The Lesser of Two Evils: E-Cigarettes
What are e-cigarettes?
Electronic cigarettes (or “e-cigarettes”) are electronic devices that take an “e-liquid” composed of diluent fluid, nicotine, and a flavoring agent and, using heat, atomize that e-liquid into inhalable form (sometimes slightly incorrectly called a “vapour”). E-cigarettes are useful for those who are interested in quitting burnt tobacco, and in that context e-cigarettes offer numerous health advantages over tobacco cigarettes. But what are the effects of e-cigarettes on oral health?
Although nicotine is not a required component in e-cigarette fluid, it usually is. Studies have shown that nicotine, in itself, does have detrimental effects to the mouth, gums, and tongue. Studies so far indicate significant effects, including the development of gingivitis and periodontitis.
Perhaps most significantly, nicotine can cause gum recession. Gums need good blood circulation for health, and nicotine is a vasoconstrictor, reducing blood flow in the gums. With improper circulation, the gums do not get all the oxygen and nutrients they need.
As a vasoconstrictor, nicotine can also mask the detection of gum disease because gums that would normally bleed when experiencing problems might not bleed, or bleed less, when influenced by the presence of nicotine. Things needing treatment might therefore end up ignored when they should be treated. This effect has also been observed with the use of nicotine gums.
Moreover, nicotine as a vasoconstrictor also reduces the production of saliva in the mouth. The consequences can be increased bacteria buildup, bad breath, and tooth decay.
Finally, as a stimulant, nicotine can lead to more aggressive tooth grinding (for those already grinding), or to starting tooth grinding among those who don’t currently grind.
E-cigarette “vapour” and cigarette smoke
E-cigarettes don’t actually produce “smoke” in the sense that smoke is a product of burned tobacco. While the health effects have not been studied in any depth, it’s quite likely that the chemistry of the aerosol they produce is less harmful than tobacco smoke, which has known detrimental effects. And, while tobacco smoke has hundreds of component chemicals, e-cigarettes have relatively very few, so as time passes analysis of effects should be easier.
However, the mechanism of generating the aerosol in an e-cigarette requires the e-liquid to be heated, and e-cigarette aerosols will meet the oral tissues first when they are at their hottest and most concentrated. Surveys have identified mouth dryness and irritation as frequently accompanying e-cigarette use. Studies are continuing, looking at e-cigarette effects on tissues (particularly ligaments), possibilities of oral cancers, and effects on blood circulation (mucosa perfusion); however, these studies are just in their early stages.
Some e-liquid flavors used e-cigarettes have been challenged as being in themselves unhealthy. For example, diacetyl, a particular flavouring ingredient used in some butterscotch flavoured e-liquids may be harmful to inhale. In the context of the manufacture of microwave popcorn, this same flavoring compound has led to workers in that industry developing bronchiolitis obliterans, or popcorn lung, a respiratory ailment. Similar problems might relate to oral, as opposed to respiratory, health.
E-Cigarette Status in Canada
The legal framework governing e-cigarettes in Canada is a patchwork of provincial regulations. In Ontario, use of e-cigarettes is governed by Bill 45, The Making Healthier Choices Act, 2015, which contains the Electronic Cigarettes Act. The Act places restrictions on the sale and use of electronic cigarettes. For example:
- The sale and supply of electronic cigarettes to persons under 19 is prohibited.
- Restrictions are placed on the display and promotion of electronic cigarettes.
- The sale of electronic cigarettes in certain places is prohibited.
- Provision is made for regulating packaging of electronic cigarettes and for regulating the sale of flavoured electronic cigarettes.
- The use of electronic cigarettes is prohibited in enclosed workplaces, enclosed public places and certain other places.
- Inspection powers are provided for, along with offences and regulation-making powers.
These regulations [are currently being contested][http://www.torontosun.com/2015/12/05/vapers-protest-provincial-regulations-on-e-cigarettes] by the e-cigarette manufacturers and the “vaping” community, who contend that e-cigarettes are mechanical devices, and not in themselves drugs, and so should not be treated as such. To the degree that the various e-liquids used in e-cigarettes can and sometimes are nicotine-free, these interests may have a point.
The potential negative effects of e-cigarette smoke need to be balanced against the benefits of tobacco smoking, when one substitutes for the other. In such cases, e-cigarettes are a better alternative.
On the other hand, the best a cigarette OR e-cigarette smoker can do for their oral health is to use neither cigarettes nor e-cigarettes. If you are interested in more information on e-cigarettes and oral health, contact Sherway Gardens Dental Centre is ready to answer your questions.