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When patients ask about vaping…

6 January 2020

When patients ask about vaping…

Vaping was all over the news towards the end of 2019 and the headlines were not good. The surge of bad publicity was due to a number of deaths in the US that had been attributed to vaping-related lung illness. This prompted the Centers for Disease Control and Prevention (CDC), to publish its recommendations.[1] As of late September, the CDC said it had received over 800 reports of cases of lung injury, with most involving patients aged between 18-32 who had a history of e-cigarette product use.

It also said that although “the specific chemical exposure(s) causing lung injuries associated with e-cigarette product use, or vaping, remains unknown at this time” it advised that people refrain from using e-cigarettes, or vaping “while this investigation is ongoing”.

Back in the UK, the NHS Smokefree website still states that e-cigarettes/vapes can help adults who want to stop smoking. It cites organisations, including Public Health England, that support the use of e-cigarettes because “based on the current evidence” they are far less harmful than tobacco-based products.[ii] The issue in the US appears also to be “specific… relating to the substances used”.

Moreover, the UK’s regulation of e-cigarettes is “one of the most comprehensive systems in the world”.[iii],[iv] All products are under the watchful eye of the Medicines and Healthcare products Regulatory Agency (MHRA), who checks for quality, safety and uses a ‘yellow card’ rule to monitor adverse reactions. But it is important to remember that many vaping solutions still contain nicotine, which is known to be a significant factor in the development of periodontal disease.

When vaping became popular, many trying-to-quitters ran to embrace something that offered the rituals associated with smoking, while apparently avoiding the harmful substances in cigarettes. Worldwide, vaping continues to rise.[v] In the UK, out of the 3.9 million people who vape, the majority are either ex-smokers (54%) or people who smoke and vape (39.8%), indicating that they are using their electronic device to cut down.[vi] Regular use remains rare in never smokers.[vii] With regards to young people aged 11-18 who have never smoked, the use of vapes/e-cigarettes is limited – 0.1% say they vape more than once a week, but not one reported vaping daily.[viii]

What’s important is that we don’t let any headlines distract us from the real big bad wolf, which is cigarette smoking (and other products containing tobacco). Quitting smoking is a tremendous personal challenge and an emotional one. Reading that vaping is not the safe alternative they thought it was, could be a terrible blow for someone trying to quit.

There are still over a billion smokers worldwide and although decline is steady, it has been small.[ix] The burden of smoking, and tobacco-related illnesses, is still a major public health problem. In the UK, the Government pledged to make England smoke-free by 2030 and there are signs that the tide is changing. Last August, Cancer Research UK revealed that, according to its analysis, monthly cigarette consumption fell by a quarter in England between 2011 and 2018, with over 100 million less smoked per month.[x]

But with any data we must think beyond the statistics. There are still millions of people who do smoke. Rather like with drinking alcohol, are people honest about how much (and if) they do? In 2018, 14.4% of adults in England said they were ‘current’ smokers (down only a tiny amount from 2017).[xi] Worrying, 10.6% of pregnant women were smokers at time of delivery in 2018/19, way above the national ambition if 6% or less. Perhaps most telling is the amount of deaths attributable to smoking, which, according to the latest figures, have shown no discernible decrease.[xii] Ditto hospital admissions. There are also regional discrepancies and discrepancies that relate to income/employment status.

Preventive-maintenance appointments give dental practitioners valuable time to discuss issues like vaping and smoking cessation. Tobacco is bad for your health, but to be effective the message needs to go deeper. Explain the current, official position on vaping. If vaping is helping them cut down on cigarettes, they can continue. But the ultimate goal is to use nothing at all and to enjoy the benefits of a healthy body and healthy, clean mouth. Let them experience what a hygienic mouth really feels like by giving it a deep clean, then demonstrating how to do this at home.

The message is, if you don’t smoke, don’t vape. Any ‘benefits’ of vaping – as far as current learning goes – are only for smokers who are trying to cut down and ultimately stop using any oral props. With regards to what is going on in the US, if headlines send just one person who was trying hard to quit back to smoking more cigarettes, this would be a shame. Dental care practitioners need to own their role as supporter and educator, initiating conversations that give patients all the information they need to make the right choices.

 

References

[i] Centers for Disease Control and Prevention. Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping. Published 27 September, 2019. Link: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html (accessed October 2019).

[ii] NHS Smokefree. E-cigarettes/vapes. Link: https://www.nhs.uk/smokefree/help-and-advice/e-cigarettes (accessed October 2019).

[iii] NHS Smokefree.

[iv] What the NHS and the UK vape regulator had to say about e-cigarettes after US deaths. NorthWalesLive, 2 October 2019. Link: https://www.dailypost.co.uk/news/uk-world-news/what-nhs-uk-vape-regulator-16994092 (accessed October 2019).

[v] Vaping: How popular are e-cigarettes? BBC, 15 September 2019. Link: https://www.bbc.co.uk/news/business-44295336 (accessed October 2019).

[vi] ASH. In 2019 around half as many Britons now vape as smoke, and the majority are ex-smokers. Published 24 September, 2019. Link: https://ash.org.uk/media-and-news/press-releases-media-and-news/in-2019-around-half-as-many-britons-now-vape-as-smoke-and-the-majority-are-ex-smokers/ (accessed October 2019).

[vii] ASH, 24 September 2019.

[viii] ASH. Use of e-cigarettes among young people in Great Britain. Published June 2019. Link: https://ash.org.uk/wp-content/uploads/2019/06/ASH-Factsheet-Youth-E-cigarette-Use-2019.pdf

[ix] BBC, 15 September 2019.

[x] Billion fewer cigarettes smoked in England a year. BBC, 28 August 2019. Link: https://www.bbc.co.uk/news/articles/cw4jd7vxxqdo (accessed October 2019).

[xi] NHS Digital. Statistics on Smoking, England. Published 2 July 2019. Link: https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-smoking/statistics-on-smoking-england-2019/part-3-smoking-patterns-in-adults-copy (accessed October 2019).

[xii] NHS Digital. Statistics on Smoking, England. 2 July 2019.

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