From:  Vaping, heated tobacco, and periodontal health: a systematic review of their effects on inflammation, microbiota, and non-surgical therapy response

 Featured research in the qualitative analysis and its characteristics.

Authors (year)Type of studyAim of the studyMaterial and methodsResults
Xu et al. (2021) [55]Longitudinal study/comparative clinical studyTo evaluate the impact of E-C aerosol on periodontal health in periodontitis patients140 participants (cigarette smokers, E-C users, non-smokers) followed for 6 months, monitoring periodontal parameters and smoking behaviors.E-C users and smokers had more severe periodontal disease progression compared to non-smokers.
Shah et al. (2023) [56]Retrospective clinical studyTo compare periodontal treatment responses in E-C users, non-smokers, and smokersA retrospective analysis of 220 periodontitis patients’ baseline charting, plaque removal, and re-evaluation. Linear models are used to analyze clinical outcomes based on smoking status.E-C users had less favorable responses to treatment compared to non-smokers, similar to current smokers, with increased need for surgery and deeper probing depths.
Kumar et al. (2023) [57]Exploratory clinical studyTo evaluate how E-C use affects response to N-SPTPatients underwent N-SPT, and clinical parameters were measured before and after treatment to assess the effect of E-C use on periodontal outcomes.E-C users showed less improvement in clinical periodontal parameters compared with non-smokers.
Holliday et al. (2019) [58]Feasibility pilot RCTTo assess the feasibility of E-Cs for smoking cessation in patients with periodontitisPilot randomized controlled trial involving patients using E-C toquit smoking, monitoring periodontal health and smoking cessation outcomes over time.The study showed that E-Cs could be a feasible smoking cessation tool for periodontitis patients, but further larger studies are needed.
Karaaslan et al. (2020) [59]Observational studyTo examine the effects of vaping on periodontitis progressionClinical evaluations of patients who vape, focusing on periodontal measurements like probing depth and attachment loss, compared to non-smokers and smokers.Vaping was associated with increased periodontal inflammation and disease progression, similar to traditional smokers.
Kiiun et al. (2023) [60]Biochemical and clinical studyTo investigate oral dysbiosis and enzyme activity in E-C users with periodontitisBiochemical tests on oral fluid for urease and lysozyme activity were performed on E-C users and compared to non-smokers and cigarette smokers with periodontal disease.E-C users showed significant oral dysbiosis and altered enzyme activity compared to non-smokers, potentially worsening periodontitis outcomes.
Akram et al. (2021) [61]Longitudinal cohort studyTo evaluate periodontal disease progression biomarkers among E-C usersClinical and biochemical markers of periodontal tissue degradation were tracked over time in smokers, E-C users, and non-smokers to compare disease progression.E-C users showed elevated biomarkers indicating tissue degradation, similar to cigarette smokers.
ArRejaie et al. (2019) [62]Cross-sectional studyTo compare peri-implant parameters and cytokine levels among smokers, vapers, and non-smokersClinical measurements of peri-implant health and analysis of pro-inflammatory cytokines in the gingival fluid across the three groups.Smokers and vapers both had higher levels of inflammation and worse peri-implant health compared to non-smokers.
ALHarthi et al. (2019) [63]Prospective clinical studyTo evaluate the effect of full-mouth ultrasonic scaling in smokers and vapersPatients underwent full-mouth ultrasonic scaling, and gingival inflammation parameters were assessed pre- and post-treatment, comparing smokers, vapers, and non-smokers.Vapers showed less reduction in inflammation compared to non-smokers after scaling, without coming close to smokers.
Mišković et al. (2024) [64]Cross-sectional studyTo assess periodontal health in adults exposed to tobacco heating systems versus cigarette smokePeriodontal health of adults exposed to HTPs, cigarettes, and non-smokers was assessed through clinical periodontal parameters like probing depth and attachment loss.Heated tobacco users had slightly better periodontal health than cigarette smokers, but worse than non-smokers.
Pouly et al. (2021) [65]Randomized controlled multicenter studyTo evaluate the effect of switching to heated tobacco on periodontitis treatment outcomesMulticenter study with patients randomized to either switch to heated tobacco or continue smoking, assessing clinical periodontal treatment outcomes after non-surgical therapy.Switching to heated tobacco showed improved periodontal treatment outcomes compared to continued smoking, but not as good as those of non-smokers.
Al-Hamoudi et al. (2020) [66]Clinical studyTo assess the anti-inflammatory cytokine response in E-C users and non-smokersAnalysis of anti-inflammatory cytokine levels (IL-4, IL-9, IL-10, and IL-13) in gingival crevicular fluid after SRP in E-C users and non-smokers.E-C users had lower levels of anti-inflammatory cytokines compared to non-smokers, suggesting a less favorable immune response.

E-C: electronic cigarette; N-SPT: non-surgical periodontal therapy; HTPs: heated tobacco products; IL: interleukin; SRP: scaling and root planing.