The oral cavity is directly exposed to tobacco smoke and e-cigarette aerosols, making it highly vulnerable to their harmful effects. Cigarette smoking has long been implicated and is well known for causing periodontal destruction, impaired wound healing, and malignant transformation [1,2]. Vaping, despite being marketed as a safer alternative, introduces aerosolized chemicals that also disrupt oral epithelial integrity, immunity, and microbiota [3,4]. Given the rising prevalence of vaping among young adults, oral health professionals must critically appraise its risks alongside those of smoking.

Effects of Smoking on Oral Health

Cigarette smoke contains over 7,000 chemicals, including nitrosamines and polycyclic aromatic hydrocarbons, which exert cytotoxic, mutagenic, and carcinogenic effects [5]. Nicotine alters neutrophil chemotaxis, impairs gingival blood flow, and fosters anaerobic biofilm growth, making smoking the strongest modifiable risk factor for periodontitis [6,7]. Vasoconstriction, reduced angiogenesis, and impaired fibroblast function delay recovery after extractions, implant placement, and orthognathic procedures [8,9]. Chronic exposure to carcinogens present in cigarette smoke increases oral squamous cell carcinoma risk by up to sixfold compared to non-smokers along with smoker’s melanosis, leukoplakia, erythroplakia, and nicotine stomatitis remain frequent findings in long-term users [10,11].

Effects of Vaping on Oral Health

E-cigarettes deliver nicotine, solvents, aldehydes, volatile organic compounds, and heavy metals at high temperatures [12]. Though free of combustion products, their effects on oral tissues are concerning. Exposure to aerosol leads to keratinocyte DNA damage, oxidative stress, and dysplastic changes [13]. Vaping alters subgingival microbiota and upregulates inflammatory cytokines, predisposing to gingivitis and periodontitis [14,15]. In vitro studies demonstrate delayed fibroblast migration and impaired collagen synthesis, with possible consequences for socket healing and osseointegration [16]. While long-term cancer risk is not fully established, early evidence shows increased mutagenicity and genotoxicity in oral epithelial cells [17].

The oral cavity, being directly exposed to tobacco smoke and e-cigarette aerosols, is highly vulnerable to their harmful effects. Cigarette smoking is undeniably linked to periodontal destruction, impaired wound healing, and oral cancer development. Vaping, despite being touted as a safer alternative, introduces aerosolized chemicals such as nicotine, formaldehyde, and propylene glycol, which disrupt oral epithelial integrity, immunity, and microbiota.

The misconception of vaping as entirely safe has led to its increased adoption, especially among young individuals. These chemical exposures from vaping can trigger oral inflammation, dry mouth (xerostomia), and contribute to dental caries and potentially even increase the risk of oral cancers. Nicotine, present in both products, further complicates matters by constricting blood vessels, negatively impacting blood flow to oral tissues, thereby impairing healing and increasing the likelihood of complications after oral surgeries, including delayed healing and dental implant failure.

For dental surgeons and oral and maxillofacial surgeons, understanding these risks is paramount for providing comprehensive patient education. This necessitates implementing targeted pre- and post-operative instructions and offering effective counseling for cessation, especially considering the rising prevalence of vaping among younger populations. Early screening for premalignant lesions and addressing both smoking and vaping habits during patient consultations are crucial steps toward improving outcomes and reducing long-term morbidity in this patient group. Further research, particularly longitudinal studies, is necessary to fully elucidate the long-term effects of vaping on oral health.

Both smoking and vaping negatively affect oral health. While the harms of smoking are well established, vaping introduces novel toxicological pathways that warrant further longitudinal research. For general dental clinicians and especially oral and maxillofacial surgeons, addressing both habits in patient counseling and surgical planning is essential to improve outcomes and reduce long-term morbidity. Also care needs to be taken regarding anxiety of patients and often tends to avoid dentists [18,19], so campaigns on social media is a good way to move forward.

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