Dear editor

I would like to report a case where there seems to be strong circumstantial evidence that an electronic cigarette caused caries. Searches of PubMed and Google found very few references to a link between caries and e-cigarettes.

A 51-year-old female presented with multiple smooth surface active carious lesions. She has recently had several extractions due to caries, coincidentally on her RHS, where she tends to place the e-cigarette. The caries particularly affects the palatal aspect of UR3, incisal aspect of UR1 and the buccal cervical areas of the lower posteriors (Figure 1).

Bitewing radiographs show interproximal caries in most teeth (Figure 2). Oral hygiene is good and, on careful questioning, the patient consistently reported a diet with low sugar quantity and frequency. She takes the following medications, and has not had changes in several years: venaflaxine, dihydrocodeine, paracetamol, tramadol, omaprazole, iron tablets.

The patient reported a frequent mild dry mouth although, on examination, saliva levels appeared normal. This is almost certainly a side effect of the opioids and venaflaxine.