E-Cigs and the Dental Field

It’s the 21st Century and the fact that smoking is bad news…. is old news.  It’s estimated that deaths related to smoking cigarettes will cause 1 billion deaths in the 21st Century, says the European Society of Csmokingardiology (1). About a decade ago, the first generation electronic cigarettes came out that looked exactly like cigarettes just replacing smoke with vapor. Fast forward 5-10 years, and the sales for these new, second generation vaporizers with flavored nicotine are on the rise. Sales have tripled and are continuing to rise exponentially with local shops and stores popping up all over the Treasure Valley.

What Are E-cigs?
Given their many names, the first generation electronic cigarettes, dubbed e-cigs, were initially made to very closely resemble cigarettes or cigars. With small batteries on the inside, the heating element produces a small amount of vapor and less nicotine than a real cigarette. The newer, second generation vaporizers, personal vapor (PV) or Electronic Nicotine Delivery System (ENDS), have a bigger battery allowing for more vapor and a larger housing for placing the flavoring element or e-liquid. There are hundreds of flavors ranging from 0mg-36mg of nicotine: 0mg being for those who may not want the nicotine, but still have an oral fixation and 36mg for people with a very high nicotine addiction that can be compared to needing to smoke two packs a day (5).

So Are They Better Or Not?
The problem with vapor smoking is that it is so new, generally speaking, that over the last decade, very little research has really gone into their effect on people, our environment, etc. The Roswell Park Cancer Institute studied 12 brands of vapor and found this (1,5):

  • E-cigs have less cancer-causing agents (carbonyls, volatile organic compounds, nitrosamines, and heavy metals) than regular cigarettes
  • The brands varied and averaged to have 9-450 times less toxins in their vapor than the average cigarette
  • They are still harmful to your health, but are a healthier approach to cigarettes (2)

Nicotine and Your Oral Health
According to the National Center for Biotechnology Information (NCBI), there is ongoing research over the past twenty years that “provide strong epidemiological evidence of a positive association between smoking and….  Periodontitis (3).”
Periodontitis or Periodontal Disease can be described as:

  • Inflammation of the gums, periodontal ligament, and other surrounding structures of the teeth and the alveolar bone supporting the teeth.
  • According to the Mayo Clinic, symptoms include:
    • Swollen gums
    • Bright red or purplish gums
    • Gums that feel tender when touched
    • Gums that pull away from your teeth (recede), making your teeth look longer than normal
    • New spaces developing between your teeth
    • Pus between your teeth and gums
    • Bad breath
    • Bad taste in your mouth
    • Loose teeth
    • A change in the way your teeth fit together when you bite
  • Treatment includes:
    • Scaling and Root Planing (SRPs): a series of “deep” cleanings requiring the patient to be numbed and a hygienist clean off tartar a smoothen the tooth’s root structure
    • Antibiotics to help fight bacterial infection in the form of a gel or mouth rinse
    • Tissue and bone grafting procedures

Nicotine is a vasoconstrictor, meaning it narrows the blood flow of arteries and blood vessels. It is hypothesized to impair gingival blood flow and soft and hard tissue wound healing (3). Both of these things are critical for periodontal health as well as certain dental procedures like SRPs, extractions, and implants requiring both tissue regeneration and bone healing in most cases. According to the NCBI, not only do smoking tobacco products reduce the periodontal ligament (the tissue that holds the tooth firmly in the socket), but it also inhibits any healing after deep cleanings and other preventative measures from helping treat the symptoms of periodontal disease.
So, the question still rises, are e-cigs/vaporizers better for you than smoking a normal cigarette or cigar? Medically speaking, considering smoking vapor has a significant amount less of toxins and other carcinogens than tobacco smoke, it is definitely better for your health. Unfortunately, studies have still yet to provide conclusive facts about how much nicotine is in a vapor (or tobacco smoke cloud for that matter) because there are too many factors to consider. According to the e-Cigarette Forum these factors need to be considered:

  • How much nicotine is in the carto (The part of the vaporizer that holds the e-liquid, which can be anywhere from 0mg-36mg of nicotine in the concentration),
  • Then, how much nicotine is in the vapor/smoke cloud on inhale,
  • And lastly, how much of that nicotine in the vapor/smoke cloud is absorbed in the human body (4).
    Futures studies may eventually unfold to conclude the ever-rising question of whether an e-cig is better for your oral health; however, in summary, the bottom line at this time is that nicotine, whether in the form of a vapor or smoke, will always be harmful to your oral health.

For other questions or more information about your oral health, call our office today (208) 402-1040.

1.    “Electronic Cigarettes Don’t Damage the Heart.” European Society of Cardiology, 25 August, 2012. Web. 28 May, 2014. http://www.escardio.org/about/press/press-releases/esc12-munich/Pages/acute-effects-electronic-cigarettes-heart-damage.aspx.
2.    “Levels of selected carcinogens and toxicants in vapour from electronic cigarettes.” TobaccoControl, 6 March, 2013. Web. 28 May, 2014. http://tobaccocontrol.bmj.com/content/early/2013/03/05/tobaccocontrol-2012-050859.short.
3.    “Nicotine and periodontal tissues.” National Center for Biotechnology Information, 24 Jan, 2009. Web. 28, May 2014. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933534/.
4.    “Tobacco cigarette vs e-cigarette nicotine equivalency.” E-Cigrarette Forum, 18 November, 2013. Web. 28 May, 2014.  http://www.e-cigarette-forum.com/forum/ecf-library/261114-tobacco-cigarette-vs-e-cigarette-nicotine-equivalency.html.
5.    “Vapor Cigarettes – Medical & Environmental Research.” EverSmoke Electronic Cigarettes, 2013. Web, 28 May, 2014. “http://www.learn.eversmoke.com/vapor-cigarettes-research.html.