Does Vaping Cause Gum Disease?

Let’s follow the path that vape takes through the body and explore what evidence we have so far for how it might be affecting our health, particularly in comparison with cigarettes. Our first stop is the mouth. A number of young people have reported on social media recently that, after particularly intense periods of vaping use, they’ve noticed a sore mouth and bleeding gums; one put this down to buying disposable vapes: being easier to use covertly - in her case even in the cinema - she found she was vaping very frequently - far more, in fact, in nicotine terms than she would have smoked. Bleeding gums is a sign of gum disease; and that can have effects all around the body. Speaking with Chris Smith, Ian Needleman is Professor of dentistry at the Eastman Dental Institute in London...

Ian - We know a lot about cigarette smoking. It increases the risk somewhere between about three and six times of developing gum disease. And the mechanisms that underpin this fall into three main categories. One is to change the bacteria in the mouth known as the microbiome. The second thing is to increase how our body reacts to the bacteria, creating greater inflammation and therefore greater risk of damage to the mouth and gums. And the third thing is that smoking gets in the way of how we fight the bacteria. In other words, it impairs our immune response.

Chris - So if all that happens with smoking, how does that compare to vaping?

Ian - It's a great question, and we're in early days of understanding this. What we know so far is there are changes in the bacteria, in the microbiome, in the mouth. And a study that was published very recently looked at three groups: non-smokers; people who were only using vapes; and people that were only smoking. And what was interesting was over a six month period, the characteristics of the vapers was very different from the non-smokers, but also different from the smokers. And what's important in thinking about risk is that the type of bacteria were those associated with problems such as gum disease.

Chris - Do we know how these products, when you put them in your mouth, change the bacteria in that way?

Ian - It's likely that vaping will change the environment like any kind of ecosystem by changes in acidity, pH by temperature. What we also know is that it's tending to favour an increase in inflammation, which can then lead to damage to the tissues. And it seems vaping might also make the cells around the mouth more able to be colonised by bacteria. So make it easier for the bacteria to get a foothold and therefore make the first stages of causing disease.

Chris - Does this occur to a lesser extent with vaping than with smoking? Because one of the arguments is that, that you can use vaping as a step down from smoking and nothing's as bad as smoking. So is it that you get the same sorts of changes as smoking, but they're not as pronounced or have we got new changes that we can see that vaping may have independent risk for the health of your mouth and teeth, that's not there if you smoke?

Ian - The evidence so far, is that vaping is still much safer compared to smoking. Is it harmful compared to not smoking? The evidence is starting to look quite concerning that vaping will carry risks, that aren't there if you're a non-smoker.

Chris - One of the things that often surprises people is to learn that if you don't look after your teeth, then often you're at higher risk of a whole raft of other diseases. Things like your heart disease risk goes up, if you have gum disease. And people argue this is because of inflammation being a systemic thing all around the body, even though it may start in one place. So if you are arguing that vaping is a risk factor for more inflammation in the mouth, does that mean that indirectly you could be at risk of a whole raft of other conditions, including things like heart disease, downstream of that?

Ian - Yeah, I'm really glad you brought it into the discussion of the sort of connection between the mouth and the rest of the body. Because for most of us, if you look around most people's heads are, and their mouths are connected to the rest of the body! So there's bound to be connection. And, you know, one of the very specific links that has been demonstrated is in the control of blood pressure, because it may be surprising to many people that one of the first steps in control of blood pressure is nitrate that we take in through things like leafy vegetables and the way that that nitrate is reduced into nitric acid, which is a very important part of the pathway of maintaining blood pressure, that is initiated in the mouth by the bacteria in the mouth. So these changes that I've talked about through smoking into the oral microbiome have also demonstrated that the types of bacteria that would favour a better control of blood pressure, they will be overtaken by species, which aren't involved in that pathway. So there's a very clear example of how a change in the bacteria in the mouth can affect health. And we know that a number of conditions, particularly severe gum disease will have impacts, as you said, on heart health. Only last week, NICE has produced a new updated guidance on the management of type two diabetes. And for the first time, one of the recommendations to manage type two diabetes is to treat gum disease, because it's been again well demonstrated that if you treat gum disease and the inflammation associated with gum disease, you can improve people's control of their blood sugar. So things are very much interconnected how the health of your mouth will have an effect on the rest of your body and the health, and the rest of your body will affect your mouth too.