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Dangerous chemicals found in e-liquids used for vaping and e-cigarettes could be worse for your patients’ oral health than smoking cigarettes. Studies have found vaping may be associated with tooth decay, gum disease and oral cancer. By Shane Conroy
Vaping and e-cigarettes are behind Australia’s latest health epidemic, and dentists are currently on the frontlines.
Many people take up vaping under the impression that it’s a safe alternative to smoking. That couldn’t be further from the truth, says Dr Amanda Phoon Nguyen, an oral medicine specialist at the Perth Oral Medicine and Dental Sleep Centre.
“While more study is needed into the health effects of vaping, we do know that a lot of the carcinogens in traditional smoking are present in vaping e-liquids,” she says. “Vaping is certainly not safe.”
Dr Phoon Nguyen is among many health professionals who are concerned by the large number of young people taking up vaping. According to the National Health Survey 2020-21, 9.3 per cent of people aged 18 years and over have used an e-cigarette or vaping device at least once in their lives, and 21.7 per cent of people aged 18 to 24 years have used an e-cigarette or vaping device at least once.
Lawmakers in Australia are well-versed in the health risks of e-cigarettes. In recent years, federal and state governments have taken steps to reduce the health impacts of vaping.
In 2021, the federal government made e-cigarettes that contain nicotine illegal without a prescription. The Australian Dental Association (ADA) NSW also backed the NSW government’s 2018 ban on the use of e-cigarettes in smoke-free areas.
However, the problem is far from solved. Research coming out of a 2022 NSW Health anti-vaping campaign revealed that vaping products are often incorrectly labeled as nicotine-free, and 80 per cent of young people surveyed said it’s easy to get a vape illegally.
That’s particularly concerning considering NSW Health also found that the nicotine in one vape can be equivalent to 50 cigarettes.
Decades of research into the health impacts of smoking has widely documented the negative effects nicotine has on oral health. Nicotine tends to reduce gingival blood flow, which weakens connective tissue and increases the chance of experiencing gum disease and tooth loss.
“Nicotine is also addictive,” adds Dr Phoon Nguyen. “It is harmful to the developing brain, and is even more reason for young people to stay away from vaping.”
Worse than smoking
Even vapes that don’t contain nicotine could be dangerous for patients’ general and oral health. NSW Health reports that many e-liquids used in vaping have been found to contain the same harmful chemicals present in cleaning products, nail polish remover, weed killer and bug spray.
According to a series of new studies by researchers at the New York University College of Dentistry, the presence of these dangerous chemicals in e-liquids could make vaping even worse for oral health than smoking cigarettes.
The studies examined how chemicals present in vapes and e-cigarettes change the oral microbiome and the balance of bacteria in the mouth. The most significant— and unexpected—finding was that vapers experienced significantly worse clinical attachment loss than cigarette smokers.
Clinical attachment loss is a key indicator of gum disease. It measures gum ligament and tissue separation from the tooth’s surface. This separation causes the gum to recede and can create pockets that become breeding grounds for the bacteria that lead to more severe gum disease.
The studies found that Fusobacterium and Bacteroidales—bacteria commonly associated with gum disease—were dominant in the mouths of e-cigarette users. Other types of bacteria including Selenomonas, Leptotrichia and Saccharibacteria were also abundant in the mouths of both cigarette smokers and vapers.
But the risks of vaping don’t end there. Propylene glycol often found in vaping e-liquids can cause dry mouth, which can contribute to tooth decay and gum disease. When vaped, propylene glycol also breaks down into acetic and lactic acids that are harmful to tooth enamel and soft issues in the mouth.
It’s not only gum disease and tooth decay that should be worrying vapers. Oral microbiome imbalances associated with vaping have also been linked to oral cancer.
A 2019 study published in the Technology in Cancer Research & Treatment journal linked bacterial imbalances in the oral microbiome to chronic inflammation that’s associated with the development of oral cancer.
According to the ADA, signs and symptoms of oral cancer include a sore, irritation, lump or thick patch in the mouth, lip, or throat, or a chronic ulcer or blood blister in the mouth that does not heal.
Dentists are the first line of defence in the fight against oral cancer, and Dr Phoon Nguyen says they play a critical role in the early detection of oral cancer.
“Dentists need to be vigilant because early detection of oral cancer makes a big difference to the prognosis,” she explains. “You need to be looking for anything in the mouth that’s unexplained. Colour or textural changes, or oral ulcers that don’t heal within two weeks should be checked out by an oral medicine specialist or other appropriately trained clinicians.”
Dentists should also look out for patients who are experiencing difficulty chewing, swallowing or moving their jaw or tongue. Difficulty speaking or a change in their voice can also indicate oral cancer, and patients with prolonged swollen glands or a sore throat that does not go away may also be showing early signs of oral cancer.
Patients eager to give up vaping and e-cigarettes can call 13 QUIT or visit iCanQuit.com.au for support.