In 2003, what would become the first commercially successful electronic cigarette was created in Beijing, China by Hon Lik, a 52-year-old pharmacist, inventor and smoker. Lik reportedly created the device as a safer alternative to cigarettes after his father, also a heavy smoker, died of lung cancer.
The use of e-cigarettes, referred to as vaping, works by heating a liquid to generate an aerosol that the user inhales. The liquid in the e-cigarette contains propylene glycol, glycerin, flavorings, water, and nicotine.
Ever since Lik’s product went on the market, smokers have been switching from cigarettes to e-cigarettes in an attempt to be healthier.
But is it actually healthier?
In their January Perio-Implant Advisory article “Vaping and oral health: It’s worse than you think,” Scott Froum, DDS, and Alisa Neymark, DDS, write about the dangers of e-cigarette use and the effect it has on oral health. After researching the topic, the two came up with four major dangers posed by vaping.
Danger No. 1: Propylene glycol
Propylene glycol is a viscous, colorless liquid primarily used in the production of polymers and food processing. Because of it’s fairly sweet taste, and can be found in edible items, such as liquid sweetness, ice cream and whipped dairy products.
In the case of e-cigarettes, propylene glycol acts as a carrier for nicotine.
“When used orally, the breakdown products of PG include acetic acid, lactic acid, and propionaldehyde, which are all toxic to enamel and soft tissue,” Froum and Neymark write. “In addition, propylene glycol is a hygroscopic product, which means water molecules in saliva and oral tissue will bond to the PG molecules, leading to tissue desiccation. The result of this is xerostomia, or “dry mouth,” which has been shown to lead to an increase in cavities, gum disease, and other oral health issues.”
Danger No. 2: Vegetable glycerin and flavorings
Vegetable glycerin and flavorings make up the majority of the e-cigarette’s inhalant. Like propylene glycol, vegetable glycerin is a colorless, viscous, sweet-tasting liquid used in the food industry as a sweetener. It is also used in many medical, pharmaceutical and personal care products. Because it’s 40 percent less sweet than sucrose and not metabolized by cariogenic bacteria, it was previously thought to not cause cavities, but studies have shown the combination of vegetable glycerin and flavorings produce an increase in microbial adhesion to enable and an increase in biofilm formation.
“In addition, a 27% decrease in enamel hardness was demonstrated when flavorings were added to e-liquid as compared to unflavored controls,” they write. “The viscosity of the e-liquid also allowed Streptococcus mutans to adhere to pits and fissures. In other words, e-liquid allows more cavity-causing bacteria to stick to a softer tooth and can lead to rampant decay.”
Danger No. 3: Nicotine
While the percentage of nicotine is much lower in e-cigarettes than in traditional tobacco products, one electronic cartridge–200 to 400 puffs–can equal the nicotine of smoking two to three packs of regular cigarettes. And because nicotine is a vasoconstrictor, it affects the gingival blood flow and can have dangerous effects on gum tissue.
“It also affects cytokine production, neutrophil function, and other immune cell function,” Froum and Neymark write. “In addition, nicotine decreases connective tissue turnover. All of this results a much higher chance of developing gum disease and tooth loss.”
Danger No. 4: Lithium batteries
There have been two reported deaths associated with vaping.
In January, a 24-year-old man died after his vape pen exploded and tore his carotid artery, and in May 2018, a 28-year-old Florida mad died when his vape pen exploded, sending projectiles into his head and causing a fire in his house.
“Although these types of sensationalized deaths are rare with e-cigarettes and vaping pens, the explosions of these pens are not,” Froum and Neymark write. “The problem lies within the vape pen and the lithium batteries overheating and exploding. These explosions are usually attributed to improper charging of the device or have been linked to a type of device called a mechanical mod that has no internal safety and can overheat and explode.”
Researchers estimate that there were about 2,035 e-cigarette explosion-related injuries between 2015 and 2017, more than 40 times the initial 195 incidents estimated by the United States government. The injuries caused by these explosions are serious, the pair write, and often lead to disfigurement of oral soft tissue.
Vaping v. Cigarettes
While vaping is thought to be a safer alternative to cigarette smoking. However, Froum and Neymark write, vaping can be just as dangerous, if not more dangerous, when compared with smoking.
They go on to write that while vaping has helped many people quit smoking, it has also upped their oral health problems. Dentists across the country have seen rampant decay, smooth-surface and interproximal lesions, tooth loss, and cervical enamel demineralization. And, unfortunately, the vaping fad is making its way down to the youth.
“The problem is that vaping is thought to be a safer alternative to traditional tobacco products, and companies are adding flavoring products to attract younger generations,” they write. “According to a 2013–2014 survey, 81% of current youth e-cigarette users cited the availability of appealing flavors as the primary reason for use.”
Froum and Neymark write that middle- and high-school-age children is the group in which e-cigarette use percentage is increasing the most.
“Because of the known dangerous effects of traditional tobacco methods, use among middle and high school students has been steadily decreasing since 2014,” they write. “However, since the introduction of the e-cigarette, that number is now increasing, and it is estimated that one in five high school students may now be using tobacco products. E-cigarette use from 2017 to 2018 increased 78% among high school students and 48% among middle school students.”
With the amount of young vapers now out there, Froum and Neymark think things are about to get worse.
“Because of this, a tidal wave of oral health problems is heading our way.”