PREVALENCE OF TOBACCO
U S E A N D V A P IN G
AMONG STUDENTS
A N D IT S E F F E C T S
O N T H E IR O R A L H E A L T H
Introduction
The World Health Organization reported that 23.6% of the global adult population (aged ≥15
years were current tobacco users in 2018, down from 33.3% in 2000. This figure is projected to
decline further to 20.9% by 2025.[1]
Tobacco has been used in various social settings for centuries. Its consumption was once so
widespread that it was even considered to have potential health benefits. In recent years,
however, the use of electronic nicotine-releasing devices (ENRDs) has increased, particularly
among adolescents and young adults. Unfortunately, the current design and marketing of these
devices often fail to clearly communicate their harmful effects to consumers.[2]
Tobacco use remains a major global public health concern, accounting for over 8 million deaths
each year, with low- and middle-income countries bearing the greatest burden. In Pakistan,
tobacco consumption places significant pressure on the healthcare system. According to the
Global Adult Tobacco Survey, the age-standardized prevalence of tobacco use in Pakistan is
13.4%, with men being seven times more likely to use tobacco than women. Notably, 40.3% of
current tobacco users consume smokeless tobacco, with naswar being the most commonly used
product, showing a prevalence of 5.1%. Tobacco use has severe implications for oral health,
contributing to conditions such as periodontal disease, peri-implantitis, implant failure, dental
caries, alveolar osteitis, and halitosis. While these conditions may not be as deadly as oral
cancer, they still result in significant health complications and financial costs for individuals and
the healthcare system.[3]
Electronic cigarettes (ECs), or vapes, have recently become increasingly popular, especially
among younger populations. These battery-powered devices heat an e-liquid—typically
containing nicotine, flavorings, and chemicals like formaldehyde and acetaldehyde—into an
aerosol that is inhaled. Studies in countries such as the United States have found that nearly one
in ten individuals who have never smoked traditional cigarettes have tried vaping, with the
highest prevalence among males and young adults aged 18–24 years. Pakistan is rapidly
becoming a significant market for the vaping and e-cigarette industry, with no current regulations
on their sale, promotion, or usage. The country’s e-cigarette market is projected to generate
$77.2 million in revenue by 2024, with an annual growth rate of 1.39%. Despite their growing
popularity, research on the oral health effects of vaping remains limited. Emerging evidence
suggests that nicotine and other chemicals in e-cigarette vapor may contribute to oral health
issues such as periodontal damage and irritation of the mouth and throat. While general health
perceptions of vaping have been widely studied, there is a lack of research on public awareness
and understanding of its specific effects on oral health.[4]
Tobacco smoking causes a wide range of adverse health effects, including cancer and
cardiovascular and pulmonary diseases. Smoking cigarettes, bidis, pipes, cigars, and the use of
smokeless tobacco are all associated with an increased risk of malignant and premalignant
lesions in the oral cavity, as well as periodontal diseases, tooth loss, and dental implant failure.
Recent studies also suggest a link between smoking and the development of bronchiolitis
obliterans, commonly known as "popcorn lung."[5]
Among these conditions, periodontal diseases are the most extensively studied in relation to
cigarette smoking. Reviews of the literature have documented the harmful effects of smoking on
periodontal tissues, including clinical consequences and the biological mechanisms that make
smokers more susceptible to periodontitis.[6]
Both cross-sectional and longitudinal studies demonstrate that smokers experience a higher
prevalence, greater severity, and faster progression of periodontal disease compared to never or
former smokers. Cigarette smoking also negatively affects outcomes of both non-surgical and
surgical periodontal treatments, including regenerative and plastic surgeries. Heavy smokers tend
to suffer more severe forms of periodontal disease and have poorer treatment outcomes.
However, quitting smoking can slow the progression of periodontal destruction and lead to
improved clinical results. Cigarette smoking has also been linked to peri-implantitis, peri-implant
bone loss, and implant failure. Therefore, smoking is a significant risk factor for both periodontal
and peri-implant diseases, and incorporating smoking cessation programs into treatment planning
is essential for prevention and management.[7]
The harmful health effects of smoking are largely due to the toxic substances in cigarette smoke.
In addition to nicotine, which is a dependence-producing stimulant, cigarette smoke contains
hundreds of other toxicants, many of which are known carcinogens. [8]
This research aims to investigates the prevalence of tobacco use and vaping among students and
their significant effects on oral health. It aims to thoroughly determine the frequency and patterns
of these habits, identify key demographic factors associated with them, and assess their impact
on oral health, including the development of oral lesions, gingivitis, and tooth decay.
