The quest for bringing down tobacco use by providing alternative systems for delivering nicotine has given rise to e-cigarettes — electronic cigarettes that can be smoked when the cravings for a puff become too strong to control.

E-cigarettes follow a long line of nicotine replacement products that include sprays, lozenges and patches. E-cigarettes are also available without nicotine and are being touted as a healthier alternative to cigarettes. Some believe that e-cigs can be used as a tool to stop smoking. However, there is little data to back this.

Youth are particularly attracted to e-cigs. By 2012, 1 of every 10 high school students in America had used them at least once.

With e-cigs being positioned as an alternative to cigarettes, researchers are trying to study their effect on oral health. Cigarette smoking has a detrimental effect on our oral health, including bad breath, tooth discoloration, gum disease and poor healing after dental procedures. Research done to date shows that using e-cigs does have a negative effect on oral health.

The vaporizing liquid used in e-cigarettes contains formaldehyde, propylene glycol, acrolein, toluene, nitrosamines, acetaldehyde, nickel, cadmium and other chemicals. As mentioned above, it also contains nicotine, which is known to cause oral conditions. Carcinogens, such as nitrosamines, found in e-cigs expose users to the risk of oral cancer.

Gingivitis, an inflammation of the gums, results from exposing the oral cavity to nicotine. Left untreated, it progresses to periodontitis.

Vaping, as the use of e-cigarettes is known, leads to a receding of the gum line. Gum recession, caused by gum tissue death, happens due to vasoconstriction caused by nicotine. Nicotine deprives gums of oxygenated blood and nutrients.

Gum recession, in turn, loosens the teeth and necessitates otherwise avoidable visits to the dentist. With e-cigs, the absorbency of nicotine by gum tissue is quite high, and that increases the risk of oral diseases.

Often, e-cigs conceal the presence of gum disease from dentists. Irritated and swollen gums that bleed easily are a telltale sign of gum disease. However, nicotine restricts blood supply to the gums and masks the symptoms. This makes it difficult to diagnose gum conditions and delays treatment.

One way in which dentists can diagnose gum disease in e-cigarette users is through pocket reading.

A dry mouth and poor production of saliva because of the nicotine in e-cigs leads to bacteria build-up in the mouth. Bad breath is the result. Over a period of time, the bacterial colonies under the gums lead to more plaque than what a healthy mouth can support. Plaque is associated with dental caries, gum irritation leading to gingivitis, periodontitis and tartar accumulation. These conditions accelerate the rate of tooth decay.

People prone to teeth grinding (bruxism) may do so even more after using e-cigs. This is because nicotine in these electronic cigarettes is a muscle stimulant.

Unlike cigarettes, e-cigs are not regulated by the FDA. Users, therefore, have to go by the manufacturer's word and marketing that are not necessarily based on scientific review.