Are E-cigarettes Less Dangerous to Oral Health Than Cigarettes?

Purnima Kumar, BDS, ’05 MS, ’05 PhD, has for years studied the impact of cigarette smoking on periodontal health and disease. As e-cigarettes have surged in popularity, the

Ohio State College of Dentistry clinician-scientist has now turned her attention to their impact on oral health—with startling findings.

To me, smoking has both a professional and very personal connection. My father was a lifelong smoker and died from complications related to smoking. He was the bravest man I knew—an officer in the Air Force who had been in three wars—and yet could not conquer a habit. On a professional level, I’m a periodontist, and a lot of people I treat are smokers. I have been a dental surgeon for 30 years now, but for these patients, the outcomes of surgery are not good at all. The question is always: Why are their outcomes so poor? What does smoking do to your mouth to cause disease and to impede efforts in treating the disease?

When e-cigarettes were introduced into the marketplace, we quickly found that there were no data out there about them. There was nothing known. We started by studying e-cigarettes only in people who don’t have gum disease. We wanted to know what happens to you when you’re healthy and start this habit.

The first thing we looked at was how e-cigarettes change the friendly bacteria in the mouth. We found that they make these bacteria completely toxic. Even the good bacteria in the mouth when exposed to vapor produced a gelatinous goo—they get very stressed. I grew bacteria from my own mouth in a petri dish under different conditions. When there’s no e-cigarette vapor, I can brush it off with a toothbrush. But when exposed to vaping, the bacteria starts looking like phlegm.

As a periodontist, I’m seeing people who use e-cigarettes in their mid-twenties and thirties who have receding gums and need gum grafts. Gum grafts never work well on these patients, so now I’m studying what e-cigarettes may do to deter wound healing. We are taking people who vape and giving them a highly standardized

e-cigarette and comparing them to a control group. What we are finding is when we make a little punch in the roof of the mouth for the study, the non-vaping group begins to heal within four days. In seven days no one would know the wound was ever there. With the e-cigarette group, at 21 days the wound still hasn’t healed.

We also did a study on a group of people who quit smoking and started using e-cigarettes, and a group who quit smoking without them. What we’re finding is when people quit smoking and don’t use anything, their oral bacteria start looking healthy. But when they quit and start using e-cigarettes, the negative effect on mouth bacteria is very powerful and happens much quicker than through smoking. Our smokers in the study had been smoking at least five years, and our e-cigarette users had been smoking 12-18 months. The effect of e-cigarettes is very accelerated and exaggerated.

Oh, yes, very popular among young people. The same flavors that are in candy are also in e-cigarettes. In addition, the nicotine used in some brands of e-cigarettes provides a high very quickly.

I go out and give talks at high schools and colleges. I take travel cans of hair spray and say, “How many of you vape?” Hands always go up. I say, “Take this hair spray and spray it in your mouth. This is an aerosol, just like an e-cigarette.” Of course, no one wants to do that. Then I’ll ask them: “If you won’t use this, why are you using that?” These are kids who think they can walk in front of a bus and not get hit. So they don’t relate to data on sickness and death; we have to begin these conversations by breaking down the myths about safety. Young people are very intelligent. If you show them the way, they’ll find their answers.

I would say not. They’re replacing one addiction with another. At least with smoking cessation, we have a few tools to help. We don’t even know how to treat e-cigarette addiction. The jury is still out on whether e-cigarettes help you quit smoking successfully, but then how do you quit e-cigarette juice? That’s one we don’t have an answer to.

I have a grant that is under review to look at the impact of e-cigarettes on pregnant women. To me, that is very important—we really have to look toward the generations that have not yet come and leave the world a better place for them. That’s my fundamental philosophy. I’m also involved in different kinds of engagement and leadership roles. We can’t just do research all the time. We can change the world one patient at a time, but we also have to change the world for the larger population, so having leadership roles in making policy decisions is important. ■