Saba Qureshi explores the impact of vaping on oral health and tooth movement and what advice dental professionals should give to vaping users.
Since it was first offered as a tool to help adult smokers quit, vaping has grown in popularity, with many promoting it as a “healthier” alternative.
Vaping is the inhalation of vaporized liquid delivered through a smoking device known as a vaporizer. Vapor is a liquid-filled cartridge that heats nicotine, flavorings, and other chemicals to create an aerosol that is inhaled.
Although vapes may have fewer harmful chemicals than cigarettes, little research has been done on the health effects of vapes and e-cigarettes, and we still don’t know exactly what chemicals are in many of them. What we do know is that the vapor produced is not made up entirely of water vapor, but is actually an amalgamation of nanoparticles, volatile organic compounds, carbonyls, heavy metals and nicotine.
Vaping data
Recent data have highlighted cases of vaping-related lung injury and death linked to chronic lung disease and asthma, with the United States-based Centers for Disease Control and Prevention (CDC) confirming 2,807 cases related to e-cigarette/vaping use lung injury and 68 deaths.
According to the latest figures from the Office for National Statistics, in the UK in 2022, 12.9% of adults over the age of 18 (or around 6.4 million people) smoked cigarettes. Estimates from the Annual Population Survey (APS) show this is the lowest proportion of smokers now in the population since records began in 2011.
Of those who smoked, the highest percentage was between 25 and 34 years old.
Additionally, approximately 4.5 million adults, or 8.7% of respondents to the Opinion and Lifestyle Survey (OPN), reported using e-cigarettes either regularly or infrequently. This is an increase from 7.7% in 2021.
Interestingly, e-cigarette use was highest among 16- to 24-year-olds (many of whom have never smoked cigarettes), with the proportion of people in this age group vaping daily or occasionally rising from 11.1 % in 2021 to 15.5% in 2022. This was particularly evident among younger women, where the prevalence of vaping saw a threefold increase.
This may be due in part to the way vapes are marketed and therefore perceived.
Although e-cig/vape companies deny that they target this demographic, many of their flavors, such as strawberry lemonade and bubblegum, along with their brightly colored packaging, nevertheless appeal to this age group.
Oral health and vaping
But why is this relevant to us as orthodontists?
The most obvious reason is that this age group represents a large percentage of our daily patient base. As a result, we need to know any relationship between vaping and orthodontic tooth movement and whether it affects treatment effectiveness and patient outcomes.
The main concerns about vaping are whether it causes:
- Xerostomia: reduced saliva can increase the risk of dental problems such as tooth decay, periodontal disease and oral infections
- Periodontal disease: changes in the oral microbiome can lead to overgrowth of pathogens, leaving patients more susceptible to oral disease
- Caries: a combination of dry mouth and exposure to harmful chemicals can contribute to tooth decay
- Oral lesions: can vaping cause tissue damage that increases inflammation and, combined with DNA damage from e-cigarette chemicals, increases the risk of oral cancer?
- Detrimental effect on tooth movement: are patients who vape more at risk of root resorption or prolonged treatment duration?
The difficulty that arises in assessing these risks is that there are two main categories of vaping users:
- Those with a history of cigarette/tobacco smoking turn to vaping to help quit smoking
- Those who have never smoked use vaping on a regular basis.
Of course, a variety of general and oral health conditions are already present in those who have smoked in the past. Because of its known vasoconstrictive effect on gum tissues, tobacco use can mask the severity of underlying periodontal problems. However, quitting smoking will have numerous short- and long-term health benefits that outweigh any reported disadvantages of vaping.
Those in the second group, on the other hand, start from a health position. Prolonged and frequent vaping can expose them to unknown risks to their oral and general health.
What does the research say?
Unfortunately, despite the fact that vaping has become a “hot topic” in the dental profession in recent years, there isn’t really enough research out there on its effect on tooth movement.
Most research has focused on periodontal health, with the majority of studies agreeing that vaping puts patients at increased risk of developing gingivitis and periodontal disease. There is undoubtedly a need for more research on this topic because some studies have produced conflicting results.
When it comes to tooth decay, there is little evidence to suggest that vaping users are at greater risk of developing tooth decay. However, vaping causes dry mouth due to the water-binding effects of the propylene glycol ingredient, which could put patients in a higher risk category.
Due to the burning and tarring process, cigarette smoke is a rich source of carcinogens. These two are avoided by e-cigarettes, dramatically reducing the risk of oral cancer in patients switching from cigarettes to vaping.
Those who vape have also been reported to have a higher incidence of candidiasis overgrowth, possibly as a result of chemical compounds in e-liquids that alter intraoral pH.
Evaporation and tooth movement
And finally, orthodontic tooth movement. Again, research on this topic is sparse and ambiguous.
Some studies suggest that nicotine, a common ingredient found in vaping liquids, has vasoconstrictive properties that restrict blood flow to tissues, including the periodontal ligament (PDL) that surrounds the teeth.
This reduced blood supply can impede cellular activities necessary for orthodontic tooth movement, such as bone remodeling and tooth movement, and can lead to increased alveolar bone loss and root resorption.
Consequently, orthodontic patients who fume may experience prolonged treatment duration and slower progress toward achieving desired tooth alignment. However, other studies have produced conflicting results.
More clinical and experimental studies are clearly needed to evaluate the effects of vapors and their components on periodontal tissues and orthodontically induced tooth movement.
What advice should we give orthodontic patients who are vaping?
Well, that depends a lot on the person.
Those using vaping as an adjunct to smoking cessation should definitely be encouraged to use it “for long enough to avoid a return to smoking”, according to current NICE guidance. Stop using them “when they’re ready to.”
On the other hand, people who vape but have never smoked—usually younger patients—should be encouraged to quit. Because nicotine is so addictive, many people who use vaping may eventually turn to smoking cigarettes.
Indeed, a recent study conducted in the United Kingdom found that 14.3% of e-cigarette users switched to smoking after one year.
While vaping may seem harmless to some, its impact on orthodontic tooth movement and oral health is not yet fully understood. From impeding the rate of healing to increasing the risk of root resorption, steaming can pose significant, as yet unknown, challenges for orthodontic patients seeking optimal results.
By raising awareness, providing smoking cessation support, and closely monitoring patient progress, orthodontists can address these challenges and ensure treatment effectiveness in the face of evolving oral health trends.
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