Something unusual happened in Washington last month. The FDA commissioner resigned in protest. The next day, the chief spokesperson for the Department of Health and Human Services did the same. Both were objecting to the same thing: the current administration’s authorization of fruit-flavored e-cigarettes.
Their concern, stated plainly in resignation letters, was that flavored vapes could make vaping more appealing to children, exposing them to “nicotine addiction, lung damage, and higher risk of cancer.”
The issue especially resonates here in Colorado. Just a decade ago, our state led the nation in youth vaping, with 27% of high school students reporting current use. Years of prevention efforts have helped drive that number below 9%, but adult vaping rates continue to rise, particularly among young adults.
The trouble isn’t just how addictive nicotine (and cannabis) can be. There’s also the power of many years of the vaping industry touting its products as a safer, healthier option to conventional cigarettes. While it’s true that the aerosols generated by vaping devices don’t contain the same tar and combustion byproducts as cigarette smoke, being “safer than smoking” is a really low bar.
It’s apparently not even much better on oral health than regular tobacco use — a matter we’ll return to shortly.
Vape liquids — “juice” — typically contain propylene glycol, vegetable glycerin, nicotine, and flavoring chemicals. Exactly which flavoring compounds are present is often difficult to determine because manufacturers frequently treat those formulations as proprietary information. But what researchers have been able to examine so far does raise some concerns. Other compounds identified in e-liquids and aerosols include volatile organic compounds and substances that can form during heating, such as formaldehyde and acetaldehyde.
The long-term inhalation effects of many other flavoring chemicals remain poorly understood because, simply put, they haven’t been studied long enough.
But according to one systematic review published this past April (2026), it does appear that fruity, minty, and sweet flavors increase nicotine use and preference for e-cigarettes. They’re also linked with inflammation, cellular damage, and DNA damage in oral cells. Its authors ultimately concluded that
The evidence available to date suggests that these products can be as harmful to health as combustible cigarettes.
But wait! There’s more!
A study published in April 2026 in Analytical and Bioanalytical Chemistry used a specialized method to break apart e-cigarette vapor, separate its components, and precisely measure what’s in it. In this case, the researchers looked specifically at toxic metals — aluminum, nickel, mercury, arsenic, and several others.
Notably, metals don’t necessarily come from the juice. They can come from the device itself — specifically the metal heating coil that vaporizes the liquid. When the coil heats up, it sheds particles. Those particles travel in the aerosol directly into the lungs. From there, it’s a quick and easy trip into the general circulation.
Lab mice exposed to nicotine vapor twice a day for just four days had detectable metal deposits in their lung tissue. The metals didn’t distribute evenly, though. They clustered in different regions of the lungs. The researchers noted that this might raise the risk of tissue damage and impaired healing.
When the measured concentrations were compared against pharmaceutical safety benchmarks used for inhaled medications, the differences were stark:
- Arsenic levels were about 480 times higher than the established safe limit.
- Nickel was about 250 times higher.
- Mercury ran about 180 times higher.
- Chromium was about 60 times higher.
- Lead ran about 17 times higher.
At the same time, iron levels in lung tissue dropped significantly. Iron supports oxygen transport, immune function, and cellular energy production. The authors described tis depletion as “particularly concerning.”
Because no regulatory standards specifically exist for metal content in e-cigarettes, there are currently no legal limits being violated. Users have no way of knowing the levels of metals they’re inhaling, and there’s no law that manufacturers must disclose or limit them.
The mouth, of course, is where all this begins. Every puff passes through the oral cavity first, and this, research shows, has important consequences for oral tissues.
As with regular smoking and other tobacco use, e-cigarette users have been found to have a much higher risk of gum disease — something documented in two separate systematic reviews. It appears that vaping disrupts the oral microbiome, shifting it from a healthy state of bacterial balance to imbalance. Plaque starts to build up more quickly on tooth surfaces. Studies suggest that vaping also may weaken the immune defenses in the tissues that line the mouth, making it harder for the body to fight the bacteria associated with gum disease.
Dry mouth is another common finding. That matters because saliva helps neutralize acids, remineralize enamel, and keep oral bacteria in balance. When saliva production drops, conditions become more favorable for decay and gum disease. Indeed research has shown those risks to be higher with e-cigarette use. Recent reviews have shown that vaping contributes of bacterial imbalance in the mouth, more biofilm (plaque) formation, and a higher risk of periodontitis (severe gum disease), peri-implantitis (inflammation around dental implants), oral candidiasis (yeast buildup), and caries.
Meantime, as suggested, the heavy metals that are inhaled while vaping don’t all stay contained in the lungs. Like the mercury released from amalgam fillings, what’s inhaled may redistribute through the circulatory system and accumulate in other organs. These are the kinds of systemic burdens that can affect energy metabolism, immune regulation, and inflammatory processes throughout the body, including the mouth.
Working as we do, with dentists and functional medicine practitioners together under one roof, makes it easier to look at the potential effects of vaping from more than one perspective. Questions about gum health, inflammation, environmental exposures, and overall wellness don’t always fit neatly into a single box, and neither should the conversation.
For those who vape, understanding what the science actually shows about what they’re inhaling, and its potential impacts, is the starting point for making more informed decisions. That’s a conversation we’d be happy to have.
