ENDS use has been linked to gum inflammation and alterations in the mouth that contribute to an infection of the gums. This infection results in gums shrinking and teeth loosening. Research has found that people who vape also report cracked teeth and gum bleeding or pain.

Adverse oral health effects can also be potentially impacted by:

• Device characteristics (e.g., age, e-liquid content, and coil temperature)
• Nicotine dependency
• Personal vaping behavior (such as frequency and puff volume)

People who vape can inhale many toxic substances into their lungs. These substances can cause cell damage and inflammation. Short-term side effects from vaping can include coughing and wheezing. More chronic health concerns could be lung diseases and lung scarring, asthma, and cancer.

An example is the 2019 e-cigarette, or vaping, product use associated lung injury (EVALI) outbreak. Although vitamin E acetate was a likely culprit, other e-liquid compounds could also cause EVALI.

Additionally, inhaled particles and chemicals can damage the lungs’ regulators and defense mechanisms, which could increase the susceptibility to viral illnesses.

Once in the lungs, chemicals from vaping can enter the bloodstream. While in the bloodstream, these chemicals may potentially cause changes to blood vessels that could increase blood pressure, which is a risk factor for cardiovascular disease.

Vaping during pregnancy may potentially cause adverse effects for the mother and the developing fetus.

Secondhand exposure to vaping when pregnant can also potentially cause issues with unborn children, including the potential transfer of glycerol and heavy metals into cord blood.

While the basic e-liquid ingredients may produce many harmful chemicals during vaping, research has also shown that nicotine might impact user exposure to harmful chemicals. Studies indicate that a higher percentage of nicotine in e-liquid could increase particle emissions. The format of nicotine (e.g., freebase and salts) may also affect the emissions process.

Additionally, flavored e-liquids contain a complex mixture of flavoring chemicals, nicotine, and humectants. Some flavoring chemicals like benzaldehyde and vanillin are known respiratory irritants.

As vaping devices age, their performance can vary. Some devices show an increase in particle emissions while others show a decrease, leading to uncertainty about the chemical content. The heating coil can lose material, including metals, over time and degrade, resulting in a decreased power output.

Vapes use a coil to heat and vaporize e-liquids. When e-liquids vaporize, they produce many known and unknown chemical byproducts alongside free radicals. The coil’s temperature (among other characteristics) determines the amount of vaporized mass per puff during the vaping process. Higher coil temperatures increase the vaporized mass. The heated coil or soldered joints produce heavy metals. These metals can be encapsulated in liquid droplets or bound to particulates and can be inhaled.

The increased power level leads to higher coil temperatures, which may increase exposure to harmful chemicals for the user. Changes in wattage may influence particle size, distribution, absorption, and metal content, potentially impacting lung health.