Research Report: E-Cigarettes, Oral Health, and Smoking Cessation

This report, prepared for a healthcare-related course, investigates the oral health implications of electronic cigarette (e-cigarette) use, comparing it to traditional cigarette smoking. The study, developed using the PICO format, examines the effects of e-cigarettes on dental health, including the risks of gum disease, tooth decay, and other oral health issues. It reviews existing literature from databases like CINAHL, PubMed, and Google Scholar, focusing on studies conducted in the last six years to ensure relevance. The report includes a literature review of 15 studies, with 6 selected for in-depth analysis, and explores the potential benefits and risks of e-cigarettes as a substitute for traditional cigarettes. The research includes a description of the Bendigo Health organization and its services. The findings of the study suggest that although e-cigarettes may pose fewer risks to oral health than traditional cigarettes, they still have negative effects. The report concludes that further research is needed to develop alternative strategies to address the issue of smoking cessation.

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Introduction:
Electronic cigarettes or Electronic vaping are a current development towards reducing the
harm caused by tobacco smoking. These are considered to be a substitute to traditional smoking
and known to have less harmful effects when compared to that of traditional smoking. However,
researches have reported that the use of electronic vaping is associated with harmful effects on
health like that of the traditional cigarette.
Electronic vaping is considered to be an effective strategy to quit smoking with less
health risks compared to that of smoking cigarettes [1]. Although, promoters for electronic
vaping or E-cigarettes claim that E-cigarettes are safe and meant for reducing addition and help
quit smoking, evidences have suggested that the use of Electronic vaping is also associated with
an increased risk of developing serious health diseases [1]. On the same grounds, a lot of
evidences have suggested that electronic vaping, although, has a lesser health implication
compared to cigarette smoking, the risks are not negligible and therefore, research must be
conducted to develop other strategies in this area [2]. Electronic vaping are currently used by
individuals of all age groups, including young adolescents and adults as a substitute of regular
cigarettes. Many studies suggest that E-electronic vaping aerosol does not comprises all the
contaminants like that of the tobacco smokes. It is still not safe. Most of the E-cigarettes
produces nicotine, which is the main reason behind addiction and has detrimental effects on
lungs, brain and other organs of the body [2]. In addition to that, Electronic vapour also includes
harmful substances like diachetyl, a chemical that can cause various lung diseases, other
chemicals that are cancer causing, volatile organic compounds and heavy metals like nickel, lead
and tin that can have detrimental effects on health. Electronic vaping contains a liquid which is

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dangerous since it can cause poisoning upon swallowing, breathing and even absorbing the
harmful liquid through eyes and skin [3]. E-cigarettes have found to be associated with severe
lung injury cases, of which a many have resulted into death. Therefore, the use of E-cigarettes is
not yet preferable and acceptable as the only source of eradicating the addition of cigarettes [4].
In addition to the health consequences developed as a result of smoking tobacco, tobacco
is also found to affect oral health of an individual and increases the chance of developing severe
diseases like oral cancer, dental plaque and an increased risk of developing gum diseases. Studies
conducted in this area suggest that the use of E-cigarettes is associated with poor oral health [5].
Therefore, E-cigarettes have been developed to minimise the risk of such diseases and health
conditions that have lifelong implications. However, the use of Electronic vaping is still not
confirmed to be an effective way of mitigating the issue. Research suggests that E-cigarettes
have similar effect and can lead to similar health consequences as that of the traditional
cigarettes and hence both must be avoided on priority basis [6].
Evidences suggest that electronic vaping has a negative effect on teeth and oral health as
a whole. However, the effects of using vaping is found to pose a fewer oral health risks when
compared to the traditional cigarettes [7]. Current research in this area suggest that vaping can
lead to various negative consequences on the teeth and gums. Studies have found that the teeth
that have been exposed to E-cigarettes aerosol have been found to contain more bacteria than
normal teeth and the differences could be seen in the pits and crevices of teeth causing cavities,
hum diseases and tooth decay [7]. Some vaping based liquids used, especially, propylene glycol
is responsible for causing dryness of mouth associated with bad breath, tooth decay and mouth
sores. E-cigarettes have also been found to cause throat and mouth irritation and include

