“Vaping” has become a hot topic in our culture as of late, and news coverage of it has particularly spiked recently. It is very important that you know exactly what vaping is and just how harmful it is to one’s body and oral health. Our hope is that you can productively use this information so that you or others you love can avoid its harmful effects.
What is Vaping?
Vapes, vaporizers, vape pens, hookah pens, electronic cigarettes (e-cigarettes or e-cigs), and e-pipes…these are some of the many terms used to describe ENDS (Electronic Nicotine Delivery Systems), or the e-cigarettes used for vaping, says the FDA’s online page entitled, “Vaporizers, E-Cigarettes, and Other Electronic Nicotine Delivery Systems (ENDS).”
Anita M. Mark explains what vaping is in her online JADA article, “The Word on Vaping: Don’t Start.” She says that it can look a lot like smoking a regular cigarette, but instead of burning tobacco, users heat a liquid which creates a fine vapor or aeosol that is inhaled. An e-cigarette comes in a variety of sizes and shapes. Some are small and may be difficult to spot. They may look like a real cigarette, pipe, or even like a USB drive. Others are larger, like the size of a cigarette package.
Kumar et al., in their online JADA article, “Living Under a Cloud,” further explain that an e-cigarette is a battery-powered device that heats a mixture containing propylene glycol, glycerol, flavoring agents, and nicotine. It should be noted, that according to Mark in her article, “The Word on Vaping: Don’t Start,” that even if ENDS products say that they are “nicotine-free” or “nonnicotine,” they may still contain this addictive agent. In addition, the FDA’s online page “Lung Injuries Associated with Use of Vaping Products,” states that in many cases, patients who report negative symptoms of vaping have claimed to use vaping products that contain tetrahydrocannabinol, or THC, the psychoactive component of the marijuana plant.
Respiratory and Other Illnesses:
In June of 2019, the national emergency department data and active case reporting from state health departments around the country showed a sharp rise in symptoms or cases of EVALI (e-cigarette or vaping product use-associated lung injury (FDA, “Lung Injuries Associated with Use of Vaping Products). Mark, in her online JADA article, “A Look at E-Cigarettes,” explains that aerosols from e-cigarettes can be inhaled deeply into the lungs, including metal particles like tin or lead as well as chemicals known to cause cancer. Serious lung diseases like asthma and chronic obstructive pulmonary disease can develop.
Cases that have been reported to the CDC by state health departments and samples connected to EVALI patients report the following respiratory symptoms: breathing difficulty, shortness of breath, and/or chest pain before hospitalization. In addition, some cases reported mild to moderate gastrointestinal illness including vomiting and diarrhea, or other symptoms such as fevers or fatigue (FDA, “Lung Injuries Associated with Use of Vaping Products). Kumar et al. support and add to this list of symptoms associated with vaping. These include: seizures and other neurologic events, gastric distress and mental health issues.
Effects of Nicotine:
Mark in her article, “A Look at E-Cigarettes,” says that nicotine can be harmful in a number of ways. For instance, she reports that it has been shown to cause problems in thinking, remembering things or paying attention. This is particularly concerning for young e-cigarette users, she adds, because the brain develops significantly from the teen years through the early 20s. To this, Kumar et al. add that nicotine causes irreversible changes in the developing brain, predisposing users to addictive behaviors and making adolescent e-cigarette users 4 times more likely to convert to smoking conventional cigarettes. Lastly, Mark, in her afformentioned article, adds that nicotine has been shown to affect the heart and circulatory system. Finally, she points to research that shows e-cigarettes users may have higher blood pressure and hearts that beat faster than non-users.
There is little regulation of e-cigarettes and no standards to control the levels of contaminants, including cancer-causing agents (carcinogens), says the ADA Mouth Healthy article, “Smoking, Non-Cigarette Alternatives.” Kumar et al. explain that ENDS use partial-combustion chemistry (high-heat and high-pressure conditions) to create their vapor, which results in the release of known carcinogens (acetaldehyde, formaldehyde, acrolein).
