Nicotine - Oral Health

Are alternative nicotine products safer than smoking? Can switching to alternative products improve oral health?

ENDS NVP ANDS E-Cigarettes

2023: The risk profile of electronic nicotine delivery systems, compared to traditional cigarettes, on oral disease: a review

• Relevant studies indicated that patients using ENDS have better preservation of alveolar bone height compared with traditional smokers.
• Overall, ENDS appear to be more implant-friendly than conventional tobacco cigarettes
• Many of the carcinogens present in tobacco are not present in the aerosol generated by ENDS, which makes ENDS appear to be less damaging to the oral mucosa.

2022: Electronic cigarettes: an update on products, regulation, public health approaches and oral health

• Regulatory approaches vary considerably around the world but in the UK and Europe, e-cigarettes are regulated as consumer or medicinal product, and their use is permitted. In the UK, e-cigarettes have increasingly been supported by public health institutions for smoking cessation as part of a Tobacco Harm Reduction strategy.
• The potential harms (including to oral health) from e-cigarette use are likely to be much less than from tobacco cigarettes.

2019: Influence of Electronic Cigarettes on Selected Antibacterial Properties of Saliva

• Lowering the level of IgA in saliva may lead to a weakening of the specific immune response and cause earlier development of more severe periodontitis. In our research, it was observed that the tobacco smokers’ level of salivary IgA was statistically significantly lower in comparison to the values in both the control group and the group of e-cigarette users. IgA content in the saliva of e-cigarette users was not statistically significant lower compared to the control group. This indicates that electronic cigarettes compared to traditional cigarettes have less effect on IgA concentration in saliva.

2019: A Comparison of Flavorless Electronic Cigarette-Generated Aerosol and Conventional Cigarette Smoke on the Planktonic Growth of Common Oral Commensal Streptococci

• A potential implication of these results is that flavorless E-liquids and their generated aerosol induce less tooth decay and periodontal disease than traditional cigarette smoke.
• A case for improving oral health (and overall health) could be made by federal health regulatory agencies for promoting the use of electronic nicotine delivery systems over the use of traditional cigarettes as a means of harm reduction.

2019: Effect of nicotine on human gingival, periodontal ligament and oral epithelial cells. A systematic review of the literature

• According to findings from in vitro studies, nicotine, at levels found in tobacco smokers, nicotine replacement therapy users and e-cigarette users, is unlikely to be cytotoxic to human gingival and periodontal cells, though saliva levels in smokeless tobacco users may be high enough to achieve cytotoxicity. There was limited and contradictory evidence for nicotine effects on cell attachment, proliferation and inflammatory mediator production.

2019: Impact of cigarette smoking and vaping on the outcome of full-mouth ultrasonic scaling among patients with gingival inflammation: a prospective study

• There are no studies that have assessed the oral soft tissue response to full-mouth ultrasonic scaling (FMUS) among cigarette-smokers (CS) (group 1), individuals vaping electronic-cigarettes (E-cigs) (group 2), and never-smokers (NS) (group 3). The aim was to assess the impact of cigarette smoking and vaping on periodontal tissues following FMUS.
• Following FMUS, gingival inflammation is worse in CS compared with individuals vaping E-cigs and NS.

2019: Clinical periodontal status and gingival crevicular fluid cytokine profile among cigarette-smokers, electronic-cigarette users and never-smokers

• Periodontal status is poorer and GCF levels of proinflammatory cytokines are higher in cigarette-smokers compared with electronic-cigarette smokers and never-smokers. However, the probability of increased periodontal inflammation and GCF proinflammatory cytokine levels in electronic-cigarette users than never-smokers cannot be annulled.

2018: Comparative study of the effects of cigarette smoke and electronic cigarettes on human gingival fibroblast proliferation, migration and apoptosis

• The damage to gingival fibroblasts was greater with conventional cigarette smoke condensate than with nicotine-rich e-vapor condensate.

2017: Comparison of Periodontal Parameters and Self-Perceived Oral Symptoms Among Cigarette Smokers, Individuals Vaping Electronic Cigarettes, and Never-Smokers

• To the authors’ knowledge, there are no studies that have compared periodontal parameters and self-perceived oral symptoms (OSs) among cigarette smokers (CSs) (group 1), individuals exclusively vaping electronic cigarettes (group 2), and never-smokers (NSs) (group 3).
• Periodontal inflammation and self-perceived OSs were poorer among CSs than among vaping individuals and NSs.

2015: Oral Health Foundation: (Formerly known as the British Dental Health Foundation)

• "Smoking is the cause of many serious oral health problems, including worsening gum disease, which is one of the most common causes of caries in UK adults. It is also responsible for the majority or mouth cancers and is the direct cause of thousands of deaths every year. Every year almost seven thousand people in the UK are diagnosed with mouth cancer, and it leads to more deaths than testicular and cervical cancer combined."
• "We need to spread the message that e-cigarettes, while not risk free, are much less harmful than smoking, as currently nearly half the population are not aware of this… The British Dental Health Foundation believe that there is a long way to go to before we get to a smoke-free lifestyle but any way which smoking numbers can be cut, and therefore lives saved, is positive and one which we will support.”