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symptoms like swelling, redness and tenderness. Studies conducted on live cells from gums if
human being suggests that vaping aerosols leads to inflammation and damage of DNA which can
further lead the cells to lose their capacity to cell division and growing, thus, contributing to
speeding up the process of cell aging resulting into cell death. The use of Electronic cigarettes
have been reported to be associated with periodontal diseases, bone loss, dry mouth, bad breath,
tooth loss and tooth decay [8].
BENDIGO health is a regional health service incorporating about 4000 staff and a
catchment area that covers a quarter of the size of Victoria. The main campuses of BENDIGO
are Bendigo, with services extended to national settings that includes areas like Mildura, Echuca,
Kyneton, Castlemaine and Swan Hill. The Bendigo organization provides services in case of
emergency, woman’s health, maternity, pathology, medical imaging community services,
psychiatric care, residential aged care, community dental, palliative care, cardiology and cancer
services. BENDIGO also offer subacute services that includes impatient and outpatient
rehabilitation, residential care, a regional psychiatric service, dialysis and a variety of services
like facilitating hospital care at home [9].
Therefore, the research question following PICO Format includes:
What are the risks associated with electronic vaping compared to smoking cigarettes what are
the effects on Oral health and which is better for the oral health?
The above question includes the following PICO elements-

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Here the effects of electronic vaping or E-cigarettes have been compared to that of the traditional
cigarettes and research has been conducted following search strategy to determine the effects of
electronic vaping on oral health.
In order to conduct the literature review, databases like CINAHL, PubMed and Google
Scholar have been used to get access to the previous studies conducted in this area. To search the
articles certain keywords related to the topic and combination of those keywords have been used
like “Electronic Vaping”, “E-cigarettes”, “conventional cigarettes”, “vaping”, “health risks of E-
cigarettes”, “E-cigarettes and traditional cigarettes”, “strategies to quit smoking”, “electronic
nicotine delivery systems”, “E-cigarette health implications”, “Risk and safety evaluation in
Electronic vaping” and “tobacco cigarette substitute”. A total of 20 studies were obtained out
which 15 studies were found to be suitable for including in the study. Out of the 15 studies, 6
studies were selected to conduct the literature review since they were matching the inclusion
criteria. The studies were examined by skimming though the abstract and conclusion to
understand the research area and the research findings. The studies that have conclusive findings
were selected and incorporated in the study. There were many studies that did not have adequate
sample size to give generalised results and used an improper method of analysing the results
were excluded. All the studies chosen were conducted in the last 6 years to get the current
scenario of the condition.

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References:
1. Farsalinos KE, Polosa R. Safety evaluation and risk assessment of electronic cigarettes as
tobacco cigarette substitutes: a systematic review. Therapeutic advances in drug safety.
2014 Apr;5(2):67-86.
2. Glantz SA, Bareham DW. E-cigarettes: use, effects on smoking, risks, and policy
implications. Annual review of public health. 2018 Apr 1;39:215-35.
3. Goniewicz ML, Knysak J, Gawron M, Kosmider L, Sobczak A, Kurek J, Prokopowicz A,
Jablonska-Czapla M, Rosik-Dulewska C, Havel C, Jacob P. Levels of selected
carcinogens and toxicants in vapour from electronic cigarettes. Tobacco control. 2014
Mar 1;23(2):133-9.
4. Korfei M. The underestimated danger of E-cigarettes-also in the absence of nicotine 2018
Aug.
5. Huilgol P, Bhatt SP, Biligowda N, Wright NC, Wells JM. Association of e-cigarette use
with oral health: a population-based cross-sectional questionnaire study. Journal of Public
Health. 2018 May 18.
6. Callahan-Lyon P. Electronic cigarettes: human health effects. Tobacco control. 2014 May
1;23(suppl 2):ii36-40.
7. Kim SA, Smith S, Beauchamp C, Song Y, Chiang M, Giuseppetti A, Frukhtbeyn S,
Shaffer I, Wilhide J, Routkevitch D, Ondov JM. Cariogenic potential of sweet flavors in
electronic-cigarette liquids. PloS one. 2018 Sep 7;13(9):e0203717.

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8. Cho JH. The association between electronic-cigarette use and self-reported oral
symptoms including cracked or broken teeth and tongue and/or inside-cheek pain among
adolescents: A cross-sectional study. PloS one. 2017 Jul 11;12(7):e0180506.
9. Bendigo Health. About Bendigo Health [Internet]. Bendigohealth.org.au. 2019 [cited 20
December 2019]. Available from: https://www.bendigohealth.org.au/about-us/