Current trends in vaping: An exclusive interview with Dr. Larry Williams

Drs. Stacey Simmons and Larry Williams discuss trends and shifts in appeal from tobacco smoking to vaping among adults and teens, as well as negative effects of nicotine on oral and systemic health.

Content Dam Diq Online Articles 2019 04 19apr25bcvapingt
Drs. Stacey Simmons and Larry Williams discuss trends and shifts in appeal from tobacco smoking to vaping among adults and teens, as well as negative effects of nicotine on oral and systemic health.

Editor's note: This article originally appeared in Breakthrough Clinical, a clinical specialties newsletter from Dental Economics and DentistryIQ. To subscribe, visit dentistryiq.com/subscribe.


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VAPING. IT’S THE LATEST in what many in the general public believe to be the safe alternative to tobacco smoking or if you’re trying to kick the smoking habit in the butt. The image of vaping is glorified on social media and through advertising platforms, giving it an appeal not only to adults but to younger populations as well. In their article “Vaping and oral health: It’s worse than you think,” Drs. Scott Froum and Alisa Neymark point out that there is much to know about this trend in nicotine addiction as its negative ramifications on oral and systemic health are starting to unfold. (1)

Larrywilliams 124x124It was my privilege recently to speak with Larry Williams, DDS, MPH, (at right) on the subject of current trends in vaping. After 30 years in the U.S. Navy Dental Corps, Dr. Williams now serves as an associate professor at the Midwestern University College of Dental Medicine-Illinois. He is also co-chair of the Cessation Subcommittee of the Illinois Tobacco Prevention and Control State Plan Work Group. His previous work with tobacco policy and education included development of the National Action Plan for Tobacco Cessation, the National Prevention Strategy, and the Veterans Affairs/Department of Defense Practice Guideline for the Management of Tobacco Use.

Here is my interview with Dr. Williams.

How has tobacco usage changed over the last five to 10 years?

Dr. Williams: The picture of smoked tobacco has dramatically changed in the U.S. It is the lowest it has ever been (12%). But the use of noncombustible tobacco has risen to offset the decrease in smoked tobacco. We need to be aware of this and carefully ask about the habits of our patients during consultations with them. (2,3)

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How has the use of vaping changed during that same period of time?

Dr. Williams: This is a very good question. How many of us remember Joe Camel and the marketing efforts of the tobacco companies aimed at youth? We move ahead 20 years, and we see the same campaigns again. The vaping industry has flavored nicotine products that our youth believe to be nonharmful. But being addicted to nicotine is not cheap, nor is it healthy. Thus, the rates of vaping among high school students is almost unbelievably high. (4)

What is the current trend with vaping among different age groups?

Dr. Williams: According to the Centers for Disease Control and Prevention (CDC), 3.7% of the U.S. adult population regularly uses a vaping product. According the latest U.S. Surgeon General’s Report, one in five high school students uses a vaping product. (5)

Is there any move to make the public aware of the rising concerns with vaping?

19apr25bcvaping03Dr. Williams: Several campaigns and directives are in place to address vaping. The U.S. Food and Drug Administration (FDA) has enacted policies to address vaping sales, products, liquids, and underage use. The CDC and other agencies are targeting those groups that use vaping products, especially children and teenagers. The real issue is the marketing of the product as being harmless, mainly directed at kids. (5)

What are the primary concerns with vaping?

Dr. Williams: There are three basic issues with vaping:

• Vaping products—electronic nicotine delivery systems (ENDS)—are made to deliver nicotine, an addictive substance that is harmful to developing brains. Nicotine also delays healing in the mouth and body.

• No studies have shown that ENDS products are an evidence-based effective method to quit smoking tobacco. However, some companies have stated such, and the FDA has quickly moved to state that this is unproven.

