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'Sticky' like candy: Vaping may increase risk of cavities

Sugary e-liquid may be behind a possible link between vapes and tooth decay, a small new study suggests.

Vaping may increase a person's risk for cavities and tooth decay, preliminary new research suggests.

The aerosolized e-liquid used in vape pens may cover teeth in a sugary, sticky film that promotes bacteria growth — like going to bed sucking on a lollipop — said Dr. Karina Irusa, a study author and assistant professor of comprehensive care at Tufts University School of Dental Medicine.

Adding artificial sweeteners and flavorings to the sticky aerosol may create the perfect breeding ground for cavities. "The sugar is what the bacteria feeds on," Irusa said.

The new study, published Wednesday in the Journal of the American Dental Association, is considered preliminary and does not prove that vaping causes cavities.

But because e-cigarette usage is so rampant among adolescents — with 2.5 million teens vaping in the United States alone — the possibility that it could increase the risk for tooth decay in this generation is worrisome, experts who study vaping in young people said.

The stickiness of the aerosol may be the major culprit.”

Dr. Karina Irusa, tufts university school of dental medicine

"We know that young people are vaping 24/7," said Bonnie Halpern-Felsher, a professor of pediatrics at Stanford University School of Medicine. "Teens have told us, anecdotally, that they'll wake up in the middle of the night and take hits," said Halpern-Felsher, who was not involved with the new study. "They keep their vaping product under their pillow and vape all night."

The Tufts research focused on mostly adult patients seeking treatment at the school's dental clinic. Of 13,216 patients, just 136 said they vaped.

Many patients were already considered high risk for tooth decay, based on factors like diet or other oral health issues.

Among these high-risk patients, e-cigarette users, Irusa found, were at a "significantly" higher risk of developing cavities, compared with those who did not vape.

The Tufts researchers suggested that people who vape may need specific treatments, such as prescription-strength fluoride toothpaste and mouthwash.

A view of teeth with vaping-related tooth decay.
The dark areas on the tips of the top front teeth are an example of vaping-related tooth decay, researchers said.2020 Wiley Periodicals, Inc.

Previous research from Irusa's team suggested that decay associated with e-cigarette use may form in an unusual area: on the tips of front teeth.

"Those areas are not commonly affected because they're easier to clean. They're easier to access," Irusa said. "I think that the stickiness of the aerosol may be the major culprit."

"This is exactly what we thought was gonna happen," said Dr. Purnima Kumar, chair of the Department of Periodontology and Oral Medicine at the University of Michigan School of Dentistry and spokesperson for the American Dental Association.

Kumar was not involved with the new study, but published separate research in 2020 that found e-cigarette usage completely and quickly altered a person's oral microbiome.

"Within six months of use, these people had changed their oral health profiles at the molecular level," Kumar said. "There were changes that we would only see after five years of smoking" regular cigarettes.

The e-cigarette users had different kinds of oral bacteria that thrive on heated e-liquid ingredients, such as propylene glycol and vegetable glycerin, which add nicotine and sweet flavors to vapes.

"Bacteria are constantly looking for food. You can vape today, and your bacteria are still feeding off of your vape for the next 10 hours," she said.