Periodontal health and caries experience of cigarette and e-cigarette users : a longitudinal study

Abstract

Recently, there has been a growing trend towards a new type of alternative device where cigarette smokers use traditional cigarettes with an electronic nicotine delivery system (ENDS) or electronic cigarettes (e-cigarettes) to receive nicotine. E-cigarettes have gained popularity after they were introduced in the market, especially among young adult smokers. Though the current government policy on nicotine control is being established to include e-cigarettes, e-cigarettes are presently almost entirely unregulated in Malaysia. To date, there is little documented evidence regarding the oral effects of e- cigarette use. The effects of cigarette smoking on health have been reported in numerous past studies including in Malaysia. However, research findings of e-cigarette effects on oral health are unclear and scattered. Therefore, the aim of the study is to determine the periodontal health and caries indices of both e-cigarette and cigarette users at baseline and 6-month follow-up. A prospective longitudinal study was done on 45 cigarette users, e-cigarette users, and non-smoking persons at the Specialist Clinic, Kulliyyah of Dentistry, IIUM Kuantan Campus. Oral health examination was conducted according to the World Health Organization (WHO) criteria. Dental caries was evaluated using the DMFT Index, while the periodontal parameters were assessed using plaque, gingivitis, gingival bleeding, and calculus indices. Time effect, smoking status group effect and time-smoking status group interaction were analysed using repeated measure ANOVA. Time-smoking status group interaction analysis showed significant findings at baseline between the control group and cigarette users on Gingival Index (p = 0.008) and Bleeding Index (p = 0.018), between the control group and e-cigarette users on Bleeding Index (p = 0.009) and lastly between cigarette and e-cigarette users on Gingival Index (p = 0.000) and Plaque Index (p = 0.006). Additionally, at the 6 month follow up, significant findings were found between the control group and cigarette users on Plaque Index (p = 0.000), and Calculus Index (p = 0.003); between the control group and e-cigarette users on Bleeding Index (p = 0.003); between cigarette and e-cigarette users on Gingival Index (p = 0.000), Plaque Index (p = 0.008), and Calculus Index (p = 0.000). In conclusion, both cigarette and e-cigarette have an impact on oral health. More research needs to be done to provide further evidence of the effects of e-cigarettes on health, specifically oral health; specifically, in a larger population and a longer longitudinal study.