Abstract
BACKGROUND: Electronic Nicotine Delivery Systems (ENDS, e-cigarettes) are a popular alternative to traditional tobacco smoking. OBJECTIVE: To evaluate the effect of ENDS use on periodontal health. METHODS: A protocol was published in accordance with PRISMA standards. Subjects with periodontal health, gingivitis and periodontitis were included. Reviews, case reports, letters, abstracts, narratives and expert opinions were excluded. Databases searched included PubMed, Embase, Web of Science, CINAHL Plus, and Dentistry & Oral Sciences Source up until February 2024. Risk of bias was evaluated using the Newcastle-Ottawa Scale, ROBINS-I and the RoB 2 tools. RESULTS: 40 eligible studies were included. Smokers had poorer clinical outcomes than ENDS users and non-smokers/former smokers, apart from bleeding on probing and gingival indices. There was no difference between ENDS users and non-smokers/former smokers in markers of periodontal destruction (pocket probing depths/marginal bone loss). ENDS users had higher plaque scores than non-smokers/former smokers. ENDS use leads to unique microbial changes compared to tobacco smokers and higher pro-inflammatory markers compared to non-smokers/former smokers. CONCLUSION: Within the limitations of the included studies which are at high risk of bias, we found evidence that ENDS use had some impact on periodontal parameters compared to non-smokers/former smokers. Tobacco smokers had consistently worst outcomes. REGISTRATION PROSPERO 2024: CRD42024496560.