Xu et al.31 also noted that ENDS use enriched periodontal disease-associated pathogens like Porphyromonas gingivalis and Fusobacterium nucleatum, with increased levels of proinflammatory cytokines (IL-10, IL-12p70, IL-13 and TNF-α) contributing to microbiome dysbiosis31. This evidence concerns the gene TNF and periodontal disorder.