Co esponding au ho : Pu u Ma ia i Kaman Dewi
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
The e ec o elec ic ciga e e uses on o al heal h and he isk o den al ca ies:
Implica ions o den al conse a ion p ac ices
Pu u Ma ia i Kaman Dewi 1, * and Made Agus ya Da ma Pu a Wesnawa 2
1 Depa men o Conse a i e Den is y, Facul y o Medicine, Uni e si as Udayana, Denpasa , Indonesia.
2 Depa men o Pulmonology and Respi a o y Medicine, Facul y o Medicine, Uni e si as Udayana, Denpasa , Indonesia.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1259-1265
Publica ion his o y: Recei ed on 09 July 2025; e ised on 16 Augus 2025; accep ed on 18 Augus 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.2.2979
Abs ac
The use o elec ic ciga e es (e-ciga e es) has isen sha ply, especially among eenage s and young adul s, as an
al e na i e o con en ional ciga e es. Al hough pe cei ed as sa e , elec ic ciga e es ha e a signi ican impac on o al
heal h, which in u n a ec s he p ac ice o den al conse a ion. This li e a u e e iew examines he e ec s o elec ic
ciga e e use on he o al mucosa, so issues, o al mic obio a, sali a p oduc ion, and isk o den al ca ies. Elec ic
ciga e e use can cause i i a ion and in lamma ion o o al issues, al e he composi ion and unc ion o o al
mic oo ganisms, and dis up sali a p oduc ion, which educes bu e ing capaci y and he emine aliza ion p ocess o
enamel. As a esul , he isk o den al ca ies inc eases, al hough i emains lowe compa ed o con en ional ciga e e
smoke s. The clinical implica ions include he need o mo e ho ough isk assessmen , modi ica ions in conse a i e
den al ca e p o ocols, and e ec i e educa ion and p e en ion o elec ic ciga e e use s. This a icle emphasizes he
impo ance o comp ehensi e unde s anding o he impac o elec ic ciga e e in he con ex o den al conse a ion o
imp o e he quali y o ca e and he apeu ic ou comes.
Keywo ds: E-Ciga e e; O al Heal h; Ca ies; Den al Conse a ion
1. In oduc ion
Recen yea s ha e seen a sha p ise in he usage o e-ciga e es, pa icula ly among you h and young adul s. Since
elec ic ciga e es don' bu n obacco, many consume s belie e hey a e a sa e op ion han adi ional ciga e es.
Teenage s in Indonesia ha e been using elec ic ciga e es a an inc easing a e in ecen yea s. Abou 3-5% o
Indonesian you hs ha e ied o used elec onic ciga e es, acco ding o da a om he Basic Heal h Resea ch (Riskesdas)
and associa ed su eys. This pe cen age is on he ise, pa icula ly among hose be ween he ages o 15 and 24 (1,2).
App oxima ely 20–30% o elec ic ciga e e use s epo expe iencing heal h conce ns like coughing, h oa discom o ,
and mode a e espi a o y p oblems, acco ding o mul iple in e na ional esea ch on he opic(2). Ne e heless, se e al
s udies a e s a ing o demons a e ha using elec ic ciga e es can also ha e de imen al e ec s on den al heal h (3).
Use s o elec ic ciga e es a e mo e likely o expe ience changes in he o al mic obio a, gingi al issue in lamma ion,
and i i a ion o he o al mucosa, all o which can aise he isk o pe iodon al disease and den al ca ies (4). Since he
o al ca i y se es as he p ima y en ance poin o a a ie y o subs ances ha can impac he so issues su ounding
he ee h, o al heal h is a c ucial componen o conse a i e den is y.
Den al ca ies, a complex condi ion impac ed by in e ac ions be ween mic obes, he hos , and he en i onmen , is one o
he p ima y p oblems wi h o al heal h (5). Howe e , he e is cu en ly li le p ecise in o ma ion on he equency o
den al heal h p oblems such ca i ies among Indonesian adolescen e-ciga e e use s, which necessi a es mo e
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in es iga ion. Al hough his isk is s ill lowe han ha o adi ional ciga e e smoke s, in e na ional esea ch indica es
ha elec onic ciga e e use s o en ha e a highe isk o den al ca i ies han non-use s (6).
