Non-Cochrane · aetiology · PM40559585
An Umbrella Review of E-Cigarettes' Impact on Oral Microbiota and Biofilm Buildup.
Panariello Beatriz, Dias Panariello Fabrízio, Misir Ashminie, et al. · Pathogens (Basel, Switzerland) · 2025 · PubMed · doi:10.3390/pathogens14060578
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
10
current version
GRADE rated
0
No studies
0
Included studies
10
linked below
No studies 0 · 0%Ungraded 10 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Systematic reviews/meta-analyses of e-cigarette (ENDS) users assessing oral microbiota composition and oral biofilm/plaque accumulation | 10 systematic reviews/meta-analyses (n=10; underlying primary studies per review range 4 to 98); populations include general adults, dental implant patients, and male implant-supported prosthesis patients |
| Intervention | E-cigarette use (electronic nicotine delivery systems / vaping) | E-cigarette use (ENDS/vaping) |
| Comparison | Non-smokers and traditional cigarette smokers | Non-smokers and traditional cigarette smokers (some reviews also included waterpipe or heated-tobacco users) |
| Outcomes | Oral biofilm/dental plaque accumulation and oral microbiota composition (dysbiosis); related oral diseases (periodontitis, peri-implantitis, dental caries, oral candidiasis) | Plaque index/biofilm accumulation; oral microbiota dysbiosis (increased Porphyromonas gingivalis, Fusobacterium nucleatum, Streptococcus mutans, Candida spp.); periodontitis/periodontal parameters; peri-implant parameters; dental caries; self-reported gingivitis |
| Study designs | Not specified | Not specified |
| Timing | Not specified (included studies published 2015 to 2025) | Included reviews published 2019 to 2025; some required at least 1 year of e-cigarette use |
Search date: 12 March 2025. Databases: PubMed/MEDLINE; Google Scholar; Cochrane Library; Scopus; plus hand-search of reference lists of relevant studies
Questions and results
E-cigarette use (electronic nicotine delivery systems / vaping) vs Non-smokers (non-users)
Population: Adult e-cigarette (ENDS) users (general oral health; predominantly natural dentition)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Oral candidiasis / Candida spp. prevalence E-cigarette users may have a higher prevalence of oral Candida colonization than non-smokers (narrative synthesis; ungraded). Source: Results 3.2; Discussion; Table 1 · same question in other reviews | Narrative synthesis: e-cigarette users showed a higher prevalence of Candida spp. (e.g., C. albicans) and increased fungal species compared with non-smokers (Ralho, Camoni [32,28]); no pooled estimate reported. | 2 studies | Ungraded |
Dental caries and cariogenic bacteria (Streptococcus mutans, Lactobacilli) E-cigarette use is associated with more cariogenic bacteria and increased dental caries risk compared with non-smokers (narrative synthesis; ungraded). Source: Results 3.2; Discussion; Table 1 · same question in other reviews | Narrative synthesis: e-cigarette use linked to increased cariogenic bacteria (S. mutans, Lactobacilli) and worsening dental caries, with flavored e-liquids noted as a caries risk factor (Zieba, Camoni, Yang… | 3 studies | Ungraded |
Oral microbiota composition (dysbiosis; increased periodontal/opportunistic pathogens) E-cigarette use is associated with oral microbiota dysbiosis and increased pathogenic bacteria compared with non-smokers (narrative synthesis; ungraded). Source: Results 3.2; Discussion; Table 1 · same question in other reviews | Narrative synthesis: reviews reported oral microbiota dysbiosis in e-cigarette users, including increased Porphyromonas gingivalis and Fusobacterium nucleatum and microbial shifts predisposing to oral infection… | 5 studies | Ungraded |
Self-reported gingivitis E-cigarette use is associated with self-reported gingivitis compared with non-smokers (single included review; ungraded). Source: Results 3.2; Discussion; Table 1 · same question in other reviews | Narrative synthesis: a meta-analysis within Camoni et al. combining 6 primary studies found an association between e-cigarette use and self-reported gingivitis, with high heterogeneity (Camoni [28]); the umbrella… | 1 study | Ungraded |
Plaque index / oral biofilm accumulation E-cigarette users tend to have a higher plaque index (more biofilm accumulation) than non-smokers (narrative synthesis of systematic reviews; ungraded). Source: Results 3.2; Discussion; Table 1 · same question in other reviews | Narrative synthesis: e-cigarette users exhibited a higher plaque index than non-smokers across included reviews (Shabil, Vamos, Youssef, Thiem, Figueredo, Yang [24,25,27,29,30,31]); the umbrella review reported no… | 6 studies | Ungraded |
