Research Looks at Vaping and Dental Caries Risk

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Recent research conducted by Tufts University School of Dental Medicine has shed light on the connection between vaping and an increased risk of dental caries. This study, featured in the Journal of the American Dental Association, emphasizes the importance of understanding the impact of vaping on oral health.1

The Study

The study focused on patients aged 16 and older who received a caries diagnosis and had a caries risk assessment on record between January 1, 2019, and January 1, 2022. These patients were asked about their use of e-cigarettes or vapes in a health history questionnaire. Those who reported recreational drug use (excluding drugs consumed through vaping or e-cigarette use) and those without a caries diagnosis were excluded from the study.1

CAMBRA (Caries Management by Risk Assessment) was used to assess caries risk, including inquiries about visible carious lesions, restorations or extractions due to caries, biofilm presence, occlusal and proximal lesions, saliva flow, dietary habits, and erosion risk. A software-generated algorithm categorized patients into risk-level categories: low, moderate, high, or extreme, with high and extreme categories combined into one “high” risk group.1

The Results

The study analyzed a convenience sample of over 13,000 patients treated at Tufts dental clinics between 2019 and 2022. The results revealed a significant difference in dental caries risk levels between those who used e-cigarettes or vaping devices and those who did not. Approximately 79% of vaping patients were classified as having a high caries risk, compared to about 60% in the control group.1

Clinical Application

One potential reason for this increased risk is vaping liquids’ sugary content and stickiness, which can adhere to teeth when inhaled through the mouth. Research has also shown that vaping aerosols can alter the oral microbiome, creating a more favorable environment for caries-causing bacteria. For example, the aerosols from vaping have been shown to hinder the growth of commensal oral bacteria, such as Streptococcus sanguinis and Streptococcus gordonii. Interestingly, vaping can lead to decay in unusual areas, such as the incisal edges of anterior teeth.1

The researchers suggest “that the use of e-cigarettes or vapes should not only be included in the routine dental-medical history questionnaire, but also among the risk factors that increase a patient’s caries risk level.”1 This information can help assess a patient’s risk of developing caries more accurately. Especially for patients who use e-cigarettes, it may be beneficial to implement a more intensive caries management protocol. This could involve prescription-strength fluoride toothpaste, fluoride rinses, in-office fluoride applications, and more frequent recall appointments.1


This research underscores the importance of recognizing vaping as a potential contributor to dental caries. Both dental professionals and patients should stay informed and proactive in addressing this emerging concern in oral health. Future studies should further explore this association to deepen our understanding of vaping’s impact on dental health.

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  1. Irusa, K.F., Finkelman, M., Magnuson, B., et al. A Comparison of the Caries Risk between Patients Who Use Vapes or Electronic Cigarettes and Those Who Do Not: A Cross-sectional Study.Journal of the American Dental Association. 2022; 153(12): 1179-1183.