This li e a u e e iew aims o examine he e ec s o elec ic ciga e e use on o al heal h, wi h a pa icula ocus on he
isk o den al ca ies among elec ic ciga e e use s. This e iew is expec ed o p o ide a comp ehensi e o e iew o he
impac o elec ic ciga e e in he con ex o den al conse a ion and o se e as a scien i ic basis o clinical p ac ice and
pa ien educa ion.
2. Composi ion and ac ion mechanism o e-ciga e e
Elec ic ciga e es a e elec onic de ices ha hea a special liquid (e-liquid) o p oduce an ae osol ( apo ) ha can be
inhaled by he use . Al hough elec ic ciga e es a e conside ed an al e na i e o con en ional ciga e es, he
composi ion o he liquid and i s byp oduc s ha e speci ic cha ac e is ics ha may po en ially a ec o al heal h.
2.1. Elec ic ciga e e liquid composi ion (E-liquid)
• Elec ic ciga e e liquid consis s o se e al main componen s, such as (2,7)
• Nico ine: The main addic i e subs ance also ound in con en ional ciga e es. Nico ine ac s as a asocons ic o
and can in e e e wi h issue healing p ocesses as well as a ec he local immune esponse in he o al ca i y.
• P opylene Glycol: A sol en in elec ic ciga e e liquids ha unc ions as a medium o apo p oduc ion.
P opylene glycol is hyg oscopic and can cause dehyd a ion o he o al mucosal issues, he eby inc easing he
isk o i i a ion and in lamma ion.
• Glyce in (Vege able Glyce in): A subs ance ha p o ides mois u e and swee ness o elec ic ciga e e apo .
Glyce in is also hyg oscopic and can a ec he iscosi y o sali a as well as he balance o he o al mic obio a.
• Fla o ing Agen s and Addi i es: Va ious addi ional chemical compounds ha p o ide a oma and as e o
elec ic ciga e e liquids. Some la o ing agen s can be i i a ing and oxic o o al issues, such as
cinnamaldehyde and anillin, which may cause oxida i e s ess in o al epi helial cells.
2.2. E-ciga e e Ac ion mechanism
When he use ac i a es he elec ic ciga e e de ice, he hea ing elemen (coil) hea s he e-liquid o a empe a u e o
a ound 200–250°C, p oducing an ae osol composed o liquid pa icles dispe sed in he ai . This ae osol is hen inhaled
by he use , allowing nico ine and o he chemicals o en e he espi a o y ac and o al ca i y. Unlike con en ional
ciga e es, which p oduce smoke h ough combus ion, elec ic ciga e es p oduce apo con aining liquid pa icles ha
can come in o di ec con ac wi h o al issues (8).
3. Impac o e-ciga e e Mechanism on he O al Ca i y
3.1. The impac s o e-ciga e e on he o al ca i y include (4,6,7)
Di ec Exposu e: The apo p oduced con ains nico ine and o he chemicals ha come in o di ec con ac wi h he o al
mucosa, causing local i i a ion and in lamma ion.
Modi ica ions in Sali a: Toxins in ciga e e smoke cause DNA damage in sec e o y gland cells. Sphingomyelin, ce amide,
and sphingosine, on he o he hand, a e known o ha e p o-apop o ic and an ip oli e a i e cha ac e is ics. These
sphingolipid ac ions a e p obably "ac i a ed" by ciga e e smoke, which esul s in p og ammed cell dea h. Ins ead o
being e ained in he cell, ce amides a e ca ied s aigh o he Golgi appa a us, whe e hey unde go a ans o ma ion
in o de i a i e chemicals. The concen a ion o he chemicals we examined may be lowe ed by long- e m i i a ion o
he o al ca i y wi h obacco smoke oxins due o he deple ion o sphingolipid ese es, which aims o lessen he
nega i e e ec s o ciga e e oxins on sali a y gland sec e o y cells.
