Electronic Cigarettes and Oral Heath
Electronic cigarettes (e‑cigarettes) are widely available, and their use is increasing worldwide. They are promoted as a safer alternative to combustible cigarette smoking and as an effective smoking cessation aid.
E‑cigarettes are designed to provide smokers with the desired nicotine dose without burning tobacco. They contain flavoured humectants that include nicotine in concentrations of 0–36 mg/mL. Evidence suggests that e‑cigarettes are a better nicotine delivery method than combustible cigarettes and have reduced adverse general and oral health effects, compared with combustible cigarettes.
However, although e‑cigarettes might be an acceptable harm-reduction strategy, the differential effects of e‑cigarettes and combustible cigarettes have been based on self-reported perceptions.
In addition, a growing number of young people, who have never engaged in combustible cigarette smoking, are smoking e‑cigarettes, which may not be harmless. We analyzed peer-reviewed publications available through PubMed to summarize the effects of e‑cigarettes on oral health.
The World Health Organization estimated that, in 2015, 19.9% of the world’s population over the age of 15 were smokers.1 The 2017 Canadian Tobacco, Alcohol and Drugs Survey found that the prevalence of current cigarette smoking was 15%, including about 17% of males and 13% of females.2 The prevalence in teens aged 15–19 years was about 8%, with 10% of males and 6% of females being current smokers. For those aged 20–24 years and those 25 years and older, the prevalence was 16%. Combustible cigarette smoking (CCS) has been causally associated with major morbidity and mortality.3 Indeed, numerous experimental and clinical investigations have linked tobacco use with over 25 diseases, including lung, heart and oral diseases, such as oral cancer.
The oral cavity is the first site to encounter tobacco smoke, which comes in direct contact with soft and hard tissues. Several studies have linked smoking to an elevated risk of periodontal disease.4 Cigarette smoke has also been associated with various cancers. A meta-analysis showed that exposure to environmental tobacco smoke is prospectively associated with a significantly increased risk of lung cancer.5
Smoking is also associated with oral cancers. 6 reported a 4-fold increase in potentially malignant oral disorders among those who smoke tobacco.
In a retrospective clinicopathological study, of people with proven cases of oral cancer, 29.4% were only tobacco chewers, 25.5% were only smokers, 42.2% used both types of tobacco (smoke and smokeless) and 2.9% were not tobacco users. For those only chewing tobacco, 83.3% had oral cavity cancers, of which 6.7% were of the oro- and hypopharynx. Among those who only smoked tobacco, 69.2% cases were of the laryngeal and oro- and hypopharyngeal, compared with 11.5% oral cavity cancers.7 Whatever the mode of tobacco use (smoking, chewing, etc.), there is a high risk of cancer development.
To counter the adverse effects of CCS on human health, various strategies have been introduced, including abstinence and nicotine replacement therapy (NRT).8 Available since early 1990, NRT products include gum, transdermal patches, nasal spray, inhalers and sublingual tablets and lozenges.
Recent reports show that NRT increases the chances of successfully stopping smoking in those attempting to quit.9 However, long-term success rates are low, as are those for all cessation options.10 Thus, the possibility of another option available to smokers is appealing, and a new strategy, the electronic cigarette (e‑cigarette), has been introduced.
Methods
This review summarizes scientific publications related to the interaction of e‑cigarettes with the oral cavity and the possible promotion of oral disease with the use of e‑cigarettes. For this purpose, we selected peer-reviewed articles using several search terms and databases, between 2012 and 2020. PubMed, Medline and Google Scholar were searched using the following groups of terms (electronic cigarette and oral health), (electronic cigarette and oral health and smoking), (electronic cigarette and oral health and smoking and nicotine replacement therapy), (electronic cigarette and oral health and smoking and cessation), (electronic cigarette and periodontal diseases), and (electronic cigarette and dental caries).
We examined the articles and selected those listed in the References of this review. We also included surveys published by Canadian Tobacco, Alcohol and Drugs Survey (CTADS)2 and the Centers for Disease Control and Prevention (CDC) Smoking & Tobacco Use website.3
Electronic Cigarettes
An e‑cigarette consists of a cylinder with a cartridge that serves as a reservoir for “vaping” substances on 1 end along with a mouthpiece. The cartridge can be prefilled or fillable. Various capacities have been designed, increasing from first to second and third generations of the e‑cigarette. E‑cigarette devic
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