Abstract:

Tobacco use remains a leading preventable cause of morbidity and mortality worldwide, with profound effects on periodontal health. Traditional cigarette smoking exacerbates periodontal diseases by promoting inflammation, oxidative stress, and microbial dysbiosis. However, declining cigarette use due to stricter regulations, public health campaigns, and cultural shifts has driven tobacco companies to introduce alternative products, such as heat-not-burn devices. These products heat tobacco without combustion, producing a nicotine-containing aerosol marketed as a reduced-risk alternative to conventional smoking. Despite these claims, the impact of these devices on periodontal health are not well understood.
The current review examines the evidence on the effects of heated tobacco products on periodontal tissues. In vitro studies suggest that their aerosol may impact cell proliferation and the cell cycle. Furthermore, next-generation sequencing of 16S rRNA genes from the subgingival microbiome has shown that heated tobacco products alter the microbial composition, increasing the prevalence of certain key periodontopathogens. Clinical studies indicate that while users of heated tobacco products exhibit periodontal indices that are closer to those of non-smokers than traditional smokers, the nicotine and toxicants in their aerosol still pose risks to periodontal health.
Although heat-not-burn products may represent a less harmful alternative to traditional smoking, they are not without risks. The significant lack of independent, long-term studies complicates efforts to fully assess their safety and potential health impacts. Further research is critically needed to comprehensively evaluate the risks associated with their use.

Keywords: heated tobacco products, IQOS, heat-not-burn, smoking, periodontal health