Additionally, we will explore students' knowledge and attitudes toward the risks associated with
these practices, providing vital information to inform evidence-based prevention and intervention
strategies. This study places a strong emphasis on evaluating the prevalence, knowledge,
attitudes, and perceptions of e-cigarette smoking among students and its implications for oral
health. Through this comprehensive approach, we aim to promote good oral health and
effectively address tobacco-related health issues among students.
QUESTIONNAIRE
To find out the prevalence of of tobacco use and vaping among the students and its effect
on thier oral health:
1. Age: _____________
2. Gender: _____________
3. Student status (undergraduate/graduate)(MBBS/ BDS): _____________
4. Field of study: _____________
5. Study year:_________________
5. Socioeconomic status:_________________
1. Do you currently use tobacco products (cigarettes, chew, etc.)?
a) Yes
b) No
2.What type of tobacco product do you use?______________
3. If yes, how often do you use tobacco products?
a) Daily
b) Occasionally
c) Rarely
4. Have you ever used vaping products (e-cigarettes, vape pens, etc.)?
a) Yes
b) No
5. If yes, how often do you use vaping products?
a) Daily
b) Occasionally
c) Rarely
6.How did you start using tobacco products?
a) Peer pressure
b) Curiosity
c) Stress relief or coping mechanisms
d) Advertising and marketing
7. How would you rate your oral health?
a) Excellent
b) Good
c) Fair
d) Poor
8) What are your oral hygiene habits?
a) Brushing
b) Flossing
c) Mouthwash
d) None
9. Have you experienced any oral health issues (tooth decay, gum disease, etc.)?
a) Yes
b) No
10. Do you notice any changes in your mouth (dryness, bad breath, etc.) since using tobacco or
vaping products?
a) Yes
b) No
11. Have you received any information about the risks of tobacco and vaping on oral health?
a) Yes
b) No
12. Would you like to quit using tobacco or vaping products?
a) Yes
b) No
REFRENCES
1. Gajendra S, McIntosh S, Ghosh S. Effects of tobacco product use on oral health and the role of oral
healthcare providers in cessation: A narrative review. Tob Induc Dis. 2023 Jan 25;21:12. doi:
10.18332/tid/157203. PMID: 36741542
2. Iacob AM, Escobedo Martínez MF, Barbeito Castro E, Junquera Olay S, Olay García S, Junquera
Gutiérrez LM. Effects of vape use on oral health: a review of the literature. Medicina (Kaunas). 2024 Feb
21;60(3):365. doi: 10.3390/medicina60030365. PMID: 38541091.
3. Khan MA, Vichayanrat T, Ngoenwiwatkul Y. The association between smoking and smokeless tobacco
use with dental caries among Pakistani patients. BMC Oral Health. 2024 Jun 24;24(1):723. doi:
10.1186/s12903-024-04508-y. PMID: 38915022. You can access the full article here:
https://link.springer.com/article/10.1186/s12903-024-04508-y
4. Khattak O, Chaudhary FA, Sakoor A, Masood M, Zafar M, Arshad H, et al. Oral health status, self-
perceptions, and risk awareness among young adult users of electronic cigarettes in Pakistan. Tob Prev
Cessat. 2024;10:37. doi:10.18332/tpc/177017. PMID: 38786387; PMCID: PMC11536514.
5. Ramôa CP, Eissenberg T, Sahingur SE. Increasing popularity of waterpipe tobacco smoking and
electronic cigarette use: implications for oral healthcare. J Periodontal Res. 2017 Oct;52(5):813–823.
doi:10.1111/jre.12458. PMID: 28393367; PMCID: PMC5585021.
6. Ramôa CP, Eissenberg T, Sahingur SE. Increasing popularity of waterpipe tobacco smoking and
electronic cigarette use: implications for oral healthcare. J Periodontal Res. 2017 Oct;52(5):813–823.
doi:10.1111/jre.12458. PMID: 28393367; PMCID: PMC5585021.
7. Ramôa CP, Eissenberg T, Sahingur SE. Increasing popularity of waterpipe tobacco smoking and
electronic cigarette use: implications for oral healthcare. J Periodontal Res. 2017 Oct;52(5):813–823.
doi:10.1111/jre.12458. PMID: 28393367; PMCID: PMC5585021.
8. Ramôa CP, Eissenberg T, Sahingur SE. Increasing popularity of waterpipe tobacco smoking and
electronic cigarette use: implications for oral healthcare. J Periodontal Res. 2017 Oct;52(5):813–823.
doi:10.1111/jre.12458. PMID: 28393367; PMCID: PMC5585021.
