It’s officially autumn. The leaves have begun their vibrant colour changes, the air is noticeably cooler, and we’ve all settled into the new routines that come with the season. This time of seasonal change may inspire some of us to make our own positive personal transformations — those looking to break their addiction to cigarettes and traditional tobacco/cannabis products come to mind.
Unfortunately, however, harmful habits can also arise in those individuals who are vulnerable to peer pressure, such as our young adolescent population, who are now well into their school year. E-cigarettes (also known as vaping devices) are currently the most commonly used tobacco product among Canadian youth and millennials, surpassing the use of conventional tobacco products including cigarettes, cigars, and chewing tobacco.
In fact, a recent article from CBC on youth vaping in Nova Scotia tells us that data from Statistics Canada show a third of high school students in the province are vaping and almost 55 per cent report having tried vaping at least once. It is thought that if stricter regulations do not come into effect, the next generation will be the most nicotine-dependant and heaviest smoking in recent history.
While some anecdotal evidence suggests that e-cigarettes could help some smokers kick their habit, the evidence also suggests that vaping can act as smoking initiation for youth. Are e-cigarettes really as bad as their traditional tobacco and cannabis counterparts? Are e-cigarettes friend or foe?
To understand the effects, we must first consider both the components and appeal of vaping. E-cigs are hand-held electronic devices that resemble traditional cigarettes in their shape, action, and inhalation. They consist of a battery part, which powers an automizer; the atomizer acts to vapourize the liquid stored in the cartridge into aerosols which are then inhaled. The liquid or “e-juice” usually contains propylene glycol and glycerol, with or without flavourings and nicotine or cannabis.
Though most experts agree that vaping is found to be marginally safer than cigarettes (containing lower levels of toxins such as diethylene glycol, lead, nickel, and chromium, and none of the tar or carbon monoxide found in cigarette smoke), e-cigs are not harmless. The long-term effects of vaping are still unknown, but emerging data suggests it may increase risk of heart damage and stroke, similar to their traditional counterparts. Vaping may also be linked to acute and chronic lung disease, resulting in documented fatalities. E-cigs may also increase the risk of other adverse health effects, including seizures, tachycardia, disorientation, congestive heart failure, airway resistance, pneumonia, and burns from defective devices.
In addition to the concerning systemic effects of vaping, it is important for dentists to be aware of the potential harm of vaping on the oral cavity and educate our patients on these adverse effects. Recent studies have shown that, similar to traditional cigarettes, vaping induces disturbances in gingival epithelial cells. In an article in the Journal of Cellular Physiology, Canadian dental researcher Dr. Mahmoud Rouabhai and his colleagues found the percentage of dead or dying cells in the oral cavity increased to 53 per cent after three exposures to e-cigarette vapour. In comparison, that percentage averaged two per cent in control groups. This damage to the gingival epithelium can increase the risk of infection, inflammation, and gum disease. Long-term, it may also increase the risk of oral cancer, though further research is needed.
Another study from researchers out of The Ohio State University examined the changes in the subgingival microbiome seen with the use of e-cigarettes. It was found “the risk-for- harm associated with vaping may be similar to or greater than smoking. The similarity in the microbiomes of former, current, or never smokers who vape does not support the hypothesis that e-cigarettes promote harm reduction in cigarette smokers.”
Like cigarettes, most e-cigs contain nicotine, and, though it is delivered in smaller doses, the negative effects of nicotine on the oral cavity should still be anticipated. These include gum recession, bad breath, and increased parafunctional habits, as well as concealing an important gum disease indicator, bleeding on probing, due to nicotine’s action as a vasoconstrictor. Another common side effect of vaping is xerostomia, which can increase the risk of dental caries. These recommendations will continue to change with developing research and long-term studies.
As it stands, e-cigs are not currently approved by Health Canada as a smoking cessation aid. Therefore, it is important that dentists recommend to patients only medically licensed smoking cessation products and fully educate those looking to use or using e-cigs on the pros and cons based on the studies available.
In addition to oral health promotion and patient education, dentists should be advocating for the regulation of e-cigarette use among young people by recommending the government prohibit the use of certain flavours, such as fruity or chocolate, as these are more likely to appeal to adolescents.
Other restrictions on e-cigs should include prohibiting the sale of these products to those under 18 years of age and regulations on advertising and promotion.