Oxida i e S ess: Some la o ing agen s and ae osol componen s can induce oxida i e s ess in o al epi helial cells,
po en ially damaging DNA and cell memb anes, and accele a ing in lamma ion and issue degene a ion.
Mic obio a Changes: Exposu e o elec ic ciga e e ae osols can dis up he balance o o al mic obio a by p omo ing he
g ow h o pa hogenic bac e ia in ol ed in plaque and ca i y o ma ion.
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By unde s anding he composi ion and mechanism o ac ion o elec ic ciga e e, den al heal h p o essionals can mo e
accu a ely assess he isks aced by pa ien s who use elec ic ciga e e and design app op ia e p e en i e and ea men
s a egies in den al conse a ion p ac ice.
4. The E ec s o e-ciga e e on O al Heal h
The use o elec ic ciga e es has become a global phenomenon ha a ec s a ious aspec s o heal h, including o al
heal h. Al hough elec ic ciga e e is o en conside ed a sa e al e na i e compa ed o con en ional ciga e es, a ious
s udies show ha elec ic ciga e e s ill has nega i e e ec s on o al issues ha can impac he heal h o ee h and
suppo ing issues (2,4,8).
4.1. I i a ion and In lamma ion o O al Tissues
Nico ine and o he compounds ound in e-ciga e e apo can di ec ly i i a e he gingi a and o he so issues as well
as he o al mucosa. Pe iodon al disease and mucosal p oblems can de elop as a esul o ch onic in lamma o y eac ions
b ough on by epea ed exposu e.
4.2. Changes in O al Mic obio a Composi ion
Among he poisonous and i i a ing ing edien s ound in elec ic ciga e e liquids a e nico ine, p opylene glycol,
glyce in, and la o ings. By al e ing ac o s like pH, mois u e, and nu ien a ailabili y, exposu e o hese chemicals can
change he habi a o he o al mic obio a and impac he g ow h and dominance o speci ic bac e ial species.
4.3. Sali a y Func ion Diso de s
Sali a's an imic obial quali ies a e also impac ed by e-ciga e e use. Simila o ciga e e smoke s, a g oup o e-ciga e e
use s had lowe sali a y IgA and lysosome le els han non-smoke s. As a esul , lac o e in, an i on-binding
glycop o ein wi h immunomodula o y and an i-in lamma o y p ope ies, had highe le els in e-ciga e e use s' sali a
han in non-smoke s', indica ing he p esence o in lamma o y p ocesses. Sali a y IgA le els a e compa a i ely low.
None heless, hey a e mo e p e alen in people wi h pe iodon i is, sugges ing a de ense mechanism agains bac e ial
bio ilm an igens. Reduced sali a y IgA le els can impede ce ain immunological esponses and inc ease he se e i y o
pe iodon i is. Al hough i also has an i i al and an i ungal ac ion, he lysosome is an enzyme ha exhibi s an ibac e ial
quali ies by igge ing he des uc ion o bac e ial cell walls. Acco ding o a di e en s udy, e-ciga e e use s' sali a had
signi ican ly highe le els o he in e leukins IL-6 and IL-1β han ha o non-smoke s. In he de elopmen o den al and
pe iodon al diso de s, IL-6, IL-1β, and TNF-α ac as media o s, s imula ing issue de e io a ion h ough an inc ease in
ma ix me allop o einases. Nico ine can also ha e an impac on he au onomic ne e sys em, which con ols sali a ion,
which can lead o less s imula ion o sec e ion. P opylene glycol and glyce in a e hyg oscopic subs ances ound in e-
ciga e e apo ha ha e he abili y o ex ac wa e om he issues o he o al mucosa. Due o localized d yness o
he mucosa and sali a y glands, his e ec lowe s he olume and p oduc ion o sali a. Exposu e o elec ic ciga e e
apo con aining la o ing agen s and o he chemicals can cause i i a ion and in lamma ion o he mucosal and sali a y
gland issues, dis up ing he no mal unc ion o hese glands. Reduced o poo -quali y sali a impai s he mou h’s na u al
p o ec i e unc ions, such as mechanical cleaning, bu e ing, and enamel emine aliza ion, hus inc easing he isk o
ca ies.
