Experts have a lot of questions still unanswered about electronic cigarettes, but evidence is starting to accumulate that the effect on the oral cavity can be as significant as tobacco cigarettes.
- Dr. Larry Williams, Assistant Professor of Dental Medicine, Midwestern University and West Side Branch President, Chicago Dental Society
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Radio Health Journal 17-21B
E-cigarettes and Oral Health
Nancy Benson: Scientists have learned that your doctor and your dentist aren’t as disconnected as they once thought. What’s happening in your mouth can say a lot about what’s going on in the rest of your body. For example, people with gum disease are much more likely to have heart disease. So experts say we should pay a lot more attention to our oral health than most people do.
Dr. Larry Williams: The most harmful thing they do for oral health is they abuse their mouths.
Benson: That’s Dr. Larry Williams, Assistant Professor of Dental Medicine at Midwestern University and West Side Branch President of the Chicago Dental Society. He often testifies before governmental agencies on health aspects of tobacco issues and says tobacco products are one of the biggest ways people abuse their mouths.
Williams: One of the things we know that when we looked at smoked cigarettes, they increase the healing time almost double. So when there’s any kind of injury or surgery that’s done, you increase the healing time. And of course anything that comes into the mouth with chemicals that are foreign, can cause an inflame response, an inflammatory response, an irritation in the oral cavity. Cancers can be found within a certain time frame, but the really sad part is that oral cancer in general has just a little bit better than a 60% 5-year survival rate. So this gum irritation, does it proceed to oral cancer? Well, it can take 15-20 years for the oral cancer to develop enough to be seen, sometimes less, this minor irritation might be a precursor to something much worse.
Benson: A lot of people have tried to avoid some of the health effects of smoking by switching to electronic cigarettes. But while e-cigarettes are marketed as a safer alternative, Williams says at least when it comes to oral health, it’s still an open question.
Williams: That’s the key issue right now – we don’t know. And this is a problem that we’ve had through several, probably a couple hundred years if you think about it, with tobacco use becoming more and more prevalent in our society. You think back into the early 1900’s where rolling your own cigarettes went away to mass-produced cigarettes, they invented the cigarette rolling machine and made mass production cigarettes available to the public and more people started smoking. People lost teeth, people had gum disease, and it wasn’t until 50/60 years later, about the same time that they started noticing the development of lung cancer, the surgeon general came out in the 60’s with a statement that cigarette use was a direct cause of lung cancer, well then we started putting other things together and learned that tobacco was harming the mouth.
Benson: Williams says that even some scientists have tried to equate the safety of e-cigarettes with the nicotine patch and nicotine gum, but he says it doesn’t really work that way.
Williams: The nicotine patch, the nicotine gum that are over the counters, that are FDA approved and FDA studied and tested and verified have been shown to be very effective in helping people quit and getting the nicotine they need to live their daily lives. There are some people that are addicted and need nicotine for a long time frame. That nicotine that’s in the patch and the gum is pharmaceutical grade nicotine, it is purified nicotine, it doesn’t have the carcinogens in it, and it is not coming directly from the tobacco plant to the factory. Whereas the nicotine that can be electronic nicotine delivery device, the vaping materials, that nicotine – that liquid – is a tobacco derivative, it is directly from the tobacco, essentially just takes the tobacco and leaves it, so it still has the carcinogens and everything else.
Benson: So if there’s no such thing as “safe tobacco” that also goes for vaping.
Williams: When you look at electronic cigarettes, the initial studies show that there’s approximately 1/10 the amount of toxins, carcinogens, other products that are in the tobacco product, because they are tobacco products. The federal court and the FDA have both stipulated that they are tobacco products, they contain the nicotine that comes from the tobacco plant and when they’re heated, there preliminary data that shows there is some damage to the gums – the gingiva, there has been some irritation that’s been noted. So in my book the jury is still out; we don’t have enough information to make a qualified statement that they are harmless, or less harmful than the regular smoked tobacco or chewed tobacco or any other form.
Benson: Research is casting doubt on vaping safety. In a study in the Journal of Cellular Physiology a sample of cells from the mouth were exposed to e-cigarette vapor for 15 minutes a day. By the third day, 53% of the cells had been killed or damaged. Compared to only 2% of a control group. Another study in the journal, Oncotarget, shows that damage from flavored vapor can be even worse that tobacco smoke. Williams has testified before government regulators that that’s potentially disastrous.
Williams: Almost all the e-cigarette liquids come flavored, that’s one of the bad parts of the flavored component because they’re all “kid” flavors. When I gave the testimony, I told them “which adult in this room is going to buy an cigarette liquid that’s labeled ‘blueberry’?” I said its not going to be an adult in this room, it’s going to be a child.
Benson: So what should someone look for if they’ve been vaping and want to be sure they’re not jeopardizing their oral health?
Williams: One of things you look for is bleeding, you look for puffy red gums, there maybe a little exudate when you look in the mirror and you open your mouth and you pull the lip down and you see that maybe there’s a little bit of a clear/yellow liquid right there at the gum line where they might be a little infection going on. But you brush your teeth and you have toothpaste and you spit the toothpaste into the sink and you notice some blood, then that’s where you start thinking “oh, something’s not right – I’ve got some gingivitis, I’ve got some gum inflammation going on. Some irritation.” The next thing of course is bad breath, you might see the gums receding, further out down the line you can notice loose teeth – the teeth don’t fit just right, they don’t feel the same – then you start to lose teeth.
Benson: An even better idea is to be sure to have regular dental check ups. Williams says avoiding them is one of the other main ways people mistreat their mouths.
Williams: We are the gatekeepers to the window of the body, which is the mouth, we take of that it’s what we’re here for. And when you look at – and I’ll go back to oral cancer – one of the reasons why the 5-year survival rate is so bad is because a lot of the people that are developing oral cancer, aren’t getting regular checkups until something has been wrong for so long it shows up and it’s too late. And the next thing could be what people do their mouths thinking that they’re sipping on low pH or acidic drinks al day long and what’s that doing to our populations that we’re seeing tooth decay – childhood tooth decay, in older adults now. Because some of the things that they’re doing, it’s coming back around. They’re’ getting more tooth decay because they’re eating and drinking things that lead to more tooth decay.
Benson: you can find out more about all our guests on our website, RadioHealthJournal.net. Our production director is Sean Waldron. I’m Nancy Benson.