How the oral exposome shapes diseases of teeth, gums and oral mucosa

The mouth is under constant environmental assault, and a new comprehensive review argues that the best way to understand the resulting damage is through the lens of the oral exposome: the totality of environmental, lifestyle-related, microbial and systemic exposures that the oral cavity encounters over a lifetime. The review synthesizes evidence on how these external determinants alter tissue homeostasis and contribute to chronic diseases of both hard and soft oral tissues, including dental hard tissues, periodontal and peri-implant structures, the oral mucosa and salivary systems.

The authors conducted a narrative review by searching PubMed, Scopus and Web of Science for English-language articles published up to April 2026 that evaluated relationships between environmental exposures and oral tissue alterations. The exposures examined included environmental pollutants, smoking, alcohol consumption, dietary factors, occupational toxicants and other external determinants, analyzed together with host-related modifiers such as salivary dysfunction, microbial dysbiosis, systemic disease and chronic inflammatory conditions.

A central finding is that the strength of evidence varies substantially across exposure–outcome relationships. The most mature human evidence concerns conventional tobacco smoking and selected carcinogenic exposures. By contrast, associations involving air pollution, heavy metals, occupational toxicants, electronic cigarettes, endocrine-disrupting chemicals and emerging contaminants showed greater heterogeneity, and for several outcomes the case rests substantially on observational, experimental or mechanistic evidence rather than established human data.

Despite the differences in evidence maturity, the review identifies recurrent biological pathways that recur across exposures: oxidative stress, inflammation, microbial dysbiosis, epithelial dysfunction and altered tissue homeostasis. Environmental exposures may interact through these inflammatory, microbial and metabolic pathways to affect both hard and soft oral tissues. The authors conclude that the oral exposome offers a useful framework for understanding the multifactorial nature of oral disease, capturing the interaction among environmental exposure, microbial ecology, host response and tissue homeostasis, with implications for oral surgery, implantology, regenerative procedures and precision oral medicine.

As a narrative review, the work synthesizes existing literature rather than presenting new experimental findings, and its conclusions reflect the scope and limitations of the studies it surveyed.

Subject of Research: The oral exposome and environment-related diseases of hard and soft oral tissues

Article Title: The oral exposome and environment-related diseases of hard and soft oral tissues: a comprehensive review

Article References: Aliberti, A., Coppola, N., Gasparro, R., Trosino, O., Sammartino, J. C., & Sammartino, G. (2026). The oral exposome and environment-related diseases of hard and soft oral tissues: a comprehensive review. Frontiers in Oral Health, 7, Article 1976898. https://doi.org/10.3389/froh.2026.1976898

Image Credits: AI Generated

DOI: 10.3389/froh.2026.1976898

Keywords: oral exposome, oral health, tobacco smoking, air pollution, heavy metals, electronic cigarettes, endocrine-disrupting chemicals, microbial dysbiosis, oxidative stress, periodontal disease, oral mucosa, narrative review