The effects of vaporization on the respiratory, cardiovascular, skin, oral and dental systems
DOI:
https://doi.org/10.12775/QS.2026.56.71627Keywords
Vaping; Electronic Cigarettes; Respiratory Diseases; Cardiovascular Diseases; Skin Disorders; Oral and Dental Diseases; Nicotine Dependence; Inflammation; Oxidative Stress; Public HealthAbstract
Introduction:
Vaping, defined as the inhalation of an aerosol generated by electronic nicotine delivery systems (ENDS), has become a rapidly growing public health phenomenon, particularly among adolescents and young adults. Despite the absence of a combustion process, e-cigarettes deliver nicotine along with numerous chemical compounds with potential toxic properties, raising concerns regarding their multisystem health effects.
Materials and Methods:
A narrative–systematic review of the literature published between 2013 and 2025 was conducted. Publications indexed in PubMed, JAMA Network, ScienceDirect, Wiley Online Library, as well as reports from international institutions, were analyzed.
Results:
E-cigarette use has been shown to be associated with multisystem health effects. Within the respiratory system, symptoms such as cough, dyspnea, wheezing, exacerbations of asthma and chronic obstructive pulmonary disease (COPD), as well as cases of acute lung injury (EVALI), have been reported. In the cardiovascular system, endothelial dysfunction, increased arterial blood pressure, and oxidative stress have been observed. Cutaneous manifestations include impaired wound healing and inflammatory processes. In the oral cavity, an increased risk of periodontal disease, dental caries, and microbiome dysbiosis has been identified.
Discussion:
Available evidence suggests that e-cigarettes exhibit biological activity and may induce multisystem health consequences. Although the levels of certain toxicants may be lower than those found in conventional tobacco smoke, this does not imply safety. A key limitation remains the lack of long-term population-based studies.
Conclusions:
Vaping is associated with significant health risks affecting multiple organ systems. Current evidence does not support its safety, and the use of e-cigarettes should be considered potentially harmful. Further research and preventive measures are warranted, particularly among adolescent populations.
References
Feeney, S., Rossetti, V., Terrien, J., et al. (2022). E-cigarettes—a review of the evidence—harm versus harm reduction. Tobacco Use Insights, 15, 1179173X221087524. https://doi.org/10.1177/1179173X221087524
Hajek, P., Phillips-Waller, A., Przulj, D., et al. (2019). A randomized trial of e-cigarettes versus nicotine-replacement therapy. New England Journal of Medicine, 380(7), 629–637. https://doi.org/10.1056/NEJMoa1911614
Centers for Disease Control and Prevention. (2019). Outbreak of lung injury associated with e-cigarette use, or vaping. MMWR Morbidity and Mortality Weekly Report, 68(49), 1081–1086. http://dx.doi.org/10.15585/mmwr.mm6849e1
World Health Organization. (2023). WHO report on the global tobacco epidemic 2023: Protect people from tobacco smoke. https://www.who.int/publications/i/item/9789240077164
Layden, J. E., Ghinai, I., Pray, I., et al. (2020). Pulmonary illness related to e-cigarette use in Illinois and Wisconsin. JAMA, 323(15), 1495–1506. https://jamanetwork.com/journals/jama/fullarticle/2755265
Miech, R., Johnston, L., O’Malley, P. M., Bachman, J. G., & Patrick, M. E. (2017). Trends in adolescent vaping, 2017–2019. JAMA Pediatrics, 171(8), 788–789. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2634377
Centers for Disease Control and Prevention. (2020). Update: Characteristics of hospitalized patients with vaping-associated lung injury. MMWR Morbidity and Mortality Weekly Report, 69(50), 1851–1854. http://dx.doi.org/10.15585/mmwr.mm6950a1
Jensen, R. P., Luo, W., Pankow, J. F., Strongin, R. M., & Peyton, D. H. (2015). Hidden formaldehyde in e-cigarette aerosols. Chemical Research in Toxicology, 28(10), 2049–2056. https://doi.org/10.1021/acs.chemrestox.0c00247
Goniewicz, M. L., Smith, D. M., Edwards, K. C., et al. (2018). Comparison of nicotine and toxicant exposure in users of electronic cigarettes and combustible cigarettes. JAMA Network Open, 1(8), e185937. https://doi.org/10.1001/jamanetworkopen.2018.5937
McNeill, A., Brose, L. S., Calder, R., Bauld, L., & Robson, D. (2018). Evidence review of e-cigarettes and heated tobacco products. Tobacco Control. https://doi.org/10.1136/tobaccocontrol-2017-054125
