No doubt we have all followed a car down a road, with billows of smoke emitting from an open window, and wondering whether said vehicle was on fire. Similarly, who hasn’t been walking down a pavement and been nasally insulted by puffs of bubblegum or apple pie and custard from an enthusiastic vaper?
Preferable maybe to the acrid irritation of cigarette smoke, but a slightly surreal olfactory sensation none the less, whilst window shopping or standing outside your favourite eatery, wondering whether to go in for a curry (a flavour not yet available on the vape menu, apparently.)
Vapes – electronic cigarettes or e-cigarettes – are devices which heat a liquid (which holds the flavours) to create a nicotine containing vapour which is then inhaled. Vaping is the flavour – literally- of the 21st century. Vaping is healthy! Vaping delivers the kick of nicotine without the noxious, carcinogenic side effects of the tarry smoke of tobacco. ‘Vaping candy vape juices’ - so says one website – ‘is like eating your favourite sweets without the calories and dental problems!’
Vaping and oral health even made the correspondence columns of the Times recently, with scientists from Newcastle stating that the scientific evidence is clear that nicotine alone does not lead to gum disease. Nicotine replacement, after all, has been used in chewing gum for many years without any recognised side effects. It’s the smoke, not the nicotine, which does the harm. Their review published in 2019 stated that ‘at concentrations found in plasma, saliva and gingival crevicular fluid nicotine is unlikely to be cytotoxic to human gingival and periodontal ligament cells in in vitro conditions.’ There was a proviso, however, that ‘saliva nicotine concentrations seen in smokeless tobacco users can be cytotoxic.’ But vaping is currently seen as safer and preferable to smoking cigarettes and as a good halfway house to quitting smoking altogether.
But what about the other stuff being inhaled? Could the flavours have a negative effect on oral health? A recent paper has suggested that the taste agents may alter the oral microbiome for the worse. The oral microbiome describes the microbial residents of the oral cavity and is, in health, a delicate balance of commensal and pathogenic bacteria.
Cinnamon and menthol flavours in particular were found to inhibit the growth of the commensal Streptococci species in the microbiome, when compared with non-flavoured vaping liquids. These risk upsetting the delicate balance of bacteria present in the mouth, the decrease in commensal bacteria leading to an increase in pathological bacteria. For instance, another study found that in killing some commensal streptococci, the growth of our old friend Streptococcus mutans was not inhibited. The carrying liquid for vaping also contains propylene glycol which has also been shown to alter the oral microbiome.
These studies were done in vitro, in a laboratory, observing bacterial colony counts and such like. They only looked at 3 or 4 of the hundreds of bacterial species present in the mouth. Variables such as puff rate and flavour concentrations require much more details in vivo investigation. But there is starting to be some science behind querying the total safety of e-cigarettes.
Even the BBC website has an article discussing potential issues with vaping, highlighting the long term potential downsides to vaping and the possibility that nicotine introduced into the body via a vapour is potentially more harmful than that introduced via chewing gum or a patch. A recent literature review has shown that risks of vaping vary from minor throat and mucosal irritations to explosions of the device itself. In emergency departments in the USA, over a 2 year period, 2,035 injuries resulting from e-cigarette explosions were reported. Injuries were primarily burns to the perioral area but tooth fracture and avulsion have been seen, one even reporting an explosion injury which ‘resulted in the propulsion of the mouthpiece of the e-cigarette through the pharynx, and into the first cervical vertebra resulting in a spinal fracture.’
There are other risks, too. Vaping is increasingly popular among teenagers. The trendy styles of e-cigarettes themselves, the different sweet flavours of liquids available, peer pressure, ‘it’s not really smoking’ can all be reasons for starting a habit which might become addictive and lead to further addictive behaviours. Vaping has been termed a ‘gateway drug’ and can lead to regular cigarette use or vaping marijuana. The advice for teenagers and adolescents from this mental health centre is ‘don’t start’.
It’s not that long ago that doctors were used by tobacco companies to advertise the health benefits of cigarettes, a practice which only stopped in the 1960’s when a causal link between smoking and lung cancer was established. Many of the providers of vape liquids are independent companies but some large tobacco companies are investing in vape products. The UK government has a plan to phase out smoking tobacco by 2030. It might be wise, then, to be prepared for seeing more frequent advertisements which upsell the health benefits of vaping and e-cigarettes but downplay the risks.
That sweet smelling smoke of apple pie and custard along the pavement may disperse rapidly in the wind but the risks to health from vaping may be longer term.