Periodontitis / periodontal disease and periodontal parameters E-cigarette users appear more likely to develop periodontal disease and worse periodontal parameters than non-smokers (narrative synthesis; ungraded). Source: Results 3.2; Discussion; Table 1 · same question in other reviews | Narrative synthesis: e-cigarette use associated with increased risk of periodontal and gingival disease and worse periodontal parameters vs non-smokers (Tattar, Shabil, Figueredo, Yang [23,24,30,31]); no pooled… | 7 studies | Ungraded |
E-cigarette use (electronic nicotine delivery systems / vaping) vs Traditional (conventional) cigarette smokers
Population: Adult e-cigarette (ENDS) users (general oral health)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Plaque index / periodontal health (relative harm vs conventional smoking) E-cigarette users tend to have a lower plaque index and less periodontal harm than traditional cigarette smokers, although still worse than non-smokers (narrative synthesis; ungraded). Source: Results 3.2; Discussion; Table 1 · same question in other reviews | Narrative synthesis: plaque accumulation and periodontal harm were less pronounced in e-cigarette users than in traditional cigarette smokers; cigarette smokers had a significantly higher plaque index than e-cigarette… | 4 studies | Ungraded |
E-cigarette use (electronic nicotine delivery systems / vaping) vs Non-smokers (never-smokers)
Population: Adult e-cigarette (ENDS) users with dental implants (incl. male implant-supported prosthesis patients)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Peri-implant clinical and radiographic parameters (plaque index, probing depth, bone loss, pro-inflammatory profile) Implant/peri-implant populations: Vamos (implant patients), Youssef (male implant patients only), Yang (broad SR incl. peri-implant) Among dental implant patients, e-cigarette users show worse peri-implant parameters (more plaque, worse clinical and radiographic outcomes) than non-smokers (narrative synthesis; ungraded). Source: Results 3.2; Discussion; Table 1 · same question in other reviews | Narrative synthesis: e-cigarette users with dental implants showed a higher peri-implant plaque index and worse clinico-radiographic and immunological peri-implant parameters than non-smokers (worse than non-smokers… | 3 studies | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tooth loss and dental symptoms (cracked teeth, toothache) associated with e-cigarette use Yang et al. [31] | Qualitative (narrative synthesis) Increased tooth loss and dental symptoms with daily e-cigarette use | 1 study | Ungraded |
Plaque index, e-cigarette users versus non-smokers: no significant difference (contrary/null finding) Ralho (6 of 8 studies); Thiem (1 study) | Qualitative (narrative synthesis) No significant plaque-index difference vs non-smokers | 2 studies | Ungraded |
Included primary studies 10
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Camoni N 2023 Electronic Cigarettes, Heated Tobacco Products, and Oral Health: A Systematic Review and Meta-Analysis DOI:10.3390/app13179654 | this review only | not stated | not extracted yet | not extracted yet |
| Figueredo CA 2021 The impact of vaping on periodontitis: A systematic review. PMID:33274850 | this review only | not stated | not extracted yet | not extracted yet |
| Ralho A 2019 Effects of Electronic Cigarettes on Oral Cavity: A Systematic Review DOI:10.1016/j.jebdp.2019.04.002 | this review only | not stated | not extracted yet | not extracted yet |
| Shabil M 2024 The impact of electronic cigarette use on periodontitis and periodontal outcomes: a systematic review and meta-analysis. PMID:39385155 | this review only | not stated | not extracted yet | not extracted yet |
| Tattar R 2025 The impact of e-cigarette use on periodontal health: a systematic review and meta-analysis. PMID:39948158 | this review only | not stated | not extracted yet | not extracted yet |
| Thiem DGE 2023 The impact of electronic and conventional cigarettes on periodontal health-a systematic review and meta-analysis. PMID:37526741 | this review only | not stated | not extracted yet | not extracted yet |
| Vámos O 2024 The Effect of Nicotine-Containing Products on Peri-Implant Tissues: A Systematic Review and Network Meta-Analysis. PMID:38618685 | this review only | not stated | not extracted yet | not extracted yet |
| Yang I 2020 The oral health impact of electronic cigarette use: a systematic review DOI:10.1080/10408444.2020.1713726 | this review only | not stated | not extracted yet | not extracted yet |
| Youssef M 2023 The effect of electronic cigarette use on peri-implant conditions in men: a systematic review and meta-analysis DOI:10.1016/j.oooo.2022.08.010 | this review only | not stated | not extracted yet | not extracted yet |
| Zięba S 2024 Can smoking alter salivary homeostasis? A systematic review on the effects of traditional and electronic cigarettes on qualitative and… DOI:10.17219/dmp/172084 | this review only | not stated | not extracted yet | not extracted yet |