A systematic review published in October 2026 in Clinical and Experimental Dental Research found that people who vape responded to periodontal and peri-implant therapy much like cigarette smokers did, and both groups fared worse than non-smokers. The evidence base is small (seven studies, 640 participants) and too varied for a meta-analysis, and the authors stop short of causal claims, but they advise clinicians to treat vaping with the same caution as smoking.
Vaping now comes up regularly in medical-history reviews, and it raises a practical question for hygienists and periodontists in Toronto and across Canada: when a patient who vapes sits down for scaling and root planing or peri-implantitis treatment, should you expect the same response as a non-smoker? As of October 2026, a new systematic review summarizes what the published studies show, and its answer is a cautious no.
What the review set out to answer
The paper, "Effect of Vaping on Treatment Outcomes in Patients With Gingivitis, Periodontitis, and/or Peri-Implant Disease: A Systematic Review," was written by Stacey May Gould and colleagues at the College of Medicine and Dentistry, James Cook University in Cairns, Queensland, Australia. It appears in Clinical and Experimental Dental Research (volume 12, issue 5) and is open access.
This review asked a specific clinical question: how do vapers respond to treatment, compared with both cigarette smokers and non-smokers? The authors describe it as, to the best of their knowledge, the first systematic review to analyze vaping's effect on the effectiveness of periodontal and peri-implant therapy using both clinical parameters and immunological markers against those two comparison groups.
How the evidence was gathered
- Databases: Ovid MEDLINE, PubMed, Scopus and Web of Science, with no date restrictions, searched through June 30, 2026.
- Screening: 7,591 records were identified; 47 full texts were reviewed; seven studies met the inclusion criteria. Two independent reviewers screened and extracted the data.
- Quality appraisal: risk of bias was assessed with the Newcastle-Ottawa Quality Assessment Scale and the Cochrane Risk of Bias tool.
- Participants: 640 in total, made up of 168 people who exclusively vaped, 138 who exclusively smoked cigarettes (each for more than a year) and 334 non-smokers.
- Study designs: four cohort studies, one case-control study, one cross-sectional study and one randomized controlled trial.
- Where: five studies were carried out in Saudi Arabia, one in the United Kingdom, and one did not specify a country.
By condition, the evidence comprised one study of peri-implant mucositis, two of peri-implantitis, two of periodontitis, one described as "periodontal inflammation," and one consistent with gingivitis. Six of the seven studies used non-surgical periodontal therapy, from full-mouth mechanical debridement to supragingival and root-surface debridement. One used open-flap debridement after non-surgical therapy had not worked.
What the review found
The headline finding is stated plainly in the abstract: there was no significant difference in clinical response to periodontal and peri-implant therapy between tobacco and e-cigarette users, and both fared worse than non-smokers. Immunological outcomes were also similar between smokers and vapers, with some exceptions, such as higher TNF-alpha levels in e-cigarette users.
The discussion section fills in the clinical picture parameter by parameter:
- Plaque: vape users and cigarette smokers both had consistently higher plaque index scores than non-smokers after periodontal and peri-implant therapy.
- Bleeding on probing: BoP in vape users followed trends similar to those of cigarette users, both before and after treatment.
- Probing depth: probing depths were higher among vape users than non-smokers after treatment, and some included studies found the least probing-depth improvement among vape users compared with both smokers and non-smokers.
- Overall severity: vape users were not as severe as smokers in most parameters, but they had clinical parameters similar to smokers and worse outcomes than non-smokers at baseline and after treatment.
One caveat cuts in an unexpected direction. Smokers in these studies had been smoking longer than the vapers had been vaping. The authors note that this longer exposure may have contributed to smokers' worse results, and that differences in duration and frequency of use may have made vape users appear more responsive than cigarette smokers. In other words, part of vapers' apparent advantage over smokers may reflect shorter exposure rather than a safer product.
Pro Tip: Add two questions to your medical-history update this month: "Do you vape?" and "How many sessions a day, and for how long?" The review found exposure was reported inconsistently across studies, and your own chart notes are the only exposure data you will have when you assess a patient's healing at re-evaluation.
Why the evidence is still limited
The authors are careful about what their data can and cannot support, and that care is worth passing on to colleagues and patients. Because the seven studies differed in design, outcome measures, exposure definitions and follow-up periods, a meta-analysis could not be performed. The conclusions rest on consistent trends across studies rather than pooled numbers, and the authors say the findings should be interpreted with caution.
