Electronic Cigarettes, Heated Tobacco Products, and Oral Health: A Systematic Review and Meta-Analysis

Smokers employing electronic nicotine delivery systems (ENDS) and heated tobacco prod- ucts (HTP) are currently the most common types of smoking patients seen in the dental practice. Both types of smoking are currently viewed as less harmful than cigarette smoking. However, many studies already indicate that they could harm oral health. This systematic review and meta-analysis aimed to collect a comprehensive overview of the actual knowledge regarding ENDS and HTP from a clinical and a laboratory perspective. Publications available through PubMed, Embase, the Web of Science, Scopus, and Google Scholar were used to summarize the effects of ENDS and HTP on oral health. Six surveys on self-perceived gum disease (T2 = 9.47 I2 = 99.32%), three cross-sectional stud- ies reporting the BOP score (T2 = 8.68 I2 = 99.13%), and four in vitro studies on apoptosis after vaping exposure in human oral fibroblasts (T 2 = 8.10 I2 = 91.50%) were separately analyzed. The risk of bias ranged from critical to low. Both ENDS and HTP seem to have detrimental effects on periodon- tal and peri-implant parameters, and laboratory tests confirmed the presence of carcinogenic and inflammatory biomarkers. flavored e-liquids may also be a caries risk factor. Comprehensive smok- ing counseling should be carried out with all types of smoking patients, investigating the type of habit in terms of duration, nicotine percentage, and additional flavorings. Additional research is necessary to assess the long-term effects of alternative tobacco products on oral health.