Bill Klaproth (host): This is OMS Voices, an AAOMS podcast. I’m Bill Klaproth. And with me is Dr. Antonia Kolokythas, who is here to discuss the effects of vaping on your oral health. Dr. Kolokythas, thanks for being here today. 

Dr. Antonia Kolokythas: Hey, Bill. Good to be here. And thank you for having me today. 

Bill Klaproth (host): You bet. This is an important subject because I know a lot of people like these things, but you know what? Not good for your health. So, tell us, what are e-cigarettes? 

Dr. Antonia Kolokythas: So, everybody refers to e-cigarettes nowadays. They’re also known as electronic cigarettes or vapes. And really, they are devices that are designed to deliver nicotine, which is the addictive part of smoking along with some other flavors and chemicals, and usually in the form of an aerosol that the user inhales. So, unlike traditional cigarettes, the e-cigarettes do not burn tobacco but instead heat an element in vape juice known as e-liquid and vaporize it, and that’s what they inhale. 

Bill Klaproth (host): And that also is not good. So even though these are not as dangerous as traditional tobacco products, they are not risk-free, right? 

Dr. Antonia Kolokythas: Absolutely not. They still contain nicotine, they deliver the nicotine, which is the addictive part of smoking. And unfortunately, they’re very appealing to our youth. They come in multiple flavors; it’s almost like a candy store. And there’s a big market out there for e-cigarettes that has contributed to the growing popularity among our teens and young adults. And this preconceived idea of their safety is a big danger, because as you mentioned, Bill, they are not safe at all. They are very easy to access as well. E-cigarettes are available online, at multiple retails, and they don’t have that big cross over them, danger, cancer, all these things that we are so used to seeing on cigarette packages. 

Bill Klaproth (host): Dr. Kolokythas, how would you summarize the use of e-cigarettes, especially when we’re talking about young adults? 

Dr. Antonia Kolokythas: They really caused a significant shift in the use of nicotine, especially among the younger population. And they are different than traditional cigarettes. They appear as a lot more socially acceptable or more quote-unquote in style, but they’re not without health risks and their rising popularity is very concerning among our young adults and teenagers, and it’s a very serious public health concern. There is a huge marketing that is going on, aggressive marketing as a safe alternative to traditional smoking. And again, the misconception that they are safe, many people believe that just because they are vaping, they’re actually not hurting themselves and their health in general. 

Bill Klaproth (host): Absolutely. So, as an OMS, you are an expert here. So, can you comment on whether the use of e-cigarettes is a safer option compared to traditional cigarettes, just so people hear it directly from an expert like you? 

Dr. Antonia Kolokythas: As an alternative to traditional cigarettes, there’s an ongoing debate about the safety, and there’s a lot of research ongoing. Now, there is some evidence suggesting that e-cigarettes may reduce the exposure to certain carcinogens that are present in tobacco and the traditional cigarettes and they’re not in the e-cigarettes. But the questionable portion is whether the effectiveness in promoting complete abstinence from cigarettes is not established. As a matter of fact, a lot of youths that start with vaping eventually transition to regular smoking or even use of other recreational drugs. The other concern we’re having is recent incidences of lung disease among young patients, and those have been linked to e-cigarette use. And that usually indicates a serious health concern, but these cases do require further investigation to really understand the relationship, the cause and effect type of question that we always have. So what’s important to know is that yes, there are different chemicals delivered, but both chemicals are still harmful to health. 

Bill Klaproth (host): Yeah, that’s really good information, and I like how you said a lot of people start these things because they think, okay, I’m not going to do traditional cigarettes, so they start vaping. For someone listening to this saying, “Yeah, okay, big deal. I don’t believe in all of that.” Can you share with us the health concerns that e-cigarettes and vaping present? Can you kind of give us an overview of what the issues are for people that vape? 

Dr. Antonia Kolokythas: We start with the lung, respiratory issues. Vaping is associated with several respiratory problems, including lung disease, especially for the younger population that is particularly vulnerable. Nicotine addiction, which is the big one. E-cigarettes do contain nicotine, and that’s the highly addictive component that is found in both e-cigarettes and regular cigarettes. 

Cardiovascular risks. There is emerging evidence suggesting that vaping may actually increase the risk of cardiovascular problems, like heart attacks and strokes. The exposure to all the harmful chemicals that are present in e-cigarettes, especially for the young, including chemical linked to lung disease and other volatile organic compounds, heavy metals like nickel, tin, lead, these components are very harmful in oral health. 

They may lead to issues such as gum disease, tooth decay, dry mouth, and all these can potentially increase the risk for oral cancers, especially in younger ages. The actual cancer risk, while there’s a long-term cancer risk for vaping, that’s still understudied and under investigation, there’s still carcinogenic substances in some vaping products that raise concerns. 

And unfortunately, those are in small prints that our youth and in general users are not really looking into. And the bottom line is the long-term effects are totally unknown. It’s a relatively new product, and we really do not know the long-term effects of e-cigarettes on the population. 

The other concern is the negative impact on brain development. Our brain is not fully developed until we are past 20 years of age, so youth vaping can definitely cause damages to the growing brain. 