4.4. Risk o Den al Ca ies
Den al ca ies de elops in an en i onmen ha is a o able due o a combina ion o sali a y p oblems, issue i i a ion,
and mic obio a al e a ions. Al hough he isk is s ill lowe han ha o adi ional smoke s, epidemiological s udies
indica e ha elec ic ciga e e use s ha e a highe p e alence o den al ca i ies han non-use s.
4.5. Impac on Healing and T ea men Success
Elec ic ciga e e nico ine slows issue egene a ion and healing by causing asocons ic ion, which p e en s blood low
o o al issues. This nega i ely a ec s he success o den al conse a ion p ocedu es and es o a i e ea men s.
4.6. Po en ial Risk o Mucosal Lesions and Cance
Exposu e o chemicals in elec ic ciga e e apo can also cause oxida i e s ess and DNA damage in o al epi helial cells,
which may inc ease he isk o de eloping p ecance ous lesions and o al cance in he long e m.
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The e o e, e en i elec ic ciga e es a e hough o be a sa e op ion han adi ional ciga e es, using hem s ill has
se e al se ious dange s o den al heal h. Conduc ing isk e alua ions, educa ing pa ien s, and c ea ing sui able
p e en i e and ea men plans o e-ciga e e use s a e all c ucial componen s o conse a i e den is y.
5. The Impac o Elec ic Ciga e e on Den al Ca ies
Den al ca ies is a mul i ac o ial in ec ious disease in ol ing he in e ac ion be ween pa hogenic mic oo ganisms, he
hos ( ee h and sali a), and en i onmen al ac o s such as die and li es yle habi s. E-ciga e e use has been shown o
a ec se e al o hese ac o s, he eby con ibu ing o an inc eased isk o den al ca ies (2,9,10).
5.1. Changes in Mic oo ganism Composi ion and Ac i i y
Elec ic ciga e e can al e he balance o o al mic obio a by inc easing he popula ion o pa hogenic bac e ia in ol ed
in plaque and ca ies o ma ion, such as S ep ococcus mu ans and Po phy omonas gingi alis. These changes inc ease
he isk o den al ca ies and pe iodon al disease. In addi ion o al e ing he composi ion o o al mic obio a, elec ic
ciga e e can also a ec he me abolic ac i i y o mic oo ganisms p esen in he o al ca i y. This is mainly ela ed o he
abili y o bac e ia o p oduce acids as me abolic byp oduc s, which is a key ac o in he ca ies p ocess. Some o al
bac e ia a e capable o me abolizing nico ine and o he chemical compounds con ained in elec ic ciga e e liquids. This
me abolic p ocess can p oduce o ganic acids such as lac ic, ace ic, and p opionic acid, which lowe he pH o he o al
en i onmen . The d op in pH c ea es acidic condi ions ha damage he mine al s uc u e o ee h. Bac e ia such as
S ep ococcus mu ans and Lac obacillus spp, which a e he main causa i e agen s o ca ies, can inc ease hei
ca bohyd a e e men a ion ac i i y o acids when exposed o chemicals in elec ic ciga e e. Nico ine has been shown
o enhance he adhesion o hese bac e ia o oo h su aces and s imula e hei me abolism, leading o inc eased acid
p oduc ion. The acids p oduced by bac e ial me abolism lowe he pH a he oo h su ace below he c i ical h eshold
(a ound pH 5.5), causing enamel demine aliza ion. I hese acidic condi ions pe sis wi hou adequa e emine aliza ion,
he enamel will su e s uc u al damage ha esul s in he o ma ion o ca ious lesions.
5.2. Dis up ion o Sali a y Func ion
Elec ic ciga e e can educe sali a p oduc ion and al e i s composi ion, he eby lowe ing he bu e ing capaci y o
sali a, which is i al o neu alizing acids p oduced by bac e ia. Fu he mo e, dec eased sali a also educes he
emine aliza ion abili y o enamel due o diminished a ailabili y o calcium and phospha e ions supplied by sali a. These
condi ions lead o a p olonged acidic en i onmen and accele a e he ca ies p ocess.
