Sharma Mulqueen, RDH
E-cigarettes are electronic nicotine-delivery systems (ENDS) that consist of a cartridge containing nicotine and propylene glycol, an atomizer, and a battery (Figure 1). When a user inhales, a pressure-sensitive circuit is activated, which heats the atomizer and vaporizes the liquid as it is brought through the mouthpiece. The vapor consists of a fine mist that does not contain smoke or carbon monoxide and disperses more quickly than traditional cigarette smoke. The act of using ENDS is often called “vaping” and users are termed “vapers.”
The nicotine cartridges used in ENDS come in a variety of flavors, including vanilla, cherry, java, piña colada, and menthol. As the demand rises there are some ENDS stores opening with over 1000 flavors. They are also offered in a myriad of nicotine strengths. When e-cigarettes are inhaled, light-emitting diodes are illuminated. Originally, these lights were red, but now they are often blue or another color to differentiate them from traditional cigarettes.
There is a lot of stir about the introduction of e-cigarettes and unknown health issues that they may cause. For the mouth, e-cigarettes seem to have some positives and negatives. It is a better option than regular tobacco cigarettes, but worse than not smoking altogether. Here are a few of the effects of e-cigarettes on the mouth.
Unfortunately, research on e-cigarettes is still very minimal. Because they are a new product, research that can space several decades is still unavailable. However, there are several chemicals and clues that help determine what e-cigarettes can do to the teeth.
Just like any cigarette, the main purpose of an e-cigarette is to inhale nicotine. Studies have shown that nicotine can slow down the production of saliva in the mouth. The more nicotine you intake, the less saliva the body is able to produce. Saliva is a main deterrent to harmful bacteria and food particles in the mouth. Low saliva levels can cause quicker tooth decay, sore gums, and eventually a loosening of the teeth. One positive of smoking e-cigarettes verses normal cigarettes is that you can control the amount of nicotine the e-cigarette will release into the body. This will slow down the eventual effect of lowered saliva levels, at least.
Another effect of nicotine in an e-cigarette or a tobacco cigarette is it acts as a vasoconstrictor, which prohibits blood flow to the mouth. This results in a fewer number of white blood cells capable of fending off infections and bacteria that harm your gums. Fewer red blood cells are also sent to your mouth tissues, which lead to faster deterioration of the tissue and your teeth.
Another concern for e-cigarettes is that they contain diethylene glycol, a highly toxic substance. However, at the current point in research, scientists have not determined how much of the substance is needed to be considered harmful to the body, especially seeing e-cigarettes use a very low amount.
Dental hygienists should continue to support tobacco cessation through evidence-based methods, such as counseling and medications. The American Dental Hygienists’ Association’s (ADHA) “Ask, Advise, Refer” program is a national tobacco intervention initiative designed to promote cessation by dental hygienists. Available at askadviserefer.org, this program follows the most successful steps to aid patients in quitting smoking, including: an in-depth presentation on the effects of tobacco and nicotine; step-by-step guide on questioning smokers; tips on advising them of why quitting is recommended; specific referrals to local quit lines; and options for Web-based cessation programs. Also, a variety of in-office handouts and reference sheets is available for immediate download or by request from the ADHA website for clinicians.
The “Ask, Advise, Refer” program recommends offering some type of smoking cessation medication in addition to a behavioral program. One option is a traditional nicotine replacement therapy, or pharmacotherapy. FDA-approved traditional nicotine replacement therapy products include gum, lozenges, transdermal patches, nasal sprays, and oral inhalers. There are several success stories of individuals sucking on hard candy day after day. Unfortunately this may cause cavities, but if this can stop someone from using tobacco products then it is a success. Bupropion SR and varenicline are medications used to aid in cessation.
E-cigarettes have not been evaluated by the United States Food and Drug Administration (FDA), and the levels of nicotine or other chemicals they contain are unknown. The FDA is concerned that e-cigarettes are sold to young people and do not contain “health warnings comparable to FDAapproved nicotine replacement products or conventional cigarettes.” The administration is developing a strategy to regulate this emerging class of products.
In response to the decreasing number of adult cigarette smokers, the tobacco industry is trying to attract young people with “healthier” tobacco products in hopes of expanding the market. None of these products is free of carcinogens, and most still contain enough nicotine to pose an addiction risk. All of them increase users’ risk of oral cancer.
The challenge for dental professionals is to identify users of these products as they may lack the typical signs of tobacco use, such as tobacco stains and odor, and the appearance of tissue changes in unusual areas, such as under the upper lip. Clinicians can play a critical role in educating patients about the nicotine content and potential harmful effects of these new tobacco products. Not only can dental professionals provide cessation support or referral for counseling, but they can also help prevent nicotine addiction in the first place.
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Polosa R, Caponnetto P, Morjaria JB, Papale G, Campagna D, Russo C. Effect of an electronic nicotine delivery device (e-cigarette) on smoking reduction and cessation: a prospective 6-moth pilot study. BMC Public Health. 2013;
American Lung Association Smoking Cessation: The Economic Benefits. Available at: lung.org/stop-smoking/tobacco-control-advocacy/reports-resources/cessation-economic-benefits/states/united-states.html. Accessed April 21, 2014
US Food and Drug Administration. FDA and Public Health Experts Warn About Electronic Cigarettes. Available at: www.fda.gov/NewsEvents/ Newsroom/PressAnnouncements/ucm173222.htm. Accessed September 1, 2013
Centers for Disease Control and Prevention. 2013 Smoking and Tobacco Use. Available at: www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/index.htm. Accessed September 1, 2013