Farsalinos, K. E., & Polosa, R. (2014). Safety evaluation and risk assessment of electronic cigarettes. Therapeutic Advances in Drug Safety, 5(2), 67–86. https://pubmed.ncbi.nlm.nih.gov/26642857/
Bullen, C., Howe, C., Laugesen, M., et al. (2013). Electronic cigarettes for smoking cessation. PLoS One, 8(3), e57987. https://doi.org/10.1371/journal.pone.0057987
National Academies of Sciences, Engineering, and Medicine. (2018). Public health consequences of e-cigarettes. https://doi.org/10.17226/24952
Margham, J., McAdam, K., Cunningham, A., et al. (2021). Chemical complexity of e-cigarette aerosols compared with smoke. Frontiers in Chemistry, 9, 743060. https://doi.org/10.3389/fchem.2021.743060
Goniewicz, M. L., Knysak, J., Gawron, M., et al. (2014). Levels of selected carcinogens and toxicants in vapour from electronic cigarettes. Tobacco Control, 23(2), 133–139. https://doi.org/10.1136/tobaccocontrol-2012-050859
Grana, R., Benowitz, N., & Glantz, S. A. (2014). E-cigarettes: A scientific review. New England Journal of Medicine. https://doi.org/10.1056/NEJMc1413069
Brown, C. J., & Cheng, J. M. (2014). Electronic cigarettes: Product characterisation and design considerations. Nicotine & Tobacco Research, 16(10), 129–138. https://doi.org/10.1093/ntr/ntu078
Rose, J. J., Krishnan-Sarin, S., Exil, V. J., et al. (2023). Cardiopulmonary impact of electronic cigarettes and vaping products: A scientific statement from the American Heart Association. Circulation, 148(8), 703–728. https://doi.org/10.1161/CIR.0000000000001160
Wold, L. E., Tarran, R., Crotty Alexander, L. E., et al. (2022). Cardiopulmonary consequences of vaping in adolescents: A scientific statement from the American Heart Association. Circulation Research, 131(3), e70–e82. https://doi.org/10.1161/RES.0000000000000544
Xie, W., Tackett, A. P., Berlowitz, J. B., et al. (2022). Association of electronic cigarette use with respiratory symptom development among U.S. young adults. American Journal of Respiratory and Critical Care Medicine, 205(11), 1320–1329. https://doi.org/10.1164/rccm.202107-1718OC
Brose, L. S., Reid, J. L., Robson, D., McNeill, A., & Hammond, D. (2024). Associations between vaping and self-reported respiratory symptoms in young people in Canada, England and the US. BMC Medicine, 22(1), 213. https://doi.org/10.1186/s12916-024-03428-6
de Miranda Schmitz, B., de Miranda Schmitz, F., Prazeres, G. B., & Marchioni, C. (2025). Major pulmonary clinical manifestations of e-cigarette use by adolescents: A scoping review. Respiratory Medicine, 108281. https://doi.org/10.1016/j.rmed.2025.108281
Soule, E. K., Bode, K. M., Desrosiers, A. C., et al. (2020). User-perceived negative respiratory symptoms associated with electronic cigarette use. Nicotine & Tobacco Research, 22(Suppl 1), S45–S53. https://doi.org/10.1093/ntr/ntaa179
Jonas, A. M., & Raj, R. (2020). Vaping-related acute parenchymal lung injury: A systematic review. Chest, 158(4), 1555–1565. https://doi.org/10.1016/j.chest.2020.03.085
Park, J. A., Crotty Alexander, L. E., & Christiani, D. C. (2022). Vaping and lung inflammation and injury. Annual Review of Physiology, 84, 611–629. https://doi.org/10.1146/annurev-physiol-061121-040014
Jonas, A. (2022). Impact of vaping on respiratory health. BMJ, 378, e065997. https://doi.org/10.1136/bmj-2021-065997
Visconti, M. J., & Ashack, K. A. (2019). Dermatologic manifestations associated with electronic cigarette use. Journal of the American Academy of Dermatology, 81(4), 1001–1007. https://doi.org/10.1016/j.jaad.2019.03.088
Mitri, A., Lin, G., Waldman, R. A., & Grant-Kels, J. M. (2021). Effects of tobacco and vaping on the skin. Clinics in Dermatology, 39(5), 762–771. https://doi.org/10.1016/j.clindermatol.2021.05.004
Jaleel, Z., Blasberg, E., Troiano, C., et al. (2021). Association of vaping with decreased vascular endothelial growth factor expression and decreased microvessel density in cutaneous wound healing tissue in rats. Wound Repair and Regeneration, 29(6), 1024–1034. https://doi.org/10.1111/wrr.12945
Maina, G., Castagnoli, C., Ghione, G., et al. (2017). Skin contamination as pathway for nicotine intoxication in vapers. Toxicology in Vitro, 41, 102–105. https://doi.org/10.1016/j.tiv.2017.02.022
Auschwitz, E., Almeda, J., & Andl, C. D. (2023). Mechanisms of e-cigarette vape-induced epithelial cell damage. Cells, 12(21), 2552. https://doi.org/10.3390/cells12212552
