(By Dr. Joseph D. Lim and Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI)
THE DEPARTMENT of Health’s Food and Drug Administration (FDA) issued an advisory saying the electronic- (e-)cigarette is not a proven nicotine replacement therapy.
The e-cigarette is a plastic and metal device that heat a liquid nicotine solution (e-juice) in a disposable cartridge. It creates a tiny light on the tip and even glows like a real cigarette. It produces a vapor that stimulates the act of smoking.
The FDA reiterated the World Health Organization’s statement that there is no scientific evidence to confirm the product’s safety and efficacy.
The e-cigarette is increasingly becoming popular among Filipinos, particularly the youth, as the number of public places that prohibit smoking is increasing and the recent higher tobacco taxes in the country make smoking more expensive.
Now comes a study showing that people who used electronic cigarettes had unique microbial communities in their mouths that more closely resembled those of smokers than of non-smokers.
The microbial communities may signal an increased risk of gum disease for those who use e-cigarettes, according to the study published in mBio.
The study was funded in part by the National Institute of Health’s National Institute of Dental and Craniofacial Research, National Cancer Institute, and New York University.
Researchers found unique microbial communities in the mouths of people who used electronic cigarettes.
The use of electronic cigarettes (also called vaping) has been on the rise. In 2019, almost 5 percent of American adults reported using e-cigarettes.
Overall, e-cigarettes are thought to produce fewer toxic compounds than conventional cigarettes, but they can still contain many harmful substances, including nicotine and heavy metals like lead.
Smoking conventional cigarettes is a known risk factor for the development of gum disease, or periodontitis. Part of this risk is driven by changes in the bacterial communities that normally live in the mouth, called the oral microbiome. But whether e-cigarettes induce similar changes hasn’t been well understood.
“We are now beginning to understand how e-cigarettes and the chemicals they contain are changing the oral microbiome and disrupting the balance of bacteria,” says Dr. Deepak Saxena of New York University.
He and colleague Dr. Xin Li examined 84 volunteers over a six-month period: 27 people who smoked conventional cigarettes, 28 who only used e-cigarettes, and 29 non-smokers.
All participants had at least mild gum disease at the start of the study.
To reduce other factors that could affect the oral microbiome, none had their teeth cleaned during the study period.
The team compared the types of bacteria found where the gums meet the teeth at the beginning and end of the six-month study.
They also compared markers of inflammation and immune cell activity.
The number of unique bacterial species living in and around the gums increased for all participants during the study. This can be a sign of gum disease getting worse.
The specific types of microbes found in the oral microbiomes differed substantially between the three groups.
There was a core set of species common among the groups, but each also had unique features. They were so distinct that a machine-learning program could use the oral microbiome to predict which group people were in with 74 percent accuracy.
The machine-learning program, however, was least accurate at picking out e-cigarette users. The patterns of their oral microbes shared characteristics with both smokers and nonsmokers, with slightly more similarities to smokers.
Unique traits among e-cigarette users included enrichment with Fusobacterium and Bacteroidales species, both species of which are linked with gum disease.
Several markers of inflammation and immune response were also higher in smokers and e-cigarette users than in non-smokers. But again, these patterns differed between smokers and e-cigarette users.
More studies are needed to determine if e-cigarette use alters the oral microbiome and potentially affects gum health and disease.
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Dr. Joseph D. Lim is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; and Honorary Life Member of the Thai Association of Dental Implantology. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.
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Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De la Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate professor; Fellow, International Congress of Oral Implantologists; Member, American Academy of Implant Dentistry and Philippine College of Oral Implantologists. For questions on dental health, e-mail limdentalcenter@gmail.com/PN
