The effects of vaping on oral health

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the effects of vaping on oral health
Photography: Miko – 123RF

Electronic cigarette devices have an assortment of negative effects that can impact a patient’s oral health, with a diagnosis of ‘vaper’s tongue’ typically just the start. By Tracey Porter

It is exactly 20 years ince electronic cigarettes first became commercially available in Australia. Then the general perception was that vaping was a ‘healthier’ alternative to smoking, probably because e-cigarettes were developed by a Chinese pharmacist to help people quit smoking.

Now a growing body of evidence suggests ‘vape tongue’, a term used to describe the transient loss of taste as a result of vaping, may be just one of the many oral health concerns dental professionals will have to treat as a result of patients inhaling such aerosols. 

In 2019, the Department of Health undertook a study that examined the non-nicotine liquids used for e-cigarette devices in Australia. The report, which used data collated from Australian customs, online vendors’ websites, chemical analysis and peer-reviewed scientific literature, found that there are as many as 243 different chemicals used as ingredients in e-cigarette liquids. 

The contaminants identified included an assortment of metals, volatile organic compounds (VOC), phthalates, pesticides, and tobacco-specific nitrosamines, including propylene glycol, commonly used as a heat transfer fluid in the air-conditioning industry. It was further reported that many were also labelled inaccurately.

The report, ‘Non-nicotine liquids for e-cigarette devices in Australia: chemistry and health concerns’, noted that far from being a healthier alternative, those who favoured e-cigarettes were also at risk of ingesting contaminants emitted from the devices themselves. 

Dr Arosha Weerakoon, a senior lecturer at the University of Queensland School of Dentistry and practice owner of Tewantin Family Dental, says while research into the effects of vaping on oral health is still in its infancy, evidence from laboratory studies and self-reported data suggests that the dental sector can anticipate a rise in vaping-related illnesses in the future. 

“Compared to the research on traditional cigarette smoking (>50 years), studies on the effects of vaping are still new (less than two years). But studies conducted in controlled lab conditions show disease-causing changes at the cellular level.” She says this is often an indicator for how vaping can impact health in the long-term.

Compared to the research on traditional cigarette smoking (>50 years), studies on the effects of vaping are still new (less than two years). But studies conducted in controlled lab conditions show disease-causing changes at the cellular level.

Dr Arosha Weerakoon, senior lecturer, University of Queensland School of Dentistry

Sensing the tidal wave of public health issues soon to crash on our shores due to vaping, the Australian Government in January made it illegal to import disposable vapes, irrespective of nicotine content or therapeutic claims.

However, Dr Weerakoon fears the damage may already have been done. She says in addition to increasing the chances of gum disease, the flavoured liquids and nicotine used in some vapes can contribute to yellow or brown discolouration of teeth, bad breath and teeth grinding, and lead to the development of oral mucosal lesions. Other possible effects include fungal infections and cancer.

“A key cause of bad breath is a dry mouth. And yes, those who vape report mouth dryness as a common side effect.”  

Dr Weerakoon says the drying effects of propylene glycol and glycerol, common ingredients in vape liquids, cause a sensation known as ‘throat hit’. It is thought this reduces saliva production, crucial for maintaining oral cleanliness and health, with insufficient saliva reducing the washing-effect in a vaper’s mouth to allow cavity and gum disease-promoting bacteria to accumulate.

ADA vaping spokesperson and oral medicine specialist Dr Sue-Ching Yeoh, says any activity associated with oral dryness is of concern. Saliva plays a role in the gustatory sensation by working to break down food and other substances, to allow them to be exposed to the taste buds and interpreted as taste. Any decrease in saliva will impact the individual’s ability to taste, she says.

“In the case of ‘vape or vaper’s tongue’, this is thought to last between a few hours to several days, although there are some reports of this lasting up to a fortnight.”

Dr Yeoh says affected individuals often report a blunted taste sensation, and in some cases lose the ability to discern taste altogether. Many people will also report symptoms of oral dryness including generalised oral mucosal discomfort or burning, difficulty eating and speaking without sipping water, as well as halitosis.

The symptoms of ‘vaper’s tongue’ are often an indication that the oral cavity is being affected by vaping. Appropriate medical/dental attention should be sought as early as possible. A thorough oral cavity examination will exclude other potential causes (sometimes sinister) of loss of taste, and also ensure that there are no other signs of vaping-related oral disease.

Dr Sue-Ching Yeoh, ADA

Although vaper’s tongue is thought to be transient, it alerts the clinician (and patient) to the fact that the oral cavity is reacting in an adverse way to the use of vapes, Dr Yeoh explains.

Vapers can also develop oral mucosal lesions, fungal infections, and secondary infections due to oral dryness and are at greater risk of periodontal disease and caries and even cancer, she says.

“The symptoms of ‘vaper’s tongue’ are often an indication that the oral cavity is being affected by vaping. Appropriate medical/dental attention should be sought as early as possible. A thorough oral cavity examination will exclude other potential causes (sometimes sinister) of loss of taste, and also ensure that there are no other signs of vaping-related oral disease.”

Both dental experts say oral health professionals must encourage patients who vape to reduce and then cease the habit altogether to safeguard their teeth and gums and avoid the impact of vaper’s tongue. 

Dr Yeoh says there are many approved and well-tested methods of smoking cessation, and for patients who are “recreational vapers”, education about the general and oral health risks is extremely important. 

Patients experiencing transient loss of taste and oral dryness associated with vaping should be encouraged to take frequent sips of water to lubricate the mouth, trial over-the-counter dry mouth products to provide moisture, avoid dehydrating stimulants such as caffeine and alcohol and be meticulous about their oral hygiene, she says. 

“They should be encouraged to be frequent dental attendees, which will allow ongoing surveillance of the oral mucosa and dentition for the deleterious effect of vaping.”  

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