Electronic cigarettes, vape pens, and other devices are gaining popularity as both a unique sensory experience and as an alternative to smoking. A lot of young people who would never touch a cigarette are quick to try an electronic device that delivers an inhaled dose of nicotine with a candy flavored finish.
This trend has been brewing for more than a decade, and innovation in devices and delivery systems have exploded in the past few years. We are quick to condemn anything that looks and feels as bad as we know smoking to be, but do we have enough information to condemn it? Yes and no. Maybe?
We do not have any long-term studies on the health effects of inhaled nicotine sans smoke, and that means we don’t know enough to call it safe. We do know a lot about nicotine, however. As a CNS stimulant, nicotine can have some dramatic effects on the brain and cardiovascular system, but is there a threshold for how much can be safely consumed? How does tolerance affect this? How are the risks of vaping different to the lungs, esophagus, and oral tissues?
And what about the subset of users who use the nicotine-free vape liquids? There are apparently enough nicotine-free vaping enthusiasts out there that most e-liquid suppliers make a nicotine-free version of their potions. We know precious little about the effects of inhaling all those ingredients used to flavor “vape juice.” Early e-cigarette liquids sometimes contained diacetyl—the same ingredient found in butter-flavored popcorn. Diacetyl is perfectly safe for consumption, but perfectly carcinogenic when inhaled (see “popcorn lung”). Additionally, most e-cigs use glycerin or propylene glycol as a base for their nicotine cocktails. Glycerin is typically benign to the human body, but we’ve never inhaled mass quantities of it before now! Who knows what horrors this may lead to? (Or may not.)
Culturally, vaping doesn’t have quite the same stigma as smoking, but it’s equally frowned upon in public spaces. Users may claim their clouds to be harmless to bystanders (by-breathers, if you will), but many report throat irritation in close proximity. The Spanish Council of Scientific Research studied the levels of volatile organic compounds in vapers’ exhalations in 2015 and found them to be comparable to normal human breath. Is the reported irritation the same cough you get when you put your face in front of a water humidifier, or something worse? Is the irritation itself danger enough?
Vaping and Oral Cancer
There is no evidence here or there on whether vaping causes oral cancer, but here’s the rub: we know that many oral cancers are caused by oral irritants. Heat, smoke, alcohol, ill-fitting dentures—all of these can be the instigators that lead to cancerous growths in the tissues of the mouth and throat. Does inhaling the vapor of glycerin and nicotine (and a million different flavorings) irritate the mouth and throat as much as, say, the heat and smoke of a cigarette? I’d put my money on “it’s possible.” Maybe even probable.
A Cure for Smoking?
From a harm reduction point of view, there may be some merit to vaping. If long-time smokers can put down their cigarettes for good, that has to be a step in the right direction, right? The Royal College of Physicians (UK) determined that vaping is 90 percent less harmful than smoking, when comparing one’s exposure to known carcinogens. Since 2017, government health campaigns in England are even promoting e-cigarettes as a way to quit smoking. I’m not quick to get on that bus because there are still so many unanswered questions. Don’t forget, heroin was first marketed by Bayer as a “non-addictive” morphine substitute! Harm reduction mistakes have been made before. Many of them.
It’s definitely a polarizing topic, I’ll give you that. If you take the time to research the subject you’ll find that for every claim of dangerous chemical exposure in vaping (formaldehyde!) you can find scientific studies that debunk the alarmist comparisons. Yet for every scientific study, you can still rely on the fact that we still have no empirical studies on the long-term health effects of the practice. The territory is still too new.
Vaping and Oral Health
As a dentist, I am hesitant to recommend the practice, of course, because I know nicotine is not good for your teeth and gums. It may not stain the teeth, but it can restrict the flow of blood to your oral tissues and make you more susceptible to developing gum disease. That much we know. If there’s any chance something can increase your risk of developing gum disease or oral cancer, I routinely advise against it. Then again, if you are smoking, I would also advise you to do whatever is necessary to quit smoking.
About the Author: Dr. Mickiewicz owns a private practice in Sacramento and lectures across the nation on TMD treatments. He is a diplomate of the American Academy of Pain Management and holds membership in many professional associations for dentistry, sleep medicine, and TMD. In addition, Dr. Mick, as his patients call him, founded Pacific Orofacial Pain Consultants, a team of experts in various disciplines, who tackle the issue of TMD pain and treatment, to help sufferers find relief from chronic pain. To talk with Dr. Mick, call his Sacramento dental office at 916-457-7710.