Since their introduction in 2003, e-cigarettes have been becoming increasingly more popular. The manufacturers claim that vaping is a healthier alternative to tobacco. They also suggest that vaping may help to quit smoking. While that in itself is a reasonable statement, vaping is becoming more popular with school and high school students with no previous history of smoking. According to Icelandic data from 2018, 45% of 10th graders have tried e-cigarettes at some point in their life, and 11% of 10th graders vaped daily. Not a month goes by without someone getting killed by an exploding e-cigarette or hospitalised due to some strange illness.
There is a clear lack of discussion about the negative effects of vaping. Dentists and other healthcare providers are starting to see more health issues connected to vaping. Extreme cases put aside, what do we dentists know about oral health effects of vaping?
Ok, you did not run away after seeing the photo above. Let us continue the discussion. No more nasty photos for now (I promise).
E-liquid contains many chemicals, and some of them have an observable effect on our mouths. Those are propylene glycol, glycerin and nicotine. We will have a look at each one of them in detail.
When propylene glycol enters the mouth, it breaks down into other substances. Among them are acetic acid and lactic acid. Everything acidic is basically bad for your teeth. For example, bacteria produce acid to dissolve the outer layer of the teeth and infect them (that is how dental cavities are formed). Furthermore, acid from sour drinks and food dissolve the outer layer of molars and cause sensitivity to sugary foods and hot and cold liquids. While the acid that is formed from the breakdown of the e-liquid is not as strong as for example battery acid, its effect on the teeth is substantial due to its constant presence in the vaper´s mouth.
Additionally, propylene glycol binds water and dries up the saliva. Saliva protects teeth from tooth-destroying bacteria. Less saliva means less protection against bacteria, which means faster decay and more cavities.
Glycerin is a viscous liquid. When combined with e-liquid flavourings, it acts like a glue that helps bacteria adhere to the tooth surface and make it harder for us to brush them away. The bacteria then multiply and form thick plaque that is more resistant to tooth brushing. The bacteria then produce acid, dissolve enamel, cause cavities, teeth rot, you get the idea.
The final hazardous substance in e-cigarettes is nicotine. Nicotine impairs the immune system of the tissues it comes in contact with. It causes soft tissues in our mouths to swell and our gums to bleed. This leads to gum recessions and breakdown of tooth-supporting bone, and eventually to teeth losing all their bony support and becoming loose. This disease is called periodontitis or periodontal disease. Symptoms of tooth loosening are usually not apparent until 40-50 years of age, but when teeth do become loose and inflamed, it is usually too late for treatment, and those teeth have to be removed.
The main selling point of e-cigarettes is that they are a healthier alternative to traditional smoking. Whether that statement is generally true or not is not the subject of this post. Dentists do know now that vaping is not as risk-free as it is often advertised. With regards to oral health, vaping poses additional dangers when compared with traditional tobacco smoking. Vapers are not only at risk of developing gum disease, they are also at high risk of developing extensive tooth decay.
With this in mind, dentists can´t really say that vaping is a better alternative to smoking when it comes to keeping your teeth healthy. Users of e-cigarettes should be very diligent about brushing their teeth, using floss at least once a day and visiting the dental office regularly for check-ups and preventive treatments.
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