Sir, vaping has received attention with a total of 2,807 hospitalisations and 68 deaths being caused by it as reported by the US CDC as of 18 February 2020.1 There is evidence to support the negative association between vaping and periodontal/gingival health as well as compromise in radiographic and clinical peri-implant assessments owing to an uptick of inflammation in people who vape.2

Vaping has been commercialised as a safer alternative to conventional cigarette smoking, with limited information on its cariogenic potential.2 Recent research has shown that patients who indulged in vaping were at a greater risk for developing cavities as opposed to those who do not.2 With 19.6% and 4.7% high and middle school students, respectively, being reported to be using e-cigarettes in the USA, it appears that a large portion of the population are vulnerable and an even larger number of teeth are at risk.

The recent finding, which implicates a higher risk of caries in people who vape should, at this stage, at least raise awareness amongst dental practitioners. The study utilised data of roughly 13,000 patients. Amongst the 136 (0.69%) patients who reported vaping/e-cigarette usage behaviour, a statistically significant difference was observed in the risk of caries levels.2

Of particular interest is that 79.1% of patients who vaped were in the high caries risk group compared to 59.6% of controls.

The study did suffer from limitations of being cross-sectional in design, a high risk of type II and social desirability bias and the inherent inaccuracies of the CAMBRIA tool. One reason why the use of e-cigarettes could result in increased caries activity is the viscosity and sugar content of vaping liquids, which might stick to the teeth subsequent to being aerosolised and inhaled.

Vaping also tends to cause atypical carious patterns, which can have its own implications including aesthetic ones. Dentists should enquire about e-cigarette usage in medical histories, particularly paediatric dentists, seeing as a great number of adolescents reportedly indulge in vaping. E-cigarette users may also be directed towards more thorough caries management strategies.