We are experiencing a rapidly growing concern about the dangers of vaping. It seems every day the news headlines are featuring yet another death, or serious condition of young people who are fighting for their lives linked to the use of E-Cigarettes. Representatives on Capitol Hill in Washington DC are holding hearings with CEOs of vaping companies, and medical professionals trying to understand what is happening, and discussing what can be done.
What is vaping, and why is society alarmed at the rapid increase of lung injuries? Electronic cigarettes are devices that heat a liquid into an aerosol that the user inhales. The liquid usually has nicotine and flavoring in it, plus other additives. They can contain harmful and potentially dangerous ingredients. Some alarming ingredients are diacetyl: a chemical linked to serious lung disease, heavy metals including iron and lead, formaldehyde, the list goes on and on. One source lists 42 harmful chemicals linked to E-cigarettes. (http://www.gaspforair.org/gasp/gedc/ pdf/E-CigSmoke.pdf)
I just read an article sharing the plight of a young man, Anthony Mayo, whose lungs were coated with oil. The teenager became severely ill and unable to breathe on his own and his parents took him to the hospital where doctors took X-rays and discovered his lungs were filled with “hardened e-liquid oil”. The boys’ father, Keith Mayo, told the media that doctors likened it to bacon grease that hardens after it has cooled. Anthony was warned that at the age of 19, he now as the “lungs of a 60-year-old, two-pack-a-day smoker” and that the damage will likely scar him for life. The teen took up vaping about two years ago and would use flavored oils, including blue raspberry, cotton candy and cinnamon toast crunch.
This shocking scan of 19-year-old Anthony Mayo’s lungs show them congested with solidified vape oil. Credit: Facebook
What is so alarming to many is the marketing of these products to teenagers and young people. More than 80% of the patients suffering from lung injury are under 35 years old. Lung injuries are not the only risks; the lithium batteries have also exploded causing serious injuries to the users face and teeth.
Let’s look at what we know at this point:
• As of October 8, 2019, 1,299 lung injury cases associated with the use of e-cigarette or vaping products have been reported to CDC from 49 states, the District of Columbia, and 1 U.S. territory.
• Twenty-six deaths have been confirmed in 21 states.
• Most patients report a history of using tetrahydrocannabinol (THC)-containing products, however there are risks with non-THC products as well.
• Exclusive use of nicotine containing products has been reported by some patients with lung injury cases, and many patients with lung injuries report combined use of THC- and nicotine-containing products. Therefore, the possibility that nicotine-containing products play a role in this outbreak cannot be excluded.
Here is what we don’t know:
• At this time, FDA and CDC have not identified the cause or causes of the lung injuries in these cases, and the only commonality among all cases is that patients report the use of e-cigarette or vaping products.
• This outbreak might have more than one cause, and many different substances and product sources are still under investigation. The specific chemical exposure(s) causing lung injuries associated with e-cigarette product use, or vaping, remains unknown at this time. (cdc.gov)
As dental professionals, we need to be aware of additional risks that our patients who vape are facing. Those who vape are considered high risk for both caries and periodontal disease. A new research study, published by Jeffrey J. Kim, DDS, discovered the continual use of e-cigarettes might increase a patient’s chances of developing dental caries in the future. Dr. Kim performed the experiment at the Volpe Research Center in Maryland with a grant from the American Dental Association Foundation.
The researchers systematically evaluated e-cigarette aerosols over time and discovered certain types of sweet e-liquid flavors increased the likelihood of a patient developing caries by promoting the growth and adhesion of Streptococcus Mutans to the surface of the tooth. This study discovered that e-cigarette flavors reacted with the oral cavity in a manner very similar to candy or highly acidic drinks. Since the youth is the fastest growing population to use e-cigarettes, this may negatively impact their oral health during their formative years. Therefore, we need to educate our patients, and the parents of our younger users, of the risks of vaping.
As with many high risk patients, this also means a stronger focus on preventive services that help protect the integrity of their enamel. These patients need to understand the value of fluoride varnish, sealants for exposed grooves, and a bonded de-sensitizing and protective agent for exposed root surfaces. They may need prescription-strength mouth rinse, and toothpaste to elevate bacteria reduction on a daily basis. It may also be appropriate to recommend more frequent preventive visits, with pro-active radiographs. Certainly discussion of a tobacco-cessation program would also be ideal.
As dental professionals, we are often on the front lines in the battle against disease. Warning patients of the risk of using E-cigarettes has become an essential component in this fight. These questions should become part of our health history review, we should be screening patients and documenting any changes consistently. We also have a responsibility to have the conversation about risks with any patients who are vaping. Our patients depend on us for world-class care. We need to help inform them of our concerns regarding this growing trend, and educate them about the facts. Hopefully our efforts will have an impact in reducing the long-term effects from using E-cigarettes.
I lay out how to have these conversations with your patients and how I use the Risk Assessment brochure to help patients in our newest book “The Ultimate Guide To Doubling Your Dental Practice Production” – FREE for readers of The Profitable Dentist. They will be available at www.DoubleProductionStartingToday.com while supplies last.