• Chemically, vaping products have serious problems, including flavoring agents that can irritate the gums and lungs, and the released vapor contains formaldehyde. (6)

19apr25bcvaping04Recently, at the Chicago Dental Society’s Midwinter Meeting, I taught a course that explored the latest policies and oral health hazards related to tobacco, including the hazards of various tobacco products—smoked, smokeless, and electronic—along with the pharmacotherapy involved in tobacco cessation. There is a lot of information out there, and it’s important that we’re talking about the risks with our patients.

What kind of economic push is there from companies to sell their products in the public sector?

Dr. Williams: As with any business, when one area of product sales plummets, one must find a better marketing strategy to increase sales. In this case, the tobacco companies have endorsed the ENDS products to sell their tobacco product. Do not forget that the nicotine in the ENDS product comes from the tobacco plant. As adult smokers have quit, the use of ENDS products has grown. (7,8)

In the general public's eye, vaping is a safe alternative to traditional smoking. However, there are concerns over other issues that are coming about with regard to oral and general overall health. What, specifically, are these red flags, and why are they such a concern?

Dr. Williams: The red flags of vaping include:

• the flavoring agents that can cause damage to the gums and lungs,

• the effect of nicotine addiction on developing brains, and

• the ease of use and access among our children and teenagers. (5)

References

1. Froum S, Neymark A. Vaping and oral health: It’s worse than you think. Perio-Implant Advisory website. https://www.perioimplantadvisory.com/articles/2019/01/vaping-and-oral-health-it-s-worse-than-you-think.html. Published January 10, 2019. Accessed April 18, 2019.

2. Current cigarette smoking among adults in the United States. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. Centers for Disease Control and Prevention website. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm. Updated February 9, 2019. Accessed April 22, 2019.

3. Surgeon General’s Advisory on e-cigarette use among youth. https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf. Accessed April 22, 2019.

4. The facts on e-cigarette use among youth and young adults. Know the risks. E-cigarettes & Young People. The U.S. Department of Health and Human Services website, created through a partnership between the Office of the U.S. Surgeon General and the U.S. Centers for Disease Control and Prevention, Office on Smoking and Health. https://e-cigarettes.surgeongeneral.gov/. Accessed April 22, 2019.

5. Vaporizers, e-cigarettes, and other electronic nicotine delivery systems (ENDS). U.S. Food and Drug Administration website. https://www.fda.gov/tobaccoproducts/labeling/productsingredientscomponents/ucm456610.htm. Updated April 1, 2019. April 22, 2019.

6. Know the risks. E-cigarettes & Young People. The U.S. Department of Health and Human Services website, created through a partnership between the Office of the U.S. Surgeon General and the U.S. Centers for Disease Control and Prevention, Office on Smoking and Health. https://e-cigarettes.surgeongeneral.gov/knowtherisks.html. Accessed April 22, 2019.

7. Schoenborn CA, Gindi RM. Electronic cigarette use among adults: United States, 2014. NCHS data brief, no. 217. Hyattsville, MD: National Center for Health Statistics. Published 2015. https://www.cdc.gov/nchs/data/databriefs/db217.pdf. Accessed April 22, 2019.

8. Tobacco company marketing to kids. Campaign for Tobacco-Free Kids website. https://www.tobaccofreekids.org/search?cx=018304093702880060621%3Advle8igoa8e&cof=FORID%3A10&ie=UTF-8&sa=&q=companies+and+ENDS+products. Accessed April 22, 2019.


Editor's note: This article originally appeared in Breakthrough Clinical, a clinical specialties newsletter from Dental Economics and DentistryIQ. To subscribe, visit dentistryiq.com/subscribe.


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Stacey Simmons Dds 124x124Stacey L. Simmons, DDS, a graduate of Marquette University School of Dentistry, is in private practice in Hamilton, Montana. She is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. Dr. Simmons is the editorial director of Endeavor Business Media's clinical dental specialties e-newsletter, Breakthrough Clinical, and a contributing author for DentistryIQ, Perio-Implant Advisory, and Dental Economics. She also serves on the Dental Economics editorial advisory board. You may contact her at ssimmonsdds@gmail.com.


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