Nicotine

2021: Potential Suppressive Effect of Nicotine on the Inflammatory Response in Oral Epithelial Cells: An In Vitro Study

• HSC-2 cell viability was not impaired by nicotine at the concentrations usually observed in smokers; increased expressions of IL-8 and ICAM-1 induced by P. gingivalis LPS or TNF-α were diminished by nicotine treatment. Additionally, an inhibitory effect on β-defensin production was also demonstrated. Apart from being the usually alleged harmful substance, nicotine probably exerted a suppressive effect on inflammatory factors production in HSC-2 cells.
• Acknowledgement: This research was supported by the grant from Ministry of Science and Technology of China under a contract from the International Science & Technology Cooperation Program Foundation Nr.1019 and the National Natural Science Foundation of China (Grant No. 81500859).
• Citation: An, N., Holl, J., Wang, X., Rausch, M. A., Andrukhov, O., & Rausch-Fan, X. (2021). Potential Suppressive Effect of Nicotine on the Inflammatory Response in Oral Epithelial Cells: An In Vitro Study. International Journal of Environmental Research and Public Health, 18(2), 483. https://doi.org/10.3390/ijerph18020483

Nicotine Gum

2012 Randomized controlled trial to evaluate tooth stain reduction with nicotine replacement gum during a smoking cessation program

• The results of this study confirm that chewing the tested nicotine replacement gum as recommended in a ‘real world’ active smoking cessation program produces a statistically significant change in the parameter of whitening as measured by change from baseline versus the negative control (Microtab) following 6 weeks in a smoking cessation programme. The Vita® Shade Guide (the secondary outcome measure) supported the trend of stain improvement. These results support the efficacy of the tested nicotine replacement gum in stain reduction, in arresting the progression of tooth stain and in shade lightening.
• Acknowledgement: The study was fully funded by McNeil AB who is the manufacturer of the test and control products. It was designed by McNeil AB in consultation with HW and DOM. The study was run, participants recruited, smoking cessation intervention administered and data collected by the team of research staff at the Oral Health Services Research Centre at University College Cork under the leadership of HW with consultant input from DOM. RK carried out the clinical examinations but was blinded to intervention allocation. The data were analysed by McNeil AB with input from HW and DOM. The study was externally monitored by MDS Pharma Services, UK and conducted to ICH GCP standards. The data were interpreted by HW, DOM and RK. The manuscript was drafted by HW with editorial comment from the other authors. HW decided to submit the manuscript for publication.
• Citation: Whelton H, Kingston R, O'Mullane D, Nilsson F. Randomized controlled trial to evaluate tooth stain reduction with nicotine replacement gum during a smoking cessation program. BMC Oral Health. 2012 Jun 13;12:13. doi: 10.1186/1472-6831-12-13. PMID: 22695211; PMCID: PMC3444372.

Nicotine Patch

2020 Effectiveness of nicotine patch for the control of pain, oedema, and trismus following third molar surgery: a randomized clinical trial

• The positive findings in the present study in surgeries performed under local anaesthesia are in agreement with data from systematic reviews that have reported the effectiveness of nicotine in the control of postoperative pain following surgery under general anaesthesia.
• This study establishes a new prevention and treatment modality regarding pain, oedema, and trismus in a versatile, convenient, safe, and effective form, thereby minimizing gastrointestinal and cardiovascular disorders caused by the use of anti-inflammatory drugs in third molar surgeries.
• PDF Version
• Citation: Landim FS, Laureano Filho JR, Nascimento J, do Egito Vasconcelos BC. Effectiveness of nicotine patch for the control of pain, oedema, and trismus following third molar surgery: a randomized clinical trial. Int J Oral Maxillofac Surg. 2020 Nov;49(11):1508-1517. doi: 10.1016/j.ijom.2019.08.013. Epub 2020 May 4. PMID: 32381373.
• Acknowledgements: Funding - CAPES, Ministry of Education, Brazil

2000 Nicotine Patches for Aphthous Ulcers Due to Behçet's Syndrome

• We describe a woman with Behçet's syndrome characterized by recurrent oral and genital aphthous ulcers, severe eye involvement, and the onset of arthritis at the age of 29 years. At the age of 35 several large and extremely painful buccal aphthous ulcers developed. Therapy with a nicotine patch led to a regression of all aphthous ulcers within a few days. A month later, after the patient had stopped using the nicotine patches, four aphthous ulcers developed within a week. These ulcers rapidly regressed once she resumed using the nicotine patches.
• PDF Version (Note: Need to scroll down to the correct section)
• Citation: Philippe Scheid, M.D., Abraham Bohadana, M.D., Yves Martinet, M.D., Ph.D., Université Henri Poincaré, 54500 Nancy-Vandoeuvre, France, December 14, 2000, N Engl J Med 2000; 343:1816-1817, DOI: 10.1056/NEJM200012143432418

Snus

2020: No association between moist oral snuff (snus) use and oral cancer: pooled analysis of nine prospective observational studies

• Swedish snus use does not appear to be implicated in the development of oral cancer in men.

Snus science database

• Snusforumet’s snus science database includes a collection of studies and research on snus and snus policy from a variety of sources and perspectives. The documents are in Swedish, English, and Norwegian.