How does vaping impact orthodontics?

Saba Qureshi explores the impact of vaping on oral health and tooth movement, and the advice dental professionals should be giving to vape users.

Since it was first offered as a tool to assist adult smokers in quitting, vaping has grown in popularity, with many promoting it as a ‘healthier’ alternative.

Vaping is the inhalation of vaporised liquid delivered through a smoking apparatus known as a vape. A vape is a liquid filled cartridge that heats nicotine, flavouring and other chemicals to create an aerosol that is inhaled.

Though vapes might have fewer harmful chemicals than cigarettes, little research has been done on the health impacts of vapes and e-cigarettes, and we still don’t know exactly what chemicals are in many of them. What we do know is the vapour produced is not made solely of water vapour, but is in fact an amalgamation of nanoparticles, volatile organic compounds, carbonyls, heavy metals and nicotine.

Vaping data

Recent data has highlighted cases of lung injuries and deaths associated with vaping and links to chronic lung disease and asthma, with the Centers for Disease Control and Prevention (CDC) based in the United States confirming 2,807 cases of e-cigarette/vaping use-associated lung injury and 68 deaths.

According to the most recent data from the Office for National Statistics, in the UK in 2022, 12.9% of adults over the age of 18 (or roughly 6.4 million people) smoked cigarettes. Estimates from the Annual Population Survey (APS) indicate that this is the lowest percentage of smokers now in the population since records began in 2011.

Of those who smoked, the highest proportion fell within the 25 to 34 year age range.

Additionally, roughly 4.5 million adults, or 8.7% of respondents to the Opinions and Lifestyle Survey (OPN), reported using e-cigarettes either regularly or infrequently. This is an increase from 7.7% in 2021.

Interestingly, e-cigarette use was highest among those aged 16 to 24 years (many of whom have never smoked cigarettes), with the percentage of people in this age group who were daily or occasional vapers rising from 11.1% in 2021 to 15.5% in 2022. This was particularly evident amongst younger females, where the prevalence of vaping saw a three-fold increase.

This may be in part due to how vapes are marketed, and therefore perceived.

Although e-cigarette/vape companies deny targeting this demographic, many of their flavours, such as strawberry lemonade and bubble-gum, together with their vibrantly coloured packaging, are nevertheless appealing to this age group.

Oral health and vaping

But why is this relevant to us as orthodontists?

The most obvious reason is that this age group represents a large percentage of our daily patient base. As a result, we need to be aware of any relationship between vaping and orthodontic tooth movement and whether it affects treatment efficacy and patient outcomes.

The main concerns around vaping are whether it causes:

Xerostomia: reduced saliva can increase the risk of dental issues such as dental caries, periodontal disease, and oral infections
Periodontal disease: changes in the oral microbiome may lead to an overgrowth of pathogens leaving patients more susceptible to oral disease
Caries: a combination of dry mouth and exposure to harmful chemicals might contribute to dental caries
Oral lesions: can vaping cause tissue damage that elevates inflammation and, in conjunction with DNA damage from e-cigarette chemicals, raise the risk of oral cancer?
Detrimental effect on tooth movement: are patients who vape more at risk of root resorption or prolonged treatment duration?

The difficulty that arises when assessing these risks is that there are two main categories of vape users:

Those with a history of cigarette/tobacco smoking, turning to vaping to aide smoking cessation
Those who have never smoked, using vapes on a regular basis.

Naturally, a variety of general and oral health conditions are already present in those who have smoked in the past. Because of its well-known vasoconstrictive effect on the gingival tissues, tobacco use can conceal the severity of underlying periodontal problems. Nonetheless, smoking cessation will have numerous short- and long-term health benefits that exceed any reported drawbacks from vaping.

Those in the second group, on the other hand, begin from a position of health. Prolonged and frequent vaping may expose them to unknown risks for their oral and overall health.

What does the research say?

Unfortunately, despite vaping having become a ‘hot topic’ within the dental profession of late, there really isn’t enough research out there with regards to it’s effect on tooth movement.

Most research has focused around periodontal health, with the majority of studies agreeing that vaping puts patients at an increased risk of developing gingivitis and periodontal disease. There is undoubtedly a need for more research on this topic because some studies have yielded contradictory results.

With regards to caries, there is little evidence to suggest vape users are more at risk of developing caries. However, vaping does cause dry mouth due the to the water-binding effects of the ingredient propylene glycol, which could place patients into a higher risk category.

Because of the tar and burning process, tobacco smoke is a rich source of carcinogens. These two are avoided by e-cigarettes, dramatically reducing the risk of oral cancer in patients that switch from cigarettes to vapes.

Those who vape have also been reported to have a higher incidence of hyperplastic candidiasis, possibly as a result of chemical compounds in e-liquids changing the intraoral pH.

Vaping and tooth movement

And finally, orthodontic tooth movement. Again, research concerning this specific topic is sparse and ambiguous.

Some studies suggest that nicotine, a common component found in vaping liquids, has vasoconstrictive properties that restrict blood flow to the tissues, including the periodontal ligament (PDL) surrounding the teeth.

This diminished blood supply can hinder the cellular activities essential for orthodontic tooth movement, such as bone remodelling and tooth displacement, and can lead to increased alveolar bone loss and root resorption.

Consequently, orthodontic patients who vape may experience prolonged treatment durations and slower progress towards achieving desired tooth alignment. Yet other studies have produced contradictory results.

More clinical and experimental studies are clearly required to assess the effects of vapes and their components on the periodontal tissues and orthodontically induced tooth movement.

What advice should we give to orthodontic patients who vape?

Well, that depends very much on the individual.

Those utilising vaping as an adjunct to smoking cessation should certainly be encouraged to use it ‘for long enough to prevent a return to smoking’, in accordance with the current NICE guidance. Stop using them ‘when they are ready to do so’.

On the other hand, individuals who vape but have never smoked – typically younger patients – should be urged to quit. Because nicotine is so addictive, a lot of people who use vapes may eventually start smoking cigarettes.

Indeed, a recent study conducted in the UK discovered that 14.3% of e-cigarette users switched to smoking after a year.

While vaping may appear innocuous to some, its impact on orthodontic tooth movement and oral health is yet to be fully understood. From impeding the pace of treatment to heightening the risk of root resorption, vaping might pose significant, as yet unknown, challenges for orthodontic patients seeking optimal outcomes.

By raising awareness, providing support for smoking cessation, and closely monitoring patient progress, orthodontists can navigate these challenges and ensure the effectiveness of treatment in the face of evolving oral health trends.

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