Tobacco and Vapes Bill

Written Evidence Submitted by the British Society of Paediatric Dentistry (BSPD) to the Tobacco and Vapes Public Bill Committee (TVB61).

Executive Summary

· Vaping, or the use of electronic cigarettes (e-cigarettes), has become increasingly popular among adolescents, often perceived as a safer alternative to smoking.

· However, there are potential significant oral health risks associated with vaping, particularly among children and young people.

· The research investigating links between vaping and oral health is very limited at present and is an emerging field.

· In particular, the evidence that does exist is mostly related to adults and the concerning potential effects in young people urgently requires more attention as recommended in the latest OHID vaping review (McNeill et al. (2022).

· This paper examines the current evidence and gaps.

Introduction

1. Vaping, or the use of electronic cigarettes (e-cigarettes), has become increasingly popular among adolescents, often perceived as a safer alternative to smoking. However, there are potential significant oral health risks associated with vaping, particularly among children and young people. The research investigating links between vaping and oral health is very limited at present and is an emerging field. In particular, the evidence that does exist is mostly related to adults and the concerning potential effects in young people urgently requires more attention as recommended in the latest OHID vaping review (McNeill et al. (2022). This paper examines the current evidence and gaps.

Key Findings

Effect on gums

2. There are several studies showing that vaping has negative effects on the oral microbiome (the bacteria and other microbes that inhabit the mouth) (Ganesan et al. (2020), Pusalkar et al. (2020) and Thomas et al (2022)).

3. It is unclear what effect the change in microbiome has on gum disease as one systematic review concluded that although most of the available evidence was weak, vaping could impact human gum health ( Iacob et al. 2024) but this contrasted with a larger systematic review which stated that there was no evidence yet of an effect on gum health ( Shabil et al. 2024).

4. There is an urgent need for further evidence on vaping and gum health (although one large trial is underway in the UK ( ENHANCE-D ), this does not include young people).

Early Onset of Dental Caries

5. Flavoured e-cigarette products, which appeal to younger users, produce acidic by-products that may contribute to tooth decay and enamel erosion. Concerns regarding the impact of vaping on children's oral health have been highlighted in the British Medical Journal ( Chivers , 2024).

Nicotine Addiction and Oral Health Behaviours

6. Nicotine exposure during adolescence can impair brain development, indirectly affecting oral health behaviours. The Centres for Disease Control and Prevention (CDC) warns of nicotine’s impact on attention, learning, and impulse control in young people ( Gentzke et al., 2020).

Dry Mouth and Bad Breath (Xerostomia)

7. E-cigarette use often leads to dry mouth, increasing the risk of tooth decay, halitosis, and gum disease. Adolescents who vape report more frequent oral health issues compared to non-users (Wiener, 2023).

Carcinogenic Risks and Cellular Damage

8. Research suggests vaping may cause cellular changes associated with oral cancer. Studies report DNA damage, oxidative stress, and the presence of carcinogens like formaldehyde in e-cigarette aerosols (Soneji et al., 2024).

Marketing and Accessibility

9. E-cigarette marketing strategies, such as flavoured products, appeal to younger audiences, increasing use and associated risks. This has been discussed extensively in public health literature (O’Leary et al., 2024).

Recommendations

Public Education

10. Increase awareness among parents, educators, and young people about the oral health risks of vaping.

Policy and Regulation

11. Implement stricter regulations on e-cigarette marketing, flavours, and sales to minors.

Preventative Care

12. Train dental professionals to screen for vaping-related oral health issues and provide tailored guidance.

Research Investment

13. Support further studies on the long-term impacts of vaping, especially in children and adolescents.

Conclusion

Vaping poses significant risks to CYP oral health, including gum disease, tooth decay, and potential carcinogenic effects. Public education, stricter regulation, enhanced preventative care, and focused research are urgently needed to safeguard the oral and systemic health of future generations.

20. The evidence underscores the significant potential risks of vaping to oral health in children and young people, including increased prevalence of gum disease, cavities, and potential carcinogenic effects. Urgent action, including public education, stricter regulation, and focused research, is essential to mitigate these risks and safeguard the oral and systemic health of future generations.

References

· Chivers , D.J. (2024) ‘Vaping and children’s oral health’, The BMJ . Available at: https://www.bmj.com/content/387/bmj.q2514 .

· Ganesan SM, Dabdoub SM, Nagaraja HN, Scott ML, Pamulapati S, Berman ML, Shields PG, Wewers ME, Kumar PS. Adverse effects of electronic cigarettes on the disease-naive oral microbiome. Sci Adv. 2020;6(22)

· Gentzke , A.S., et al. (2020) ‘Tobacco Product Use Among Middle and High School Students - United States, 2020’, Morbidity and Mortality Weekly Report , 69(50), pp. 1881–1888. Available at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a1.htm .

· Iacob AM, Escobedo Martínez MF, Barbeito Castro E, Junquera Olay S, Olay García S, Junquera Gutiérrez LM. Effects of Vape Use on Oral Health: A Review of the Literature.  Medicina . 2024; 60(3):365. https://doi.org/10.3390/medicina60030365

· McNeill A, Simonavicius E, Brose L, Taylor E, East K, Zuikova E. Nicotine vaping in England: an evidence update including health risks and perceptions 2022. A report commissioned by the Office for Health Improvement and Disparities. 2022. Available from:  https://www.gov.uk/government/publications/nicotine-vaping-in-england-2022-evidence-update

· O’Leary, R. et al. (2024) ‘Review of systematic reviews on vaping health effects’, Institute of Public Health . Available at: https://www.publichealth.ie/news/report-review-systematic-reviews-health-effects-vaping-children-and-adolescents .

· Pushalkar S, Paul B, Li Q, Yang J, Vasconcelos R, Makwana S, González JM, Shah S, Xie C, Janal MN, et al. Electronic cigarette aerosol modulates the oral microbiome and increases risk of infection. iScience . 2020; 23(3):100884.

· Shabil , M., Khatib, M.N., Ballal , S.  et al.  The impact of electronic cigarette use on periodontitis and periodontal outcomes: a systematic review and meta-analysis.  BMC Oral Health   24 , 1197 (2024). https://doi.org/10.1186/s12903-024-05018-7

· Soneji, S., et al. (2024) ‘The role of e-cigarettes in carcinogenesis’, Cancer Research , 83(7), pp. 201–210. Available at: https://www.nature.com/articles/s41598-023-30016-0 .

· Thomas SC, Xu F, Pushalkar S, Lin Z, Thakor N, Vardhan M, Flaminio Z, Khodadadi- Jamayran A, Vasconcelos R, Akapo A, Queiroz E, Bederoff M, Janal MN, Guo Y, Aguallo D, Gordon T, Corby PM, Kamer AR, Li X, Saxena D. Electronic Cigarette Use Promotes a Unique Periodontal Microbiome. mBio. 2022;13(1 ):e 0007522.

· Wiener, C. (2023) ‘Current E-Cigarette Use and Oral Healthcare Needs among Adolescents’, Hygiene , 3(4), pp. 374–382. Available at: https://www.mdpi.com/2673-947X/3/4/27 .

January 2025