Stefaniak, A. B., LeBouf, R. F., Ranpara, A. C., & Leonard, S. S. (2021). Toxicology of flavoring- and cannabis-containing e-liquids used in electronic delivery systems. Pharmacology & Therapeutics, 224, 107838. https://doi.org/10.1016/j.pharmthera.2021.107838
Rose, J. J., Krishnan-Sarin, S., Exil, V. J., et al. (2023). Cardiopulmonary impact of electronic cigarettes and vaping products: A scientific statement from the American Heart Association. Circulation, 148(8), 703–728. https://doi.org/10.1161/CIR.0000000000001160
Sun, Y., Lin, K., Effah, F., et al. (2025). Toxicity of humectants propylene glycol and vegetable glycerin in electronic nicotine delivery systems. Toxicology Letters, 111739. https://doi.org/10.1016/j.toxlet.2025.111739
Wold, L. E., Tarran, R., Crotty Alexander, L. E., et al. (2022). Cardiopulmonary consequences of vaping in adolescents: A scientific statement from the American Heart Association. Circulation Research, 131(3), e70–e82. https://doi.org/10.1161/RES.0000000000000544
Kundu, A., Feore, A., Sanchez, S., et al. (2025). Cardiovascular health effects of vaping e-cigarettes: A systematic review and meta-analysis. Heart, 111(13), 599–608. https://doi.org/10.1136/heartjnl-2024-325030
Critselis, E., & Panagiotakos, D. (2024). Impact of electronic cigarette use on cardiovascular health: Current evidence, causal pathways, and public health implications. Angiology, 75(5), 417–424. https://doi.org/10.1177/00033197231161905
Wold, L. E., Tarran, R., Crotty Alexander, L. E., et al. (2022). Cardiopulmonary consequences of vaping in adolescents: A scientific statement from the American Heart Association. Circulation Research, 131(3), e70–e82. https://doi.org/10.1161/RES.0000000000000544
Zong, H., Hu, Z., Li, W., et al. (2024). Electronic cigarettes and cardiovascular disease: Epidemiological and biological links. Pflügers Archiv – European Journal of Physiology, 476(6), 875–888. https://doi.org/10.1007/s00424-024-02925-0
Daiber, A., Kuntic, M., Oelze, M., Hahad, O., & Münzel, T. (2023). E-cigarette effects on vascular function in animals and humans. Pflügers Archiv – European Journal of Physiology, 475(7), 783–796. https://doi.org/10.1007/s00424-023-02813-z
Tsai, M., Byun, M. K., Shin, J., & Crotty Alexander, L. E. (2020). Effects of e-cigarettes and vaping devices on cardiac and pulmonary physiology. The Journal of Physiology, 598(22), 5039–5062. https://doi.org/10.1113/JP279754
Zhang, Q., & Wen, C. (2023). The risk profile of electronic nicotine delivery systems, compared to traditional cigarettes, on oral disease: A review. Frontiers in Public Health, 11, 1146949. https://doi.org/10.3389/fpubh.2023.1146949
Holliday, R., Chaffee, B. W., Jakubovics, N. S., Kist, R., & Preshaw, P. M. (2021). Electronic cigarettes and oral health. Journal of Dental Research, 100(9), 906–913. https://doi.org/10.1177/00220345211002116
Ralho, A., Coelho, A., Ribeiro, M., Paula, A., Amaro, I., Sousa, J., Marto, C., Ferreira, M., & Carrilho, E. (2019). Effects of electronic cigarettes on oral cavity: A systematic review. Journal of Evidence-Based Dental Practice, 19(4), 101318. https://doi.org/10.1016/j.jebdp.2019.04.002
Yang, I., Sandeep, S., & Rodriguez, J. (2020). The oral health impact of electronic cigarette use: A systematic review. Critical Reviews in Toxicology, 50(2), 97–127. https://doi.org/10.1080/10408444.2020.1713726
Jeong, W., Choi, D. W., Kim, Y. K., Lee, H. J., Lee, S. A., Park, E. C., & Jang, S. I. (2020). Associations of electronic and conventional cigarette use with periodontal disease in South Korean adults. Journal of Periodontology, 91(1), 55–64. https://doi.org/10.1002/JPER.19-0060
Yang, I., He, X., Jeon, J., Claussen, H., Arthur, R., Cushenan, P., Weaver, S. R., Luo, R., Black, M., Shannahan, J., & Wright, C. (2025). The impact of vaping behavior on functional changes within the subgingival microbiome. Scientific Reports, 15, 34374. https://doi.org/10.1038/s41598-025-17121-y
Ganesan, S. M., Dabdoub, S. M., Nagaraja, H. N., Yang, M., Eberhard, J., Kaplan, A., ... & Kumar, P. S. (2020). Adverse effects of electronic cigarettes on the disease-naive oral microbiome. Science Advances, 6(22), eaaz0108. https://doi.org/10.1126/sciadv.aaz0108
Irusa, K. F., Vence, B., & Donovan, T. (2020). Potential oral health effects of e-cigarettes and vaping: A review and case reports. Journal of Esthetic and Restorative Dentistry, 32(3), 260–264. https://doi.org/10.1111/jerd.12583
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