Heterogeneous Oral Health Outcomes by Combustible Cigarette Smoking, E-Cigarette Use and Dual Use: A Cross-Sectional...

Combustible cigarette smoking is a well-established risk factor for poor oral health, but the implications of e-cigarette use and dual use remain uncertain. Distinguishing the effects of vaping from the lingering consequences of prior smoking is a persistent challenge in the literature.

To assess how distinct nicotine use profiles relate to oral health-related quality of life, self-reported oral health indicators and self-rated dental health among adults in England, while differentiating e-cigarette users by smoking history.

We conducted a cross-sectional analysis of 6027 adults (aged ≥ 16 years) from the nationally representative 2021 Adult Oral Health Survey for England. Participants were classified into five current smoking/vaping categories (never users, former smokers, exclusive cigarette smokers, exclusive e-cigarette users, dual users) and, separately, by combined vaping-smoking history. Outcomes included any oral health difficulty and the number of impacts derived from the 14-item Oral Health Impact Profile (OHIP-14), as well as loose teeth, gum disease history, dry mouth and self-rated dental health. Binary outcomes (any oral health difficulty, loose teeth, gum disease history) were analysed using logistic regression, and ordinal outcomes (number of OHIP-14 impacts, dry mouth, self-rated dental health) using ordered logistic regression, with adjustment for sociodemographic, behavioural and oral hygiene covariates.

Compared with never users, exclusive cigarette smokers had the highest adjusted odds of reporting any oral health difficulty (OR = 1.85, 95% CI: 1.51-2.27), loose teeth (OR = 3.18, 95% CI: 2.47-4.09), gum disease history (OR = 1.94, 95% CI: 1.52-2.49) and poorer self-rated dental health (OR = 2.88, 95% CI: 2.36-3.52). Dual users showed similarly elevated odds for loose teeth (OR = 3.11, 95% CI: 1.95-4.97), the highest odds for gum disease history (OR = 3.21, 95% CI: 2.06-4.99) and elevated odds for any oral health difficulty (OR = 1.55, 95% CI: 1.04-2.30) and poorer self-rated dental health (OR = 2.45, 95% CI: 1.68-3.58). Exclusive e-cigarette users also showed elevated odds across outcomes, though generally of smaller magnitude. Estimates for the very small subgroup of never-smoking current e-cigarette users did not show significant excess odds across outcomes, but were imprecise and should be regarded as exploratory.

In this cross-sectional population-based analysis, combustible cigarette smoking and dual use were associated with poorer self-reported oral health outcomes. Findings related to e-cigarette use require cautious interpretation because of prior smoking history, the sparse never-smoker vaping subgroup and the absence of detailed exposure data (e.g., smoking intensity, pack-years, time since cessation, vaping duration, device type and nicotine concentration). Smoking cessation should remain central to preventive dentistry.