Oral and Systemic Effects of ENDS/E-cigarette Use

There is little documented evidence regarding the oral effects of e-cigarette use. In one 2011 study, Polosa, et al,32 found 6% of patients reported mouth irritation; 8% sore throat and dry mouth; and 9% mouth ulcers after 4 weeks of use. After 8 weeks, 8% reported coughing and after 24 weeks, 8% had throat irritation and 7% dry mouth.

The FDA posts adverse event reports it has received concerning electronic cigarettes since 2008. To date, 115 adverse events concerning e-cigarettes have been reported, including four reports of mouth irritation and/or gums bleeding.62

It is well known traditional cigarettes have many health risks associated with its use. Upon inhalation of tobacco smoke, the dry heat produced from the cigarette causes a hypoxic (dry) environment that is detrimental to the oral cavity. If there are, in fact, no toxic chemical substances in the ENDS solution, but the smog production causes a dry environment within the oral cavity, are e-cigarettes a better alternative?

At this time, overall research demonstrates a relatively low incidence of adverse oral effects; however, more long-term studies are needed to fully assess this device.

Systemic effects of e-cigarette use also needs further research. Goniewicz, et al,33 evaluated the vapors from 12 brands of e-cigarettes. The study found the vapors contained 9-450 times lower toxic substances than that of traditional tobacco cigarettes. However, although data is limited, it is clear that e-cigarette emissions are not merely “harmless water vapor,” as is frequently claimed, and can have negative health impacts and be a source of indoor air pollution.43

The nicotine levels in the blood stream are unclear and vary depending on the research. Levels range from a similar level to that of cigarettes and others indicate a lower blood nicotine level. More research is indicated in this area.

It is known that nicotine, at high levels, can be lethal. ENDS cartridges contain concentrated nicotine, ranging from 6mg-24mg. If a child were to ingest the nicotine from an ENDS cartridge, acute nicotine poisoning, and possibly death, could result.34 Indeed, in April 2014, a CDC study reported that the number of calls to poison centers involving e-cigarette liquids containing nicotine rose from one per month in September 2010 to 215 per month in February 2014.63