5.3. Inc eased Acid P oduc ion by Mic oo ganisms
Nico ine and o he chemicals in elec ic ciga e e s imula e ca ies-causing bac e ia o inc ease acid p oduc ion as a
esul o hei me abolism. These acids lowe he pH on he oo h su ace, causing enamel demine aliza ion and ca ious
lesion o ma ion. This p ocess becomes as e and mo e se e e i elec ic ciga e e use s also equen ly consume swee
oods o d inks.
5.4. E ec s o I i a ion and In lamma ion on Too h-Suppo ing Tissues
Exposu e o elec ic ciga e e apo can cause ch onic i i a ion and in lamma ion o he gums and suppo ing issues,
which can wo sen pe iodon al condi ions. Poo pe iodon al heal h can accele a e damage o he ha d issues o he ee h
and inc ease he isk o oo ca ies.
5.4.1. Compa ison wi h Con en ional Ciga e es
Al hough he isk o ca ies in elec ic ciga e e use s ends o be lowe han in con en ional ciga e e smoke s, elec ic
ciga e e use s s ill ha e a highe isk compa ed o non-use s. This indica es ha elec ic ciga e e is no a comple ely
sa e al e na i e o o al heal h (2,6).
In conclusion, elec ic ciga e e con ibu es o an inc eased isk o den al ca ies h ough mechanisms in ol ing changes
in mic obio a, dis up ion o sali a unc ion, inc eased acid p oduc ion, and issue in lamma ion. Unde s anding hese
mechanisms is c ucial o den is s o p o ide educa ion, p e en ion, and app op ia e managemen o pa ien s who use
elec ic ciga e e.
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6. Implica ions o Elec ic ciga e e Use o Conse a i e Den al P ac ice
Elec ic ciga e e use p esen s new challenges in conse a i e den al p ac ice due o i s complex impac on o al heal h.
Den is s need o unde s and he isks posed by elec ic ciga e e use o p o ide app op ia e and e ec i e ea men
(2,5,7,10).
6.1. Risk Assessmen
Risk assessmen is a c ucial ini ial s ep in conse a i e den al p ac ice o iden i y ac o s ha can in luence o al heal h
and he success o he apy. In pa ien s who use elec ic ciga e e, isk assessmen mus be ca ied ou mo e ho oughly
and comp ehensi ely because o he mul i ac o ial impac o elec ic ciga e e on bo h ha d and so o al issues.
6.2. Impo ance o Anamnesis and Elec ic ciga e e use
Den is s need o collec comple e in o ma ion ega ding he pa ien 's his o y o elec ic ciga e e use, including du a ion,
equency, ype o elec ic ciga e e liquid used, and o he habi s ha migh con ibu e o o al heal h isks. A de ailed
anamnesis helps iden i y exposu e o chemicals ha can igge mucosal i i a ion, sali a y dis u bances, and changes
in mic obio a.
6.3. Comp ehensi e Clinical Examina ion
In addi ion o anamnesis, clinical examina ion should include e alua ion o he condi ion o he o al mucosa, pe iodon al
s a us, sali a y unc ion, and ea ly signs o ca ies. Examina ion o sali a y unc ion, o example by measu ing he a e
o sali a sec e ion and bu e ing capaci y, p o ides an o e iew o he mou h's na u al p o ec i e unc ion which may
be dis u bed due o elec ic ciga e e use.
6.4. Addi ional Diagnos ic Tools
In some cases, he use o addi ional diagnos ic ools such as mic obiological examina ions o iden i y changes in
mic obio a, o digi al imaging echnology o de ec ea ly ca ious lesions, can assis in isk de e mina ion and mo e
p ecise ea men planning.
6.4.1. Bene i s o Tho ough Risk Assessmen
A comp ehensi e isk assessmen enables den is s o classi y pa ien s based on hei isk le els o ca ies and
pe iodon al disease, allowing o he design o ailo ed ea men p o ocols. This also acili a es he deli e y o speci ic
and e ec i e pa ien educa ion ega ding he impo ance o beha io modi ica ion and he p e en ion o complica ions
(2,11).