They list several specific weaknesses in the underlying studies:
- Some studies used the 2017 World Workshop classification of periodontal and peri-implant diseases and others did not, which likely introduced variability in baseline disease severity.
- Several studies did not specify whether vape users had previously used tobacco products, or whether their vapes contained nicotine.
- No standardized method exists for measuring vaping exposure, so reporting was inconsistent.
It is also worth noting that six of the seven studies were observational and five were conducted in Saudi Arabia, which limits how far the results can be generalized.
The authors also point out that smoking-cessation advice was not provided in any of the included studies, so the included studies did not examine the effect of cessation.
What the authors recommend for clinical practice
The review's practice recommendations are measured. The authors write that current evidence does not allow definitive causal claims, but that the available studies show vape users' outcomes trending similarly to those of cigarette smokers, while non-smokers consistently do better. On that basis they recommend:
- approaching vaping with the same caution clinicians apply to conventional smoking;
- continuing to prioritize smoking-cessation counselling;
- clearly communicating that vaping should not be considered a proven safer alternative in the context of periodontal or peri-implant therapy; and
- recognizing that current evidence does not support vaping as an effective harm-reduction strategy within periodontal or peri-implant therapy.
The authors also suggest that shorter supportive periodontal care appointments may be recommended for both vapers and smokers, alongside routine oral hygiene instruction, given the higher plaque scores they observed.
Pro Tip: When a patient tells you they switched from cigarettes to vaping "for their gums," use the review's own wording: vaping "should not be considered a proven safer alternative in the context of periodontal or peri-implant therapy." It is accurate, it is not alarmist, and it opens the door to a cessation conversation.
Is there a Canadian signal?
The review contains no Canadian data, but Statistics Canada's 2023/2024 Canadian Oral Health Survey offers a related, self-reported data point. In a Health Reports analysis of that survey published in April 2026, 24.1% of adults who used nicotine products daily or occasionally (a category that included cigarettes, cigars, vaping products and chewing tobacco) rated their oral health as fair or poor, compared with 15.9% of current non-users. That figure combines all nicotine products and measures perception rather than treatment response, so it does not confirm the review's findings, but it shows the same direction in a Canadian population.
For practices in Toronto, Mississauga, Brampton and the rest of the GTA, the practical upshot is modest but real: a patient's vaping history belongs in the same part of your periodontal risk assessment as smoking history, and re-evaluation and recall planning should account for it.
What researchers still need to answer
The authors call for well-designed longitudinal and interventional studies with larger and more diverse populations, and for research into which specific constituents of vape aerosols may affect host immune responses. Until those studies arrive, the safest clinical position is the one the review itself takes: vaping is not a proven safer option for patients undergoing periodontal or implant therapy.
EBIKO Dental will continue monitoring research on vaping and oral health and will report on new findings relevant to Canadian dental professionals. For clinical supplies for your periodontal and hygiene programs, visit EBIKO Dental.
Sources
- Gould SM, Gilchrist CA, Gaza HD, Sidhu IK, Hugo KJ, Amaral RR, de Mello-Neto JM. Effect of Vaping on Treatment Outcomes in Patients With Gingivitis, Periodontitis, and/or Peri-Implant Disease: A Systematic Review. Clinical and Experimental Dental Research, 2026;12(5). Full text (Europe PMC) · doi:10.1002/cre2.70456
- Rotermann M, Murphy K. Prevalence and correlates of self-reported fair or poor oral health in Canada. Health Reports, Statistics Canada, April 15, 2026. Article
Frequently Asked Questions
Q: Does vaping affect the results of periodontal treatment?
A 2026 systematic review of seven studies found that vapers' response to periodontal and peri-implant therapy was not significantly different from that of cigarette smokers, and both did worse than non-smokers. The authors caution that the evidence is limited and does not prove cause and effect.
Q: Is vaping safer than smoking for patients with gum disease or dental implants?
The review's authors say vaping should not be considered a proven safer alternative in the context of periodontal or peri-implant therapy, and that current evidence does not support it as a harm-reduction strategy in that setting. They recommend treating vaping with the same caution as smoking.
Q: How many studies looked at vaping and periodontal treatment outcomes?
The review identified 7,591 records and included seven studies with 640 participants: 168 vapers, 138 cigarette smokers and 334 non-smokers. Differences between the studies meant no meta-analysis could be performed.