It’s the story that’s been sweeping through newsrooms across the country – that as of December 10, 2019, 2,409 people have been hospitalized and an additional 52 people have died – as a result of what the Center for Disease Control (CDC) has called EVALI. That is an e-cigarette, or vaping, product use associated lung injury, shortened to EVALI (also known as VAPI for vaping-associated pulmonary illness)[1].
But, with little research available as to the short- and long-term side effects of vaping and e-cigarettes, confusion and even panic seem to shroud this topic – so we’ve gathered what we know here to hopefully help clear the smoke, so to speak, about vaping and your oral health.
Click here to jump to nicotine and oral health.
Click here to jump to THC and oral health.
What We Know About EVALI
The CDC has identified vitamin E acetate as a “chemical of concern,” found in the lung samples of 29 of those diagnosed with EVALI [1]. Vitamin E acetate is a thickening agent often mixed into both black market nicotine and tetrahydrocannabinol (THC) vape cartridges – although it has not yet been identified as the sole harmful agent in the EVALI cases, as the investigation is still ongoing [2].
THC was found in 82% of the samples submitted for testing to the CDC, and nicotine was found in 62% of the samples. Also included in the sample testing, were screenings for other chemicals that might be found in e-cigarette and vaping products, including “plant oils, petroleum distillates like mineral oil, MCT oil, and terpenes (which are compounds found in or added to THC products)” [1].
The FDA notes, perhaps most importantly, that the investigation is ongoing and that the variations in usage, products, and substances mean that there could be multiple causes of the lung injuries [3].
Many of the vape cartridges identified by the CDC were purchased illegally (many under the brand name “Dank Vapes,” which were packaged to look like a commercial product).
The CDC recommends that people avoid the use of e-cigarettes or vapes all together under the investigation concludes and that people do not purchase these products from family members, friends or online dealers, as well as avoiding the modification or addition of substances involved in or to a vape [1].
For chronic smokers who have transitioned to an e-cigarette, or are considering transitioning to an e-cigarette as a way to quit, the FDA recommends using FDA-approved nicotine replacement therapies (such as patches, gums and lozenges). Despite potential risks associated with vaping or e-cigarette use, smokers should not return to traditional tobacco. There is no safe tobacco product, and all such tobacco products carry risks [3].
Nicotine E-Cigarettes and Your Oral Health
While a vape containing nicotine may be used by a chronic smoker as a way to cut back on some of the chemicals found in cigarettes, an average vape cartridge often holds as much nicotine as 20 cigarettes and with dozens of flavors or juices to choose from, some users may find themselves actually upping their nicotine consumption [4].
Nicotine, which is the addictive component in tobacco, makes it hard for our bodies to repair themselves and damages the soft tissues in the mouth. Nicotine reduces the amount of oxygen that our vital organs and tissues receive. When oxygen isn’t circulating properly in the body, the risk of infections goes up [5].
Additionally, the American Association of Nurse Anesthetists writes that the use of an e-cigarette is no better than a cigarette when it comes to dental surgery, such as extractions [5]. Just as patients are cautioned not to use straws or smoke cigarettes following an extraction, an e-cigarette carries the same risk of damaging blood clots and causing dry socket [6].
Furthermore, the NCBI reports that the negative side effects of nicotine alone can include gastrointestinal distress, heart palpitations, and headaches. If too large of a dose is taken, nicotine can cause seizures, respiratory depression and severe bradycardia (slowed heartbeat). In fact, doses of nicotine that are tolerable to adults can be life-threatening if consumed by a child [4].
The FDA has not approved nicotine vaping as a method of smoking cessation. While there is some evidence that vaping can help people stop smoking, the data is limited and the comparison of vaping to nicotine patches, gums, or lozenges is unclear. Behavioral and cessation counseling is often a free and accessible resource for smokers who are trying to quit [3].
THC Vapes and Your Oral Health
With recent legislation allowing access to cannabis products to medical patients, and in some state, recreational users – we’re learning more about the effect cannabis consumption has on our oral and overall health.
There are three main forms of cannabis: marijuana (which consists of dried leaves and flowers), hashish (which is resin from the flower heads compressed into small blocks), and hash oil (which is a thick liquid extracted from hashish), all of which contain THC – the main psychoactive ingredient. While most commonly smoked, it can also be added to foods and once it enters the bloodstream, it begins to affect almost every part of the body. This includes the cardiovascular, respiratory and immune systems [7].
Of these forms, smoking marijuana is the most popular. Vapes allow users to inhale the THC vapors without the associated odor or set up of traditional smoking. However, the high temperatures at which this smoke is inhaled has been shown to cause changes in oral tissues and even to disrupt the normal activity of cells. It is important to note that while these changes to the oral tissue could lead to oral cancer, the link has not yet been established [8].
The ADA notes that the most frequent side effects of THC use are xerostomia (also known as dry mouth), more than average cavities, and leukoderma – which are small, watery lesions found in the mouth. Additionally, THC is an appetite stimulant, which can lead to users snacking more frequently, leaving behind sugary debris that turns into plaque. Lastly, cannabis use has been suggested to have a direct relationship with periodontal disease – which can result in swollen, red, and tender gums – but additional long-term studies are still underway [9].
Patients should not consume THC through a vape or other methods prior to dental appointments, as this can lead to patients experiencing acute anxiety, dysphoria, and paranoia. Because of the nature of dentistry, patients who experience anxiety are given other options for making themselves comfortable while maintaining their safety [10].
The Bottom Line: Talk to Your Doctor
In many of the EVALI cases, patients reported a gradual start of symptoms, following their use of vapes or e-cigarettes. These symptoms included breathing difficulties, shortness of breath and/or chest pain before hospitalization. Some patients reports mild to moderate gastrointestinal illness, including vomiting and diarrhea, and additional symptoms such as fevers or fatigue [11].
Patients should always inform their doctors of any substance use so that they can help patients make informed decisions in regards to their healthcare; this includes the use of e-cigarettes and vapes.
As the investigation into the EVALI cases continues, users should think twice before vaping. The CDC and FDA are working around the clock to test samples and cross-reference results. If you do decide to continue using e-cigarettes or THC-containing vapes, avoid those purchased “off the street,” and stick with licensed retailers. If you become concerned about possible EVALI symptoms, see a healthcare provider as soon as possible [12]. Additionally, you can call your local poison control center at 1-800-222-1222 [3].
If you experience vaping-associated respiratory illness, the FDA also encourages you to report this information, including providing any associated product, to your state or local health departments. Reporting to your state or health departments is crucial as federal and state partners work together to have accurate case identification and reported case counts. For more information regarding state and local health department directories, please refer to cdc.gov/publichealthgateway/
If you experience a problem with any tobacco product, such as an unexpected health or safety issue, report it online using the Safety Reporting Portal. You may submit reports about any tobacco product, including cigarettes, roll-your-own cigarettes, cigars, smokeless tobacco, electronic cigarettes, and waterpipe tobacco. You can also report problems with the components and parts of tobacco products. The FDA website has more information on what to include in a report.
The Oklahoma Tobacco Helpline is a free service available 24/7. There are no judgments, only help in providing tobacco users with the tools and support they need to quit tobacco use. For more information, please visit www.okhelpline.com or call 1-800-Quit-Now (1-800-784-8669).