Electronic nicotine delivery systems raise risk of poor oral health outcomes: JAMA

Recent research published in the Journal of the American Medical Association has revealed that evolving tobacco use patterns, including increased use of electronic nicotine delivery systems (ENDS), leads to an increased risk of gum diseases, bleeding after brushing or flossing, and loose teeth.

Electronic nicotine delivery systems (ENDS), often known as electronic cigarettes, e-cigarettes, vaping devices, or vape pens, are battery-powered devices used to smoke or "vape" a nicotine-laced flavored solution. While smokeless tobacco use has since long been associated with pre-cancerous oral lesions in South Asia, where these products are designed to be highly addictive, and their use is culturally and socially acceptable and often combined with other carcinogens-the effects of ENDS remain controversial. The FDA, CDC, and the American Academy of Family Physicians (AAFP) are currently concerned about the drastically rising use of ENDS, particularly among teenagers and young adults, and individuals seeking to stop smoking tobacco.

To bridge the gap, the research team examined associations between tobacco use and the incidence of adverse oral health outcomes (i.e., gum bleeding, pre-cancerous oral lesions, bone loss around teeth, bleeding after brushing or flossing, loose teeth, and one or more teeth remov ed) across different tobacco products among adults (aged ≥18 years) using data from the Population Assessment of Tobacco and Health (PATH) Study. Data analysis revealed some interesting facts.

• Cigarette smoking was associated with several adverse oral health outcomes (i.e., gum disease diagnosis, loose teeth, and one or more teeth removed).

• Increasing cigarette pack-year history was significantly associated with this oral health outcome, confirming the importance of both the number of cigarettes smoked and the duration of smoking to the risk of poor oral health.

• ENDS use was positively associated with bleeding after brushing or flossing.

• E-cigarette vapor, with or without nicotine, and its additional flavoring agents may harm periodontal ligament, stem cells, and gingival fibroblasts in culture due to aldehydes/carbonyls, which cause protein carbonylation of extracellular matrix, DNA adducts/damage, and cellular senescence.

Although e-cigarettes were created and marketed as a healthier alternative to smoking tobacco products, there is a growing body of information demonstrating that their aerosols contain a variety of toxicants, carcinogens, and organic compounds formed by the thermal breakdown of the solvents. In addition to supporting the FDA's tobacco regulation initiatives, the recent findings highlight the necessity of tobacco cessation counseling and services in clinical practice.

References-Silveira ML, Everard CD, Sharma E, et al. Tobacco Use and Incidence of Adverse Oral Health Outcomes Among US Adults in the Population Assessment of Tobacco and Health Study. JAMA Netw Open. 2022;5(12):e2245909. doi:10.1001/jamanetworkopen.2022.45909

Source-JAMA