Electronic Cigarettes

Sharma RDH

Sharma Mulqueen, RDH

Electronic Cigarettes

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.”

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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.

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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.

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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.

Conclusion

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.

Want to learn more? Visit us at

http://www.shalimarfamilydentistry.com

http://www.northstapleydentalcare.com

http://www.alamedadentalaz.com

http://www.dentistingilbert.com

Sources:

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

http://www.askadviserefer.org/

PLEASE, Stick Your Tongue Out at Your Dentist

Kim McCrady

Kim McCrady RDH, BA

Dedicated to Phil Swanson and his courageous family

     Come on, you know you have always wanted to stick your tongue out at your dentist and or your hygienist. Honestly, we invite you to be as impolite as possible. During the oral cancer-screening portion of your dental check up we need and want to see as much of your tongue, tissues, lips, and throat as we can.

Oral Cancer Risk Factors

     Unfortunately, according to The Oral Cancer Foundation, cancers of the tongue, lips, cheeks, throat and floor of the mouth are on the rise and have been for the last five years.   In fact, one person passes away every hour from oral cancer.  Those at the highest risk for oral cancer are people with past or current tobacco use habits.  Patients with a family history of oral cancer and men are at a greater risk for oral cancer than women.  The latest consideration as a causative factor for oral cancer is the human papilloma virus (warts) in the oral cavity.  Other listed risk factors include heavy alcohol consumption and over-exposure to the sun.  However, there are many people with oral cancer who will have none of the major known risks factors.

Signs and Symptoms

     There are some signs and symptoms of oral cancer, but most are not detectable until the later stages of development. The National Cancer Institute lists a few of the symptoms of possible oral cancer.  They are patches of tissue that become white or red or a combination of white and red.  Sores on the inside or outside of the lips, mobile teeth, difficulty or pain when swallowing.  If you wear dentures, pain while wearing your dentures can be a warning sign.  Lumps in your neck, along your jawline, behind your ears, pain in your ear that does not subside and lumps in the floor of the mouth are also possible symptoms of oral cancer. 

Oral Caner Screening

     Your dentist and hygienist will check your tissues by having you stick out your tongue.  We catch your tongue with a piece of gauze and will pull it from side to side. We will ask you if you have noticed any sores in your mouth that have been present for more than two weeks.  We will have you touch the roof of your mouth with the tip of your tongue so we can easily view the underside of your tongue.  We also evaluate the inside of your cheeks, lips, floor of the mouth and the back of your throat is also examined. Even the lymph nodes in your neck and along your jawbone need to be checked regularly for abnormalities.  We also check your face, neck and lips for abnormal changes.

     Luckily, new technology is available for oral cancer screenings.  Our office uses a piece of equipment called, the VELscope.  The VeELcope allows the doctor to see changes in the tissue using fluorescence.    This technology allows the doctor to detect changes in the tissue earlier than he can with the naked eye.   Like most technology, we are confident these tools will continue to evolve in accuracy and be used more and more in dental offices.  It is our office philosophy to stay aware of these changes in technology and make them available to you.

Diagnosis and Treatment

     If a suspicious area is detected during your oral cancer screening, your dentist will refer you to an oral surgeon, ear nose and throat specialist or a dermatologist for evaluation and probable biopsy of the area in question.  If you are diagnosed with an oral cancer, treatment will likely vary depending upon the stage of the cancer.  Surgery, radiation, targeted therapy and chemotherapy are often used in combination as treatments.  Early detection and immediate treatment is critical to survival.  Prognosis in a latter stage of development is poor because oral cancers spread (metastasize) quickly to the lymph nodes and other parts of the body as they grow. 

Prevention

     Decrease your risk of oral cancer by reducing your alcohol intake, commit to tobacco cessation.  If you need help quitting, contact your doctor or contact a support program like Ashline.  Be proactive, check your tongue and tissues at home regularly and report to your dentist immediately if you find any concerning areas in your mouth.  The ADA estimates 60% of the US population will see a dentist each year.  This means dental professionals are your partner providers in early detection.  When you see your dentist and your hygienist at your regular visit, insist on an oral cancer screening.  Our office takes oral cancer screening seriously and we invite you to, “PLEASE, stick your tongue out at your dentist!”

 

The Oral Cancer Foundation:  http://oralcancerfoundation.org

National Cancer Institute:  http://www.cancer.gov/cancertopics/wyntk/oral/page1

Ashline: http://www.ashline.org

Oral Surgeons and the VELscope system:  Partners in Early Detection and Diagnosis:  http://www.velscope.com/upload/VELscopeVX_Oral_Surgeons.pdf