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Medical Intel

Mar 19, 2019

From 2017 to 2018, vaping increased by nearly 80 percent among high schoolers and 50 percent among middle schoolers. Dr. Jonathan Giurintano discusses the short-term effects vaping can have on dental health and the lungs.



Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine.

Host: We’re speaking with Dr. Jonathan Giurintano, a head and neck cancer surgeon at MedStar Washington Hospital Center. Thank you for joining us, Dr. Giurintano.

Dr. Giurintano: Thank you so much for having me.

Host: Today we’re discussing how vaping affects oral health. Typically, when doctors talk about the effects of vaping, the concern is for patients’ lungs. Dr. Giurintano, what are some of the more common oral health side effects of vaping?

Dr. Giurintano: So, of the more common health side effects, simple general irritation of the oral mucosa is probably the most common side effect that we see. However, there have been recently published studies that show that there are higher rates of colonization of the oral cavity mucosa with a fungal organism called Candida albicans in patients who vape or who use e-cigarettes regularly compared to patients who do not use vape devices. The importance of this fungal organism is that if there is an overgrowth of the fungal organism in the mouth, patients can experience what is called oral candidiasis or more commonly known as oral thrush. This can be an inflammatory and very uncomfortable situation to have when it is located on the tongue or on the inner cheeks and can require the use of an antifungal medication in order to resolve the infection.

Host: What concerns you the most about vaping?

Dr. Giurintano: The thing that concerns me the most about vaping or e-cigarette use is that many people see this as a healthy alternative to smoking cigarettes. Among a lot of vape users a common phrase that you’ll hear is, “Oh, it’s just water vapor. It’s safe” which we’re finding to be untrue. There was a big article that was published on CNN as the FDA released the results of an initial study showing that, just over the past year, that the use of vaping among high schoolers has increased nearly 80 percent and among middle schoolers, the use of vaping has increased almost 50 percent. One in five high schoolers has vaped and this is just a really, really shocking number. The reason this is so concerning to head and neck cancer surgeons, such as myself, is that we know that most patients who vape do not only limit their use of nicotine products to vaping itself. Many of these patients often go on to use traditional tobacco cigarettes or other tobacco products in order to fulfill the desire for nicotine, which is the addictive substance that’s often present in the vape liquid. And, any potential benefit that one might have seen from vaping rather than smoking quickly disappears whenever you’re both vaping and smoking cigarettes in order to get the nicotine effect.

Host: How do you address the health hazards of vaping with your patients?

Dr. Giurintano: So, one of the things I like to do is I actually like to explain to the patient how a vape pen or an electronic cigarette works. So, located within that vape pen or that e-cigarette, there’s one or two lithium ion batteries that powers separate heating wires that are composed of a heavy metal that then evaporate a flavored liquid which most oftentimes contains nicotine. And, the carrier substance for this nicotine typically consists of the chemicals glycerin or propylene glycol. We know that these are not inherently dangerous substances themselves. However, whenever you are evaporating these substances such as nicotine, glycerin or propylene glycol, we do know that more harmful or possible carcinogenic side molecules can be released. One of the most concerning things about the vape usage is that the FDA only began to regulate the vape industry in 2016. And today, there’s over 7000 different types of flavorings which have been described in the liquids. The majority of these flavorings are used in the food industry. However, they were only truly developed for oral consumption, not for vaporization. So, the long-term effects of taking these substances that are typically meant for oral consumption and converting them into a vaporized form that’s then inhaled into the oral cavity and into the lungs, is largely unknown at this point. A few of these substances have been studied in the past and have been shown to cause severe inflammation of the bronchi and of the lungs. And, it is assumed that these chemicals that are irritating to the bronchi and the lungs, could also have an irritant effect to the mucosa of the upper aerodigestive tract as well. The American Head and Neck Society, so this is the society of head and neck cancer surgeons across the United States, recently issued a statement stating that ‘given the lack of clear scientific evidence regarding the safety and effectiveness of e-cigarettes for the sensation of, as well as the bystander risk of e-cigarette emission, the American Head and Neck Society does not endorse the use of, e-cigarettes as a safer alternative to traditional tobacco cigarettes.’ The H & S agreed that e-cigarette emissions are not simply harmless water vapor, as they are often promoted and advertised. And this organization further expressed the concern that e-cigarettes represent a viable potential for harm to both individual health and environmental pollution. We’re still in the process scientifically investigating these vape and e-cigarette devices to help provide a clearer understanding of what the risks and/or benefits are of using vape or e-cigarettes and the indications for or against their use. 

Host: What are the long-term oral health implications for patients who vape?

Dr. Giurintano: Well, we’re not 100 percent sure at this point what the 20- or 30-year health implications will be for patients who vape. We do know that there are substances within the vapor that’s inhaled that harbor carcinogenic potential. We know that studies have shown that these typically are in much lower quantities than the chemicals produced in traditional cigarette smoking. However, we have yet to see what the long-term effects of regular application of these chemicals to the lining of the upper air digestive tract might cause. The biggest thing we do know is that most e-cigarette or vape users do not exclusively use vape devices in order to obtain nicotine and that many of them will also smoke traditional cigarettes, as well. And for these patients, they are at risk for the typical long-term complications seen in most cigarette smokers, including periodontal disease and increased rates of cavity of the oral cancer, voice box, and lungs.

Host: Thanks for joining us today, Dr. Giurintano.

Dr. Giurintano: Thank you so much for having me.

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