted in PubMed and Cochrane Library databases for articles published in English between January 2012 and October 2022.

Study selection: Articles were selected using both the term "electronic nicotine delivery system" (ENDS), as per the Medical Subject Heading (MeSH), in conjunction with specific oral domains. In vitro studies, animal models, unregistered clinical trials, and articles with conflicts of interest were excluded.

Data extraction and synthesis: Clinical and public health studies comparing ENDS users, smokers, and non-smokers in the context of oral-related diseases were included. Results from duplicate articles were not considered.

Results: The study indicates a potential carcinogenic effect due to cytogenotoxicity from intrinsic components of ENDS. However, this does not establish ENDS as an independent risk factor for oral cancer. ENDS use may alter the oral microbiome, leading to increased biofilm adhesion and potential associations with caries, periodontal disease, and peri-implantitis. The wide variety of flavors available in the ENDS market is a significant factor influencing initiation and long-term use by young people.

Conclusions: ENDS users are susceptible to periodontal disease, caries, soft tissue injuries, and changes in tooth and prosthesis coloration. The chemical components in ENDS can induce cellular changes associated with a potential risk of oral cancer. However, more long-term studies are required to fully understand the impact of ENDS use on oral health.

Publication types

  • Review
  • Comment

MeSH terms

  • Adolescent
  • Dental Caries*
  • Electronic Nicotine Delivery Systems*
  • Humans
  • Mouth Neoplasms* / chemically induced
  • Oral Health
  • Periodontal Diseases*
  • Risk Factors
  • Smoking Cessation* / methods