The electronic cigarette (e-cig) introduced in 2007 has been marketed as a safe alternative to tobacco smoking but to date there has been little research on the impact of e-cigs on public health.  Dental professionals are concerned about the effects of e-cigs as the chemicals contained in the vapor of an e-cig first enters the body through the mouth.

How do e-cigs work?

E-cigs use a heating device to vaporize nicotine and other ingredients which provide the effects of smoking without the need for tobacco. Even without tobacco present, nicotine is known to be harmful to the body and associated with addiction and toxicity.

E-cigs use nicotine cartridges, each of which can provide 200 to 400 puffs or the equivalent of two to three packs of cigarettes. When liquid nicotine is heated inside the mechanism of the e-cig, it turns into a vapor that smokers inhale.

There are other differences with traditional smoking that could be negative health factors as well.  E-cig users tend to inhale more frequently and with greater depth which could mean that they absorb higher concentrations of nicotine and other toxins than conventional tobacco smokers.

Dental research on e-cigs

One of the challenges with e-cigs is that there is little research available on the health risks to users and non-users and very little on the oral effects of the contents and emissions of these nicotine delivery systems.

According to the American Dental Association:

“The National Institute of Dental and Craniofacial Research, one of the National Institutes of Health, proposes filling the research gap to better inform regulators, health care professionals and consumers about the effects of e-cigarette aerosol mixtures on the mouth, the gums and tissue that constitute the periodontal epithelia.

“With the growing social acceptance of ECs as an alternative smoking product, an urgent need exists to determine their true biological effects on oral tissues,” said an NIDCR announcement proposing research initiatives and inviting comment on the proposed themes, one of them “Effects of E-cigarette Aerosol Mixtures on Oral and Periodontal Epithelia.”

“Currently, the effects of long term exposure to ECs are completely unknown and present a potential oral cancer and periodontal disease risk for users, due to their higher exposure to these chemical mixtures,” the NIDCR said. “

(Excerpted from the American Dental Association news:  NIDCR proposes e-cigarette research September 05, 2014)

Preliminary conclusions about e-cigarettes

The general advice for patients considering using e-cigarettes is to use caution.  According to the British Dental Journal:

• “The long term safety of e-cigarettes is not yet established
• E-cigarettes are likely to be less harmful than tobacco cigarettes
• The effectiveness of e-cigarettes as either a smoking cessation tool or a harm reduction tool is not yet established
• Advice to patients who are unable or unwilling to use licensed NRT products is that although the safety of e-cigarettes cannot be assured they are likely to be a lower risk option than continuing to smoke.
• Advise patients that there is the potential for advice about e-cigarettes to change as findings from research about the safety and effectiveness of e-cigarettes is published.”

(Excerpted from: British Dental Journal: Patients are asking about e‑cigarettes. What do we tell them? July 2014)