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Teens and vaping: What dental professionals need to know

Feb. 1, 2023
As vaping use continues to increase across the country, so do the oral health issues that may result from it. Here's what you need to know, and some ways you can help your patients.

Amid an explosion of vaping products and use over the past several years, some of the most effective ways dental professionals can help their patients are approaches that are part of their jobs already: listening, recommending home care strategies, and educating patients.

At “Vaping: A viable alternative? Or danger in the air” at the 2023 Yankee Dental Congress in Boston, Jamie Collins, RDH, discussed the history, trends, and statistics about vaping and e-cigarettes, telling the audience that the issue is more pervasive than many in the dental field may realize. While the oral signs of vaping aren’t as telltale as those of patients who smoke cigarettes, you can be sure you’re seeing patients who vape, whether they discuss it with you or not, she said.

“If you think your patients aren’t doing this, you’re wrong,” she said. “And it’s more than you realize.”

Use among teens skyrockets

According to Collins, between 2019-2021, vaping use increased by 1800%, with one in 20 Americans vaping and one in five from ages 18-29 doing so. In all, this amounts to some 55 million adult users in the US.

Among teens in particular, the numbers are sobering.

In 2021, some 3.62 million teens were vaping, Collins said. Other information she shared about teen use includes:

  • Use among high school students increased 78% between 2017 and 2018
  • Use among middle school students increased 48% between 2017 and 2018
  • In 2022, four of 100 middle school and one in six high school students reported tobacco use, per the CDC 
  • In 2022, one in 10 middle and high schoolers reported using e-cigarettes, per the FDA

While many long-term effects of teen use are not yet known, some repercussions are starting to be. For example, while one of the purported intents of vaping is to help users stop smoking cigarettes, many young people who use e-cigarettes also smoke cigarettes or may be more likely to do so in the future.

Why do they start? For many of the same reasons previous generations of teens and adults started smoking cigarettes, said Collins: to see what it’s like, to feel good or feel a high, because it “looks cool,” and because they already had an addiction.

That’s not to mention its ease of use: “It’s so pervasive with teens because [using it] it’s the push of a button. It’s everywhere,” Collins said.

The effects on gums and teeth

In November 2022, the first known study specifically to look into the relationship between vaping and an increased risk for dental caries showed that patients who said they use vaping devices are more likely to have a higher risk of developing cavities.

Research from Tufts University School of Dental Medicine analyzed data from some 13,000 patients ages 16 and older who were at Tufts clinics from 2019-2022 and showed that 79% of patients who vape were categorized as having high-caries risk, compared with 60% of the control group.

How does this play out at the dental office? It varies, of course, but “I hear from doctors whose patients suddenly have three or four cavities,” Collins told the audience.

Other oral effects of e-cigarettes Collins noted include xerostomia, increased risk of periodontal disease, burns, inflammation, halitosis, altered taste, and painful tongue.

How you can help

Teens are teens, and often they don’t want to admit that they’re vaping. Instead of asking teen patients directly, Collins suggested starting a conversation by asking if they know people who vape and taking it from there.

That approach “opens a dialogue in a less scary way,” Collins said. “It’s a dialogue versus an accusation.”

She also advises an approach of understanding with adult patients who vape: “It’s hard to quit and we have to realize that…but we [should] do what we can to help them if they’re not ready or can’t quit.”

This includes the dialogue around home care tools (such as power toothbrush, water flosser, interdental brushes, floss picks, and mouthrinse) and office treatments such as fluoride varnish, acceptance of which goes up if you explain why [it helps].

“With any treatment recommendation, educating the patient on the reasons improves acceptance rates,” Collins said. With fluoride, for example, “when you explain the higher risk of caries when vaping and fluoride may provide some protection to reduce the risk, you are more likely to get acceptance versus ‘you need fluoride.’”