6.4.2. Modi ica ion o T ea men P o ocols
Due o possible issue in lamma ion and impai ed healing in elec ic ciga e e use s, den is s should conside a mo e
cau ious app oach in es o a i e and endodon ic p ocedu es. The use o es o a i e ma e ials wi h an imic obial
p ope ies and p o ec ion agains sensi i i y may be conside ed.
6.4.3. Rou ine Moni o ing and Follow-Up
Elec ic ciga e e use s equi e mo e in ensi e and egula moni o ing o enable ea ly de ec ion o new ca ies
de elopmen o so issue complica ions. This is impo an o p e en mo e ex ensi e damage and o main ain den al
unc ion.
7. P e en ion S a egies and Pa ien Educa ion o e-ciga e e Use s
P e en ion is a key aspec o den al conse a ion, especially o pa ien s who use elec ic ciga e es. P ope educa ion
can help educe he isk o complica ions and inc ease awa eness o he impo ance o main aining o al heal h(2–4).
7.1. Educa ion on he Risks o Elec ic ciga e e
Den is s should p o ide clea , e idence-based in o ma ion abou he nega i e impac s o elec ic ciga e e on o al
heal h, including he isks o ca ies, pe iodon al disease, and sali a y dis u bances. This educa ion is impo an o
encou age pa ien s o econside hei use o elec ic ciga e es.
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7.2. P omo ing Op imal O al Hygiene
Pa ien s should be encou aged o main ain good o al hygiene by b ushing hei ee h wice a day wi h luo ide
oo hpas e, cleaning be ween hei ee h wi h den al loss, and using an isep ic mou hwash i necessa y.
7.3. Use o Remine aliza ion P oduc s
The use o p oduc s con aining luo ide, such as luo ide gels, a nishes, o special oo hpas es, can help enhance he
emine aliza ion o enamel and p o ec ee h om demine aliza ion caused by acid exposu e.
7.4. Managemen o Xe os omia
Fo pa ien s expe iencing d y mou h due o elec ic ciga e e, den is s can ecommend sali a s imulan s, sali a
subs i u es, o o he ea men s o inc ease o al mois u e and pa ien com o .
7.5. Smoking Cessa ion Counselling
I possible, den is s can e e pa ien s o smoking cessa ion p og ams o help educe o s op elec ic ciga e e use,
he eby minimizing o al heal h isks.
Wi h hese s a egies, i is hoped ha elec ic ciga e e use s can main ain op imal o al heal h and educe he isk o
complica ions ha could a ec he success o den al conse a ion he apy.
8. Conclusion
The use o elec ic ciga e es o elec ic ciga e es has a signi ican impac on o al heal h, especially in he con ex o
den al conse a ion. Elec ic ciga e e can cause i i a ion and in lamma ion o he o al mucosa and so issues, al e
he composi ion and unc ion o he o al mic obio a, and dis up he p oduc ion and quali y o sali a. The combina ion
o hese ac o s c ea es an en i onmen conduci e o he de elopmen o den al ca ies by inc easing acid p oduc ion by
pa hogenic bac e ia and educing he enamel’s emine aliza ion capaci y. Al hough he isk o ca ies in elec ic ciga e e
use s is gene ally lowe han in con en ional ciga e e smoke s, elec ic ciga e e use s s ill ace a highe isk compa ed
o non-use s. The e o e, in den al conse a ion p ac ices, i is impo an o conduc a comp ehensi e isk assessmen ,
modi y ea men p o ocols, and p o ide app op ia e educa ion and p e en i e s a egies o elec ic ciga e e use s o
main ain op imal o al heal h.
Compliance wi h e hical s anda ds
Acknowledgmen s
The au ho would like o exp ess g a i ude o Facul y o Medicine Uni e si as Udayana.
Disclosu e o con lic o in e es
The au ho decla es no con lic s o in e es .
Re e ences
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