The American Dental Association’s online Mouth Healthy article, “Smoking, Non-Cigarette Alternatives,” says that there is no such thing as a healthy tobacco product. Kumar et al. explain that the evidence on the effect of vaping on the oral cavity is currently limited because chronic diseases such as periodontitis (gum disease), caries, and cancer take several years to manifest as clinical signs and symptoms. At the same time, they state that the extensive knowledge that exists from research on conventional tobacco products can be used. Of considerable concern is the statistic they site showing that 45% of the nicotine released from ENDS is deposited in the oral cavity regardless of how deeply or frequently one inhales. And according to the ADA online article, “Tobacco Use and Vaping,” tobacco use is causally associated with higher rates of tooth decay, receding gums, periodontal disease, mucosial lesions, bone damage, tooth loss, jaw bone loss and more.
Mark, in her online article, “A Look at E-Cigarettes,” reports that there have been some cases of e-cigarettes exploding or catching fire, either while being used or when the battery is being charged. This obviously puts users at risk for injuries to the mouth or face. She adds that the nicotine in refill bottles can be poisonous if it is swallowed, and that young children, who may mistake the liquid for sweets, are especially at risk for this.
Michelle Manchir, in her ADA online article, “Study: Some E-Cigarette Liquids May Increase Caries Risk,” states that some sweet flavors in e-cigarette liquids may increase the risk of dental caries. She points to a study in which researchers evaluated e-cigarette aerosols in flavors such as pineapple and cotton candy. The research found that these flavorings have similar properties to sugary gelatinous candy and acidic drinks which interact adversely with the hard tissues of the oral cavity.
Mark, in her article, “A Look at E-Cigarettes,” says that nicotine products have been associated with an increased risk of developing severe gum disease which can result in tooth loss. Kumar et al. also reference reports that show that e-cigarettes are associated with dry mouth.
While vaping has often been touted as a more harmless alternative to smoking, it is clear that the nicotine that exists in e-cigarettes can have very harmful effects on the lungs, heart and brain, and that its carginogens can potentially lead to cancer as well. And as with all nicotine products, it can contribute to higher rates of tooth decay, receding gums, periodontal disease, mucosial lesions, bone damage, tooth loss, jaw bone loss and more. Particular to e-cigarettes is the risk for injuries to the mouth and face due to possible explosions, as well as cavities from e-cigarette flavorings. In summary, the verdict on vaping as it relates to one’s overall health and oral health is poor indeed.
ADA. Smoking, Non-Cigarette Alternatives. Mouth Healthy. https://www.mouthhealthy.org/en/az-topics/s/smoking-noncigarette-alternatives. Accessed August 11, 2020.
ADA. Tobacco Use and Vaping. Mouth Healthy. https://www.ada.org/en/advocacy/advocacy-issues/tobacco-use. Accessed August 11, 2020.
FDA. Lung Injuries Associated with Use of Vaping Products. https://www.fda.gov/news-events/public-health-focus/lung-injuries-associated-use-vaping-products. Current as of April 13, 2020.
FDA. Vaporizers, E-Cigarettes, and other Electronic Nicotine Delivery Systems (ENDS). https://www.fda.gov/tobacco-products/products-ingredients-components/vaporizers-e-cigarettes-and-other-electronic-nicotine-delivery-systems-ends. Current as of June, 3, 2020.
Kumar, P., Geisinger, M., DeLong, H. R., Lipman, R. D., & Araujo, M. W. Living under a cloud. Journal of the American Dental Association. 2020; 151 (3); 155-158. https://jada.ada.org/article/S0002-8177(20)30004-0/fulltext.
Manchir, M. Study: Some e-cigarette liquids may increase caries risk. ADA News. Oct. 01, 2018. https://www.ada.org/en/publications/ada-news/2018-archive/october/study-some-ecigarette-liquids-may-increase-caries-risk.
Mark, A.M. A look at e-cigarettes. The Journal of the American Dental Association. 2019; 150 (3); 236. https://jada.ada.org/article/S0002-8177(19)30037-6/fulltext.
Mark, A. M. The word on vaping: Don’t start. Journal of the American Dental Association. 2020; 151 (3); 222. https://jada.ada.org/article/S0002-8177(20)30003-9/fulltext.