Dental News - World No Tobacco Day: E‑cigarettes present growing challenges for dental care

Jeremy Booth, Dental Tribune International

Fri. 29. May 2026

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GENEVA, Switzerland: Dental teams are on the front line in addressing tobacco use; however, advising patients on cessation has become more complex with the growth of new and emerging tobacco and nicotine products. World No Tobacco Day is marked annually on 31 May, and this year’s campaign by the World Health Organization (WHO) focuses on the evolving strategies used by the tobacco and nicotine industry to reach consumers. For dental professionals, the campaign is a reminder that tobacco-related risk is not limited to conventional smoking. Electronic cigarettes, heated tobacco products and other nicotine delivery systems are increasingly part of patient conversations and present new challenges for prevention, screening and cessation advice.

Recent research has added to concerns about the oral health implications of non-combustible nicotine products. A 2026 systematic review by Dipalma et al., published in Exploration of Medicine, examined the effects of e-cigarettes and heated tobacco products on periodontal inflammation, oral microbiota and response to non-surgical periodontal therapy. Although these products may reduce exposure to some of the harmful constituents found in conventional cigarettes, the review found that they were associated with increased pro-inflammatory and reduced anti-inflammatory activity, changes in oral microbiota composition, delayed periodontal healing and less favourable periodontal treatment outcomes.

Heated tobacco products, often referred to as heat-not-burn systems, raise similar concerns. WHO states that these products produce aerosols containing nicotine and toxic chemicals and that there is no evidence to demonstrate that they are less harmful than conventional tobacco products. For dental professionals, this means that tobacco history taking should also include vaping, use of heated tobacco products, smokeless tobacco or nicotine pouches, as well as multiple product use. Dental teams could then provide evidence-based guidance that reflects the particular products patients use, how those products expose the oral cavity and what is known about their possible oral health effects.

“When nicotine constricts the blood supply in oral tissue, it can dull the early visual signals we rely on to detect disease, sometimes allowing pathology to develop before patients realise anything is wrong.”
Dr Sung Hee Cho, Riverside Oral Surgery

Dental Tribune International spoke with oral and maxillofacial surgeons at Riverside Oral Surgery in the US state of New Jersey about the oral health implications of the use of new tobacco and nicotine products for diagnosis, patient communication and risk assessment. According to Dr Jason M. Auerbach, one key concern is that patients may view vaping as a low-risk alternative to smoking. This perception, he said, can obscure the reality that e-cigarettes still expose oral tissue to biologically active substances. Although vaping eliminates combustion, it can involve exposure to nicotine, carrier liquids, flavouring chemicals and ultra-fine particles that are deposited on the oral tissue. In practice, he said, dental teams are seeing effects such as xerostomia, gingival inflammation, disruption of the oral microbiome and delayed healing—all of which may increase the risk of periodontal disease and postoperative complications.

Nicotine remains central to these concerns. As a potent vaso-constrictor, it reduces blood flow to oral tissue and can compromise healing. Moreover, Dr Sung Hee Cho, an oral and maxillofacial surgeon at Riverside Oral Surgery with particular expertise in head and neck cancer and pathology, emphasised that this effect may also make early signs of disease more difficult to identify during routine dental examination. “When nicotine constricts the blood supply in oral tissue, it can dull the early visual signals we rely on to detect disease, sometimes allowing pathology to develop before patients realise anything is wrong,” he said.

Dr Cho said that dental professionals should therefore remain alert to symptoms such as persistent oral ulceration or lesions that do not heal within two weeks, unexplained swellings or masses, altered sensation in the mouth or jaws and thickened tissue. These findings should prompt further assessment or referral, regardless of whether a patient smokes conventional cigarettes, vapes or uses another nicotine product.

Nicotine pouches add another layer of complexity because they may be perceived as less harmful than smoking or vaping. Evidence on newer tobacco-free nicotine pouches remains limited, but studies of smokeless tobacco suggest that oral nicotine products placed against the mucosa may have local effects. A 2026 systematic review found associations between Swedish snus use and gingival recession and gingivitis. Dental teams should therefore ask specifically about these products and monitor for local mucosal changes and periodontal concerns.

The lack of reliable, long-term data on the effects of e-cigarettes and other novel nicotine delivery systems on the oral cavity is further complicated by the variability of products available on the market. This concern is reflected in the review by Dipalma et al., which noted that e-cigarette emissions can vary according to device design and use patterns, making it difficult to draw uniform conclusions about long-term oral health risk.

Dr Auerbach observed: “Devices vary significantly in heating temperatures, nicotine concentrations and chemical additives. From a clinical standpoint, we may very well still be in the early phase of understanding the long-term oral health consequences, including potential cancer risk. The key message for patients is simple: being ‘safer than cigarettes’ does not necessarily make these products safe, and regular oral cancer screenings remain essential.”

For dental professionals, World No Tobacco Day is a reminder to address all forms of tobacco and nicotine use as part of routine prevention screening to holistically support patients’ oral and general health. The FDI Tobacco Cessation project provides resources to support dentists in integrating brief cessation counselling into routine care. More information about the campaign is available on the WHO website.