What is the Craic with Vaping and Gum Health?

A long long time ago, (well in 1963) in a galaxy far far away, Herbert Gilbert invented a smokeless, non-tobacco cigarette. This 'smokeless cigarette' however didn't really catch on until 2003 in China where the concept was modified by inventor Hon Lik. ^[1] Now the electronic cigarette and vaping market is estimated to be worth over £2billion and expected to be worth a massive £47billion by 2025 ^[5], with 3.2 million users in the UK today alone. So the vaping industry is taking off big time and the race has been on to keep this industry regulated, on the governments radar and as a dental hygiene-therapist, keep my flock informed.

I have been researching this topic for several weeks and found much more information than I was expecting to, especially as vaping is a pretty recent phenomenon that we need to consider in the dental world.

I think the really important thing to note is that as soon as a smoker attempts to swap smoking regular combustible tobacco eg filtered cigarettes, rolled cigarettes, pipes or chewable tobacco we need to give them a real pat on the back for deciding to make a change. By choosing an e cigarette patients are reducing opportunities for smoking. Some people will use an e cigarette to stop smoking and ultimately using and e cigarette entirely, some will use an e cigarette for the foreseeable future, and some will use an e cigarette in conjunction with using some other form of combustible tobacco like filtered cigarettes so there really is no one size fits all approach to vaping as I maybe initially thought.

Like phones, TVs, cars there are several different types and sizes of vaping units available to suit many budgets. Which was news to me as I have never set foot into a vaping shop..until today. I was met with a wall of vaping oils, flavoured unflavoured, nicotine and nicotine free with vaping units to the left of me a vaping units to the right. My advice if you're thinking about vaping is always to call into a vape shop first and get a bit of advice about where to start, anyone I have spoken to have always been friendly, informative and more than happy to help. Most vape shops actually offer starter bundles to help make the transition easier, and as all vaping shops have to be regulated and comply with Government and EU guidelines you should be in safe(r) hands ^[7][10].

Not unlike Willy Wonka the vaping industry seems to be producing all manner of flavours and most seem to be available with or without nicotine and part of a good old '3 for 2' offer. In the vape shop I was advised that the most popular flavour is called 'Dragons Breath' *cue game of thrones reference* which is actually a mixed berry flavour and blueberry also seems to be very popular. Sometimes these berry flavours and darker oils generally can cause a LOT of dental staining, which is pretty unsightly and not much fun to remove - for me or for you. So if staining is an issue that you encounter regularly I would advise a flavour with lighter or colourless oil. I have also learned at a recent lecture that oils can sometimes irritate the soft tissues within the mouth and choosing vegetable based oils seems to be better for patients if this is the case.

Most electronic cigarettes or vaping devices convert these oils into a mist or vapour which the user then inhalers helping them avoid the 400+ chemicals, tar, ammonia etc that are found in cigarettes 70 of which of these are thought to cause cancer ^[6][10]. It has also been suggested buy the NHS that 1.5 million people have used this method to stop smoking entirely ^[9]. Two thumbs up. So, the intentions of e-cigarettes and vaping seem to be good, but how much better are they really?

A recent article in the Clinical Journal of Oral investigations has shown that there is less inflammation around the gums in patients who vape or use e cigarettes compared to cigarette smokers ^[13]. This has been reinforced by a further study which showed that there were fewer incidences of adverse events (changes in the tissues of the mouth) in patients who vape than in patients who smoked AND vaped ^[14]. However a small pilot study in 2016 by Wadia et al on a small group of patients found that switching to vaping over a two week period actually increased inflammation ^[15]. What to do, what to do, what to do? Inflammation of the gums is definitely not ideal, but to have recent research that has showed at reduction of inflammation when vaping as opposed to cigarette smoking can only be positive.

And what are the implications for that other hot topic, Dental Implants? There is evidence to suggest an increase in Implant complications when smoking e cigarettes ^[16], ArRejaie at al found that inflammatory substances still exist in the dental tissues of implant patients who are using vaping products compared to non-smokers ^[3] and Khulud et al had similar findings in his March 2018 study ^[4]. As we discussed above, inflammation around teeth and gums and especially around implants is not great. Hmmmmm.

The hard evidence we know is that you are more likely to lose your implant if you are smoking versus not smoking ^[17], so any positive movement towards stopping smoking should be the way to go ideally with the ultimate goal being patients stopping smoking entirely.

So a bit of a mixed bag, and I imagine this research will change over time. I certainly expect to see a lot more of my patients moving away from combustible tobacco and on to some sort of substitute, like vaping, as time moves on and in turn the advice that we can give will get better and better the longer its around and it certainly looks like the trend is here to stay.

At the ADI congress in Edinburgh this year Elaine Tilling spoke on the subject of vaping and directed us to a really interesting video which I will link here , its long, about 15 minutes, so get a cup of tea.

When I first started looking into this topic I was very much of the opinion that e cigarette smoking was in the same category and smoking combustible tobacco and a blanket N.O. spells NO approach was the only way forward. (Ok, maybe I'm exaggerating a bit here, I have always supported any efforts of my patients as a means to stop smoking.) But, like many other times in my dental career if have decided to try and be a bit more chilled out about it. Less fire and brimstone, more tread carefully friends. And still yes I think the best advice to give my patients moving forward is the best thing for gum health, general health, and their risk for oral cancer is not to smoke, but I would say no my stand point is perhaps less rigid. I don't think we will ever come out and say that vaping is totally safe, and the evidence I have looked at especially regarding dental implants suggests caution is required, but I think with confidence we can say it is less harmful. What can I say I'm full of surprises.

If you would like a Dental Hygiene appointment, you can visit me at Moira Cosmetic Dental or Bupa Dental Care Glengormley or follow me on Instagram @homegirlhygienist

(1)https://www.livescience.com/41211-how-electronic-cigarettes-work-infographic.html

(2) https://www.hopkinsmedicine.org/health/wellness-and-prevention/5-truths-you-need-to-know-about-vaping

(3)https://aap.onlinelibrary.wiley.com/doi/abs/10.1002/JPER.18-0045

(4)https://onlinelibrary.wiley.com/doi/abs/10.1111/cid.12597

(5)https://www.vapingpost.com/2017/04/25/global-vaping-market-to-reach-47-billion-by-2025/

(6)https://science.howstuffworks.com/innovation/everyday-innovations/electronic-cigarette.htm

(7)https://www.gov.uk/government/publications/tobacco-products-and-e-cigarette-cross-border-sales-registration/list-of-registered-retailers

(8)https://www.gov.uk/government/collections/e-cigarettes-and-vaping-policy-regulation-and-guidance

(9)https://www.nhs.uk/smokefree/help-and-advice/e-cigarettes

(10)https://www.gov.uk/guidance/e-cigarettes-regulations-for-consumer-products

(11)https://www.kcl.ac.uk/ioppn/news/records/2018/february/Expert-review-of-e-cigarettes-raises-concern-over-misperceptions

(12)https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/684963/Evidence_review_of_e-cigarettes_and_heated_tobacco_products_2018.pdf

(13)https://link.springer.com/article/10.1007/s00784-018-2725-2

(14) https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6629-0

(15)https://www.nature.com/articles/sj.bdj.2016.914

(16)https://www.joionline.org/doi/abs/10.1563/aaid-joi-D-18-00009

(17)https://www.ncbi.nlm.nih.gov/pubmed/29864381

#vaping #ecigarettes #dentalhygiene #smokingcessation #dentalimplants #dentalhygienist #smoking #gums #gumhealth

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What is the Craic with Vaping and Gum Health? - Darth Vaper

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