Comparative Effects of E-Cigarette Aerosol on Periodontium of Periodontitis Patients

Abstract

Introduction: Tobacco use is one of the main causes of periodontitis. E-cigarette are gaining in popularity, and studies are needed to better understand the impact of e-cigarettes on oral health.Objective: To perform a longitudinal study to evaluate the adverse effects of e-cigarettes on periodontal health.Methods: Naïve E-cigarette users, cigarette smokers, and non-smokers were recruited using newspaper and social media. Age, gender, and ethnicity, were recorded. Participants were scheduled for two visits 6 months apart. At each visit, we collected data on the frequency and magnitude of e-cigarette and cigarette use, and alcohol consumption. Carbon monoxide (CO) levels, cotinine levels, salivary flow rate, periodontal probing depth (PD), bleeding on probing (BoP), and clinical attachment loss (CAL) were also determined at both baseline and follow-up visits and compared between groups with two-way repeated measures ANOVA. Periodontal diagnosis and other categorical variables were compared between groups with the chi-square statistic and logistic regression.Results: We screened 159 subjects and recruited 119 subjects. One-hundred-one subjects (31 cigarette smokers, 32 e-cigarette smokers, and 38 non-smokers) completed every assessment in both visits. The retention and compliance rate of subjects was 84.9%. The use of social media and craigslist was significant in recruiting e-cigarette subjects. Ethnicity and race differed between groups, as did average age in the male subjects. Carbon monoxide and salivary cotinine levels were highest among cigarette smokers. Bleeding on probing and average PDs similarly increased over time in all three groups, but CAL uniquely increased in e-cigarette smokers. Rates of severe periodontal disease were higher in cigarette smokers and e-cigarette users than non-smokers, but interpretation is confounded by the older age of the cigarette smokers.Conclusion: Among the recruited participants, CAL after 6 months was significantly worse only in the e-cigarette smokers. This study design and protocol will assist in future larger studies on e-cigarette and oral health.

Electronic cigarette use enriches periodontal pathogens

“…The ES group had a relatively balanced number of severe cases and mild/moderate cases, but all of the ES mild cases at enrollment progressed to moderate after ∼6 months. In total, from the baseline visit to the follow-up visit, 29% of the mild/moderate cases in the ES group had disease progression, compared to only 18% in the NS group (Xu et al, 2021).…”

“…The study was approved by the Institutional Review Board of New York University Langone Medical Center. Ethical guidelines, participant enrollment, recruitment, and eligibility criteria were previously published (Xu et al, 2021). To investigate the long-term effects on oral health of e-cigarette smoking, participants were scheduled for two visits scheduled approximately 6 months apart.…”

“…All participants received a periodontal disease clinical assessment at enrollment, and only those with at least mild periodontitis were recruited. Periodontitis disease status (mild, moderate, or severe) was determined according to the definition given by the CDC in collaboration with the American Academy of Periodontology (CDC-AAP) (Table S1) (Eke et al, 2013;Xu et al, 2021). In total, 119 subjects were successfully recruited, 101 of whom completed all the assessments at both study visits.…”

“…All subjects received comprehensive examinations of the gums conducted by the clinician, and saliva samples were collected at both visits. Of the 119 initial participants, 101 (31 CS, 32 ES, 38 NS) completed all assessments for both study visits, resulting in a retention rate of 85% (Xu et al, 2021). (f) Follow-up (V2) alpha diversity measures among 53 mild and moderate patients across the MCS, MES, and MNS groups.…”

Electronic Cigarette Use Promotes a Unique Periodontal Microbiome

“…The use of electronic cigarettes (e-cigs) is on the rise in adults and young people ( 1 – 7 ). The use of e-cigs is often perceived and promoted as a safer alternative to cigarette smoking due to the absence or reduction of harmful combustion products ( 4 , 8 – 10 ).…”