NMDA Journal Fall 2019

nmdental.org 25 lung disease, volatile organic compounds such as benzene, found in car exhaust, and heavy metals such as nickel, tin, and lead. Another risk to consider involves defective e-cigarette batteries which have caused fires and explosions resulting in serious injuries and even death of users. Research states that flavored tobacco is more likely to serve as an initiation product for youth and individuals beginning a nicotine addiction because the flavors mask the harsh- ness and bitterness of the tobacco. While the customer base switched away from combus- tible cigarettes, the tobacco industry adapted with the development of e-cigarettes to maintain profit levels. The quality control and industry standards for the manufacturing process are not yet fully implemented. This means that there can be considerable batch variations, and the impu- rities that can be found in these consumer products go beyond what can be found in regular cigarettes, which include, and are not limited to, carcinogens and neurotoxins. The ingredients in the e-liquid usually contain four base chemicals: propylene glycol, veg- etable glycerin, nicotine, and flavoring(s). The e-liquids are available in various appealing fruit-like and candy flavors which include pineapple and cotton candy, as well as tradi- tional flavors such as tobacco and menthol.⁵ E-liquids can be ordered without nicotine which can be enticing to youth and young adults. 6,7 On “CBS This Morning,”Dr. Tara Naru- la called the use of e-cigarettes among young people “an epidemic” that is affecting 3.6 mil- lion youth and it can lead to the initiation of smoking conventional tobacco products.⁸ Dr. Denise Delic, a dentist with a private prac- tice in Albuquerque, NewMexico states that sudden surge in dental cavities in the youth patient base has led her to research the impact of electronic-cigarettes (e-cigarettes) usage and oral health. As dental caries are consid- ered the most infectious disease in the world, she believes professionals in the dental field have the obligation to raise awareness of the negative effects of e-cigarettes on oral cavities and get involved by talking with their patients who vape. Analyzing the risks of e-cigarette usage, using applicable treatment protocols, and offering appropriate steps to cessation will decrease its negative impact on the oral health and the overall health in general. The research supported by the ADA Foun- dation, found that some sweet flavors in e-cigarette liquids may be the cause for the increase in the risk of dental caries. Scien- tists have evaluated e-cigarette aerosols and found that the aerosols have similar physio-chemical properties to high-sucrose, gelatinous candies, and acidic drinks and interact with hard tissues of the oral cav- ity in similar fashion.⁸ The type of dental caries in the patients who vape are similar to those who consume acidic drinks and sugary gelatinous candy throughout the day. These patients can have any combina- tion of localized or generalized cervical, pit and fissure, and/or interproximal carious lesions. In the study supported by the ADA Foundation, e-cigarette aerosols produced four-fold increase in microbial adhesion to enamel. Exposure to flavored aerosols led to two-fold increase in biofilm formation and up to a 27% decrease in enamel hard- ness compared to unflavored controls.⁹ E-cigarettes are not safe for youth, young adults, pregnant women, or adults who do not currently use tobacco products (CDC, 2019). E-cigarettes pose a significant health risk, especially to young people whose brains are not yet fully developed. E-cigarette use increases the possibility of addiction and long-term harm to brain development and respiratory health. Consequentially, users of e-cigarettes are more likely to become dual tobacco users or switch to combustible to- bacco products than those who have never tried e-cigarettes. Among high school ciga- rette smokers, more than 7 out of 10 also use e-cigarettes. What has been done currently? Locally, on June 14, 2019, a new law was enacted that includes e-cigarettes as part of the Dee Johnson Clean Indoor Air Law in New Mexico. E-cigarette use is now prohibited at any loca- tion where smoking is banned. This includes all indoor and public places of employment, including vaping in movie theaters, restau- rants, bars, and office spaces, along with buses and taxis. Additionally, the revised law includes private homes that provide daycare; and 90% of hotel or motel guest rooms, ball- rooms, and meeting rooms. The law states that smoking or vaping is not allowed within a reasonable distance of business entrances. Furthermore, outdoor smoking areas are required to be away from doors or windows and ventilation systems. This law also in- cludes a 12.5% tax on e-cigarette liquid pur- chases as part of the revised tax code. 10 Oppo- nents of this policy argue that e-cigarettes are safer than cigarettes and that vaping assists with people quitting. Lawmakers supported the legislation as there is no significant re- search on the positive health consequences of e-cigarette vapor. Dr. Delic states that dental professionals are responsible for raising the awareness of the risk of dental caries to patients by asking pa- tients who smoke to clarify whether they use conventional tobacco or whether they vape. Dentists should begin to ask youth whether they vape. Our dental regimen should include application of fluoride in their routine dental visits, and the use of fluoridated products at home on a daily basis should be imple- mented. In addition, more research needs to be done with respect to the short-term and long-term effects of the usage of e-cigarettes and on their impact to our overall health. In addition, case studies based on clinical obser- vations from oral health providers will greatly enhance the understanding of the real cost of e-cigarettes on oral health. To prevent e-cigarette use, the public at large should encourage local businesses to make a reasonable effort to prevent smoking and vaping and can request signs and detailed information from www.smokefreenewmexico. com. The public or employees can report vio- lations to local fire or police departments. In addition, advocates can work towards greater protection for youth from tobacco and e- cigarette use by supporting local policies that regulate tobacco sales including requir- ing licenses for tobacco retailers, increasing tobacco taxes, and raising the minimum purchasing age for tobacco from 18 to 21. Current users can access free tobacco cessa- tion treatments services with the 1-800-QUIT NOW campaign available in New Mexico. 11 References 1. Singh T. Arrozola RA, Corey CG, Husten CG, Neff LG, Homa DM, et al. Tobacco use Among Middle and High School Students- United States, 2011-2015. MMWR Morb Mortal Wkly Rep. 2016;65(14):361-367. pmid:27077789. 2. truthinitiative.org/research-resources/smoking-region/ tobacco-use-new-mexico-2018 3. www.cdc.gov/mmwr/volumes/67/wr/mm6745a5.htm 4. Manchir, Michelle. Some e-cigarette liquids may increase caries risk. 5. CBS/AP June 10, 2019/ 4:15 PM. Vaping device maker Juul pledges $7.5 million to research impact of e-cigarettes. 6. Ambrose BK, Day HR, Rostron B, Conway KP, Borek N, Hyland A, et al. Flavored Tobacco Product Use Among US Youth Aged 12-17 Years, 2013- 2014, JAMA,. 2015;314(17):1871-3. Pmid:26502219. 7. Singh T, Kennedy S, Marynak K, Persoskie A, Melstrom P, King BA. Characteristics of Electronic Cigarette Use Among Middle and High School Students- Untied States, 2015. MMWR Morb Mortal Wkly Rep. 2016; 65(5051):1425-9.pmid:28033310. 8. ADA Foundation. Research Study Finds Sweet Flavors in E-cigarette Liquids May Increase Risk of Dental Cavities. 9. Shin Ae Kim, Samuel Smith, Carlos Beauchamp, et al. PLOS/ONE Study. Cariogenic Potential of Sweet Favors in Electronic-cigarette Liquids. 10. www.lcsun-news.com/story/news/local/2019/05/06/ vaping-restrictions-taxes-new-mexico/1119368001 11. www.smokefreenm.com/enforcement