Are e-cigarettes a safer alternative to reduce incidences of oral cancer?

Abstract

The rapid increase in the use of electronic nicotine delivery systems (ENDS), such as e-cigarettes and vape pens, has raised concerns about their potential impact on oral health and the risk of oral cancer. Despite their popularity and claims of being a safer alternative to traditional smoking, there is a lack of conclusive evidence regarding the detrimental effects of vaping. ENDS were initially introduced as a safer option for smokers, attracting both traditional smokers and adolescents due to appealing flavours. These devices use a battery-powered heating element to aerosolise a liquid containing nicotine, flavourings, formaldehyde, glycerol, and heavy metals. However, the variability in product composition and design makes it challenging to establish reliable toxicity profiles. This commentary aims to provide an overview of the existing evidence to inform oral and maxillofacial surgery (OMFS) practitioners about the potential risks associated with vaping on oral health and cancer. Data was extracted from ten recent studies, which included systematic reviews, meta-analyses, literature reviews, cross-sectional analyses, and in-vitro studies. While e-cigarettes have fewer carcinogens than traditional cigarettes, concerns remain about their potential for DNA damage. Reported oral symptoms related to e-cigarette use include dry mouth, irritation, pain, oral ulcers, nicotine-related conditions, and accidents resulting from device malfunctions. ENDS exposure has been linked to oral health issues like dysbiosis, inflammation, periodontal disease, and alterations in the oral microbiome. In-vitro studies have shown that e-cigarettes can induce DNA damage, oxidative stress, and genotoxicity in oral cells. Although direct causality between e-cigarettes and oral cancer remains unclear, there are case reports of oral cancer in heavy e-cigarette users without other traditional risk factors. Additionally, some ENDS components, such as formaldehyde and acetaldehyde, are known human carcinogens, potentially posing a nasopharyngeal cancer risk. ENDS use may increase chemotherapy resistance and alter immune-related gene expression, potentially facilitating HPV-16 infection. Moreover, there is concern that ENDS use could lead to future tobacco smoking among adolescents. The variability in ENDS products further complicates assessing their oral health effects. Based on current evidence, ENDS should not be considered 'safe'. The authors recommend documenting ENDS consumption and emphasise the need for extensive research to better understand their effects on oral cavity tissues. Clinicians should remain vigilant and educate patients about the potential risks associated with vaping to make informed decisions about their oral health.