Adam Lang

E-Cig Review
E-Cigarette Aerosols on Oral and Periodontal Epithelia
There has been increasing acceptability of electronic cigarettes; those being
purported as safe alternatives to tobacco smoking by a varying range of age groups
those of current tobacco users, (who are using electronic cigarettes as a cessation
vessel) and characteristically, younger users who have never smoked tobacco in the
past. Little research has been conducted regarding the use of electronic nicotine
delivery systems, and its deleterious effects on the periodontium. The teratogenic,
carcinogenic, and neurotoxic effects of ECs, (electronic cigarettes) have been
speculated; however as stated earlier; few studies have been able to correlate the
use of electronic nicotine delivery systems and its effects on the periodontium.
The use of ECs are appealing: Concealment for indoor use, environmentally
friendly to those non-users in proximity as compared with conventional tobacco
smoking, and a reduction in cost of operation, (as compared with traditional
smoked tobacco use.) Cigarette smoke has over 4800 chemicals, many of these are
widely understood to have adverse effects on human tissues and cells,
(Willershausen, 2014.)
As Willershausen, et al cites, tobacco smoking is responsible for 85% of
lung carcinomas. which are due largely to the deleterious effects of tobacco
combustion. The vapor from ECs, on the contrary, are aerosolized and do not
involve the heat which is offered from traditional tobacco combustion; which
contributes to oral, oropharyngeal, and upper/lower respiratory tract epithelial cell
irritation. This consistent irritation on said epithelial tissue is linked to carcinoma
development.
The effects of smoking tobacco and its effects on the periodontium are well
documented, (as well as the overall effects on systemic health as well.) Smoking
tobacco contributes to the progression of periodontal disease and negatively affects
host response to non-surgical periodontal therapy, (Willershausen, 2014.) The EC is
composed primarily of a battery, and tank which houses e-liquid. An atomizer
within the tank heats the e-liquid, which results in its aerosolization. The
component of this e-liquid is mostly propylene glycol and vegetable glycerin, (with
additive flavors) and variable nicotine content. The metallic components of the tank
which house the e-liquid may be comprised of nickel, cadmium, or titanium. The

free-floating e-liquid may react with the tank housing components to produce
additional detrimental aerosolized peripheral carcinogens upon aerosolization.
The manufacturing of e-liquids remains unstandardized. Taste-favorable
additives of e-liquids contain government approved flavorings which are indeed
government approved: For edible consumption. The effects of aerosolized
government approved flavorings are unknown. Six flavor-variable, e-liquids were
tested by Willershausen et al ranging from hazelnut, menthol and lime flavors.
Gingival tissue swabs were obtained from an unstated population against controlled
healthy cells, and evaluated by subjecting gingival fibroblast reactivity to the
various e-liquids implemented within the variable group through Prestoblue cell
viability test, (which resembles fluorescence reactivity to the e-liquids tested) ATPdetection or behavior upon exposure to e-liquids tested, and cell visualization
through stained microscopy, (Willershausen, et al, 2014)
In conclusion, ECS offer many benefits to the user over traditional smokedtobacco methods such as greater social acceptance through
behavioral/environmental usage, cost difference, and portability. In the study
reviewed herein, it is demonstrated that the components of some e-liquids could
cause appreciable damage to gingival fibroblastic cell proliferation. The molecular,
structural composition of e-liquids, (and its interaction with tank-metallic
components) offer an alluring appeal to conventional smoked-tobacco modality;
even though the carcinogenic capability of e-liquids is much, much lower than that
of smoked tobacco.
Willershausen, I., Et al., (2014). Influence of E-smoking Liquids on Human
Periodontal Ligament
Fibroblasts. US National Library of Medicine National
Institutes of Health. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237808. (20, APR 2015.)