Bill Klaproth (host): That is really important. I’m glad you mentioned that. That’s a lot of health concerns that you just mentioned. Everything from respiratory issues to nicotine addiction, cardiovascular risks, potential for harmful chemical exposure, impact on oral health. Of course, the cancer risk and the unknown long-term effects, as well as the impact on the brain as well.

Can we touch on cancer risk just a little bit more, Dr. Kolokythas? You mentioned vaping raises concerns of cancer risk. Can you share more information about that? 

Dr. Antonia Kolokythas: Absolutely, Bill. The main issues with cancer, although the research is still evolving, we have several key points to consider. First of all, we have the exposure to chemicals. E-cigarettes can heat and aerosolize various chemicals and flavors, and some of them are very harmful. For example, we have carcinogens that are present in e-cigarettes, such as formaldehyde. 

That is what we use to preserve specimens. And we have plenty of literature from that subset that we know is carcinogenic. We have cell damage. Studies have shown that aerosols from e-cigarettes can cause DNA damage to cells. And we know that part of how oral cancer is developing is due to DNA damage and the inability of the cells to self-repair, which can damage precursor cells and allow those to become cancerous. 

The nicotine effects on oral health. We know that nicotine is found in cigarettes, but it’s definitely found in e-cigarettes as well and is linked to potentially exacerbating periodontal disease and again, risk for oral cancer. Inflammation of the oral cavity is considered a contributing factor to cancer development. 

We have a lot under investigation right now, but we have enough evidence to be very, very concerned about this e-cigarette use and the development of oral cancer.

Bill Klaproth (host): Yeah, you mentioned oral cancer a few times. People might be wondering, “Hmm, what is that?” So what is oral cancer and what are some of the symptoms that we should be watching out for? 

Dr. Antonia Kolokythas: Absolutely, there are a lot of misconceptions about oral cancer as well. So, oral cancer really refers to cancerous lesions that develop in any part of the mouth. That can be on the lips, the tongue, the cheeks, the portion of the mouth underneath the tongue which is referred to as the floor of the mouth, the upper jaw, the palate, as well as the sinuses and the throat. And oral cancer can present as a sore or a lesion on the gum tissue or in general the oral cavity that doesn’t heal as normal. For example, if you have a hot beverage or you bite into a piece of pizza and you burn your palate, that should resolve within a week to 10 days. 

But sores that are not healed past that are concerning, can present as a lump or a swelling of the cheek, a red or white patch, or you can have unexplained bleeding. When it comes to the throat, people complain about sore throat or having a lump when they swallow, and it can get worse than that. People can have difficulty chewing or swallowing. Numbness is a very important one along the tongue or the lips that is usually unexplained, or even changes of the voice when the cancer presents in the voice box. 

Bill Klaproth (host): Yeah, that’s a lot of things to watch out for and some of these things would mimic other non-threatening conditions. So, how do you properly diagnose oral cancer? Are there different stages as well that you look out for? 

Dr. Antonia Kolokythas: Absolutely, and the earlier the stage we find the cancer, the better the outcomes for the patient. So, when something is not right, meaning an ulceration that has not healed, and you don’t remember if you injured the site on something, the important thing is for the patient to go check it out, have a good physical examination. 

Sometimes, an early biopsy of any areas that look suspicious can help save someone’s life. Then we have tests that we do like X-rays, most commonly CAT scans and MRIs. And those are used to determine the staging of the cancer. So, speaking about staging, every cancer is staged in the traditional ways. 

We have four stages of cancer, and we use the tumor size, the presence or absence of potentially involved lymph nodes. Lymph nodes are those glands, especially for the oral cavity in the neck where the cancer drains, and that is a part of the staging. And whether the cancer has stayed in the primary site or has metastasized to other body parts. 

So, that’s what we use to stage cancers. And if the cancer is localized only to the tongue, let’s say, that’s an early-stage cancer. If it has moved into the lymph nodes, that becomes advanced, and obviously if it has spread to other body parts, then it’s a more advanced sort of cancer. 

Bill Klaproth (host): So early diagnosis is crucial here. So if you feel something is not right, please go see your OMS. And as you said, this is serious stuff. 

So what are the treatment options then once someone is diagnosed with oral cancer? 

Dr. Antonia Kolokythas: The key part for cancer, especially for the oral cavity, is to find it early and treat it early. This tumor is not going to go away. So, early diagnosis, at stage one or two increases the survival by a lot. We have great outcomes for these kinds of cancers. And, the good thing about oral cavity cancer for small cancer, the primary treatment is surgery. 

And the cancer is removed, along with a lymph node, potentially. And then, you can add radiation or chemotherapy or, we have targeted therapy and others. We normally want to be able to find the cancer early enough that we use only one of these options. We call them modalities, treatment modalities. 

So, find it early, remove it, and then follow up the patient for a long time to ensure that nothing has recurred. 

Bill Klaproth (host): Dr. Kolokythas, thank you. This has really been informative and fascinating, and we really appreciate you educating us on a really important topic, how the use of e-cigarettes does carry many, many risks. Thank you so much for your time. We appreciate it. 

Dr. Antonia Kolokythas: Absolutely, Bill, anytime. 

Bill Klaproth (host): You bet. Once again, that is Dr. Antonia Kolokythas. And for more information and the full podcast library, please visit MyOMS.org. And if you found this podcast interesting, please share it on your social media and don’t forget to subscribe.