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Clearing the Air: The Relationship Between Electronic Cigarette Use, Vaping, and Oral Health

The use of electronic cigarettes, otherwise known as e-cigarettes, has increased in popularity in the United States (US) since 2007, particularly among middle and high school students. In 2020, approximately 3.6 million adolescents and 9.1 million adults reported e-cigarette use.

E-cigarettes are designed to heat a liquid, often flavored, until it is hot enough to become an aerosol, which the user then inhales. Although the smoke-like product put out by an e-cigarette is sometimes referred to as a vapor (and the use of e-cigarettes is often called vaping), unlike a vapor, the aerosol produced by an e-cigarette contains ultrafine particles that are inhaled into the lungs.

Some users of conventional cigarettes have turned to e-cigarettes in an attempt to stop smoking regular cigarettes. However, as of June 2022, no e-cigarette products have been approved by the US Food and Drug Administration (FDA) as a tobacco cessation device. Additionally, the Centers for Disease Control and Prevention (CDC) recommends that smokers use alternative smoking cessation options (such as nicotine replacement patches, gum, or lozenges) due to the unknown hazards associated with chemicals in electronic cigarettes.

Some of these risks include a condition known as “e-cigarette or vaping use-associated lung injury ” (EVALI) linked to the use of some tetrahydrocannabinol (THC)- containing e-cigarettes that include vitamin E acetate. This condition can cause respiratory symptoms such as shortness of breath and chest pain as well as nausea, vomiting, and stomach pain. Use of e-cigarettes is linked to symptoms such as cough, sore throat, shortness of breath, headache, and change in or loss of taste. However, menthol flavoring in some e-cigarettes may mask the sensation of throat irritation or dryness.

In addition to increasing the risk of cardiovascular disease and pulmonary conditions like asthma and chronic obstructive pulmonary disease (COPD), growing evidence demonstrates the negative impacts of electronic cigarettes on various aspects of oral health.

  • Individuals who use e-cigarettes are significantly more likely to report having periodontal (gum) disease compared to those who do not smoke or use other nicotine products.
  • E-cigarette use is linked with signs of periodontal disease such as increased plaque, deeper periodontal pockets around the teeth, and bone loss.
  • Oral lesions such as nicotine stomatitis (“smoker’s palate”), hairy tongue (discoloration of the tongue), and angular cheilitis (sores in the corners of the mouth) are commonly seen in the mouths of individuals using e-cigarettes.
  • There is growing evidence that individuals who use e-cigarettes are at a higher risk for dental caries (decay), potentially because of sugars (such as sucrose) used in the flavoring of some e-cigarette liquids that may increase risk of caries.
  • Currently, no long-term studies exist showing a direct relationship between e-cigarette use and oral cancer. However, researchers describe “an array of environmental toxins” in e-cigarettes “that considerably exceed federal occupational exposure limits” and may place users at higher risk for oral cancer after prolonged exposure to e-cigarettes.

Because of the risks to oral health posed by e-cigarette use, the American Dental Association encourages oral health professionals to ask their patients about their e-cigarette use and offer them resources regarding cessation treatment options. These resources can include behavioral and pharmacological options, such as those suggested by the American Lung Association.

A significant health concern with e-cigarette use among young people is the potential long-term neurologic effects of high levels of nicotine exposure on the developing brain. As e-cigarette use is a particular cause for concern in youth, the US Surgeon General and the CDC provide resources about engaging in conversations with young people regarding the risks of e-cigarette use for health care providers, parents, teachers, and other concerned adults.

Oral health professionals have long been involved in encouraging tobacco cessation with their patients. The more evidence that emerges about the risks to oral health from e-cigarette use, the more important it becomes for dental professionals to discuss e-cigarette use with their patients.

CareQuest Institute for Oral Health 

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