Dental professionals are able to be at the forefront of health-related education through their contact with patients during regular dental prevention appointments. Unlike physicians they see healthy patients regularly.
Just as in the case of traditional tobacco use, teaching about the dental health damage that e-cigarettes and vaping cause, can be incorporated into prevention visits for patients of all age groups, especially for younger adults, as this is a group that is at increased risk of addiction.
Electronic nicotine delivery systems, commonly known as e-cigarettes and vaping, were first developed in 2003 by Chinese pharmacist Hon Lik and were introduced in the United States in 2007.
An e-cigarette is a device with a heating element at one end that produces an aerosol from a liquid nicotine solution, creating a vapour, which is inhaled through a mouthpiece.
The liquid portion of the e-cigarette, commonly referred to as vaping juice, comes in various flavours and is composed of propylene glycol(as a strong skin irritant, it has been implicated in contact dermatitis and glycerin. E-liquid is available with or without nicotine.
Studies of current smokers who plan to quit have reported that e-cigarettes and vaping are viewed as a safe method to stop smoking cigarettes. Additionally, the manufacturer of a popular vaping device describes the ingredients of its devices as materials that are commonly used by the medical, beauty, and food industries, suggesting safety.
Consequently, many consider the use of e-cigarettes and vaping as a safe alternative to conventional cigarettes with little or no harmful health effects, this does not appear to be true.
The use of e-cigarettes has greatly increased in the past few years among middle and high school American students. According to the 2018 National Youth Tobacco Survey in the US, 3.6 million middle and high school students are currently using e-cigarette users, which represents a 78% increase in high school users and a 48% increase in middle school users from 2017 to 2018.
In Canada too, in Ontario, 26 per cent of high school students said they vaped in the 2018-19 school year, compared with 18 per cent the previous year.
In Alberta, Canada – 30% of students say they vaped in the past month in 2018-19, compared with 23 per cent the year before.
Nearly one-third of high school students in Alberta and Quebec and one in four in Ontario say they have vaped in the past month, according to Canadian survey data that show sharp increases in e-cigarette use in the country’s four most populous provinces. British Columbia also saw increases, although not as high as the other provinces.
The increased use of e-cigarettes among teens has been attributed to the appealing design of the vaping pens, which in some cases may resemble a flash drive, and the many flavours that are available.
Vaping devices can have high nicotine content. The top three reasons that middle and high school students list for vaping are claimed as: (1) friends or family members use the products, the availability of flavours such as mint, candy, fruit, or chocolate, and (3) the belief that e-cigarettes are less harmful than other forms of tobacco like cigarettes.
Middle and high school students are a demographic group associated with higher caries rates due to subpar oral hygiene; consumption of sugary, low pH drinks; and, often, the presence of fixed orthodontic appliances.
The decay and erosive potential of soft drinks is well recognized. The presence of fixed orthodontic appliances in teens further puts them at greater risk of developing decay with as many as 50% of children treated with fixed braces reportedly had at least one white spot lesion (initial decay) after the fixed appliances were removed.
The ability of e-liquids containing propylene glycol, glycerin, and sweet flavours to cause changes in the surface of tooth enamel that promote the attachment of certain bacteria (streptococcus mutans), combined with poor oral hygiene and/or a high sucrose diet, can result in damage to teeth. Combining vaping with the aforementioned risk factors associated with teens can create an oral environment with a high potential for the development of extensive dental caries.
Teens may be reluctant to confirm a vaping habit due to fear that their parent or guardian may learn of this activity. This message may be communicated through in-office posters and brochures as well as a short script inserted into routine oral hygiene instructions reviewed with patients of all ages.
Showing patients images of the unsightly changes that e-cigarettes can produce in the dentition may greatly impact a patient’s decision to stop vaping, even more so than expressing concern for their general health. All members of the dental and medical profession could educate the public about the health damage vaping can cause so that patients can make informed choices.
I’d like to thank Dr. Cynthia, Dr. York, Ms. Saggiomo and Mr. Tsai in presentation.