Oral and Systemic Effects of ENDS/E-cigarette Use

Growing evidence from research suggest potential gum and tissue damages from e-cigarette vapors. In an letter published in the New England Journal of Medicine, researcher expressed concern over formaldehyde in e-cigarette aerosols. During the "vaping" process aerosols in "vaped" e-cigarettes are converted into formaldehyde-releasing agents inhaled in the pulmonary system80 increasing an inflammatory and oxidative responses leading to tissue damage in e-cigarette users.81 The study also examined e-cigarette flavorings used in the cartridges also known as "e-juices". The flavors with more of a triggered inflammatory response were coming from cinnamon, vanilla, and buttery flavored e-juices81 How the aerosols behave in the respiratory tract is unknown, but formaldehyde is an International Agency for Research on Cancer group 1 carcinogen.80

In another study, Irfan Rahman, a Ph.D. professor of Environmental Medicine at the UR School of Medicine and Dentistry, published the first scientific study in Oncotarget a bio-medical journal covering research on all aspects of oncology. In his research it addressed e-cigarettes and their detrimental effects on oral health. Rahman explained, that "We showed that when the vapors from an e-cigarette are burned, it causes cells to release inflammatory proteins, which in turn aggravate stress within cells, resulting in damage that could lead to various oral diseases," Rahman who also published a study last year about the damaging effects of e-cigarette vapors and flavorings on lung cells and an earlier study on the pollution effects. "How much and how often someone is smoking e-cigarettes will determine the extent of damage to the gums and oral cavity."82

Fawad Javed, a post-doctoral student at Eastman Institute for Oral Health, part of the UR Medical Center, who contributed to the study stated "It’s important to remember that e-cigarettes contain nicotine, which is known to contribute to gum disease."82

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