The good news is that tobacco smoking among Americans has decreased in prevalence from 40% in the 1960s to around 14% in the year 2017. The bad news? Habits like vaping and water pipe (hookah) smoking are on the rise, primarily among teens and young adults, mostly due to the misconception that they are harmless (1).
While most of us are aware of how damaging cigarettes can be to the mouth and overall health, the newer habits of vaping and waterpipe (hookah) smoking are a bit less clearly understood.
The CDC estimates that vaping, also known as e-cigarette use, grew in popularity among high school students by 78% and middle school students by 49% from 2017 to 2018. Additionally, hookah smoking, a practice with origins as far back as 4 centuries ago in India and other Middle Eastern countries, has been tried by around 34% of today’s 13 to 15-year-olds across the world and close to 20% of modern-day college students (8, 9). Closer to home, a study showed that 7% of 12th graders in AZ are current waterpipe users (10).
What is known and being discovered about these habits? Can they affect your mouth and/or the success of your orthodontic treatment?
According to one recent study, “Tobacco smoking contributes to more mortality and morbidity nationwide than any other preventable risk factor. Tobacco use damages nearly all systems of the body, and its effects on oral tissues drive up risk for tooth loss, implant and other surgical failures, periodontal disease, and oral cancer” (1).
Erroneously believed to be harmless by many, vaping not only increases the risk of seizure and heart disease, but can also contribute to the development of cavities, cause the death of gum tissue, lead to gum disease, and even result in the loss of teeth.
How do these activities cause you to lose teeth? It occurs because gum disease, also called periodontal disease (and gingivitis in its earliest stages), is essentially a gum infection that can impact the bone structure of your teeth. Without sufficient support from your bones, teeth can fall out (4).
Waterpipe smoking, also viewed as harmless by the 2.3 million Americans who partake in the practice, is far from it. The World Health Organization states that a single water pipe smoking session is equal to smoking over 100 cigarettes (3, 8).
Note: Each hookah smoking session can last up to 80 minutes with each smoker inhaling anywhere between 50 to 200 tobacco-filled puffs (9).
While e-cigarettes are slightly less harmful in the sense that they don’t contain actual tobacco, they do, however, consist of nicotine -- which is a carcinogen, and therefore harmful. It leads to issues like gum disease and tooth loss, increased cavities, gum tissue death, and gum recession due to its restriction of blood flow.
For these reasons, vaping can lower the ability of your teeth and gums to respond to correction via orthodontic treatment. Vapers should ask their orthodontist to assess their oral health when first considering orthodontic treatment.
Be sure to let us know if you vape so we can thoroughly examine your teeth and gums to make sure you’re a healthy candidate for orthodontic work (7).
While more research is needed, there is some certainty about the effects of vaping on oral health. It is established knowledge that vaping can cause various problems for your teeth, gums, and oral health in general. For example, a recent study indicated that vapers had greater amounts of bacteria in the nooks and crannies of the teeth than non-vapers did. Excess bacteria is problematic as it leads to issues like cavities and gum disease.
Additionally, dry mouth can be caused by the liquids used in vaping, while a 2016 study noted that vaping triggers an inflammatory response in gum tissues. If this type of inflammation is prolonged, it can lead to periodontal disease.
Before the final word is said about vaping juices and how the different kinds can damage your oral health, more research is required. However, a few facts are known now:
Vaping juices that contain nicotine may cause receding gums, teeth stains, jaw grinding, periodontitis, and gingivitis.
While one study showed that most e-juice flavors lowered the number of healthy cells in certain tissues of the mouth, menthol was found to be the most damaging of all flavors.
Similar traits are shared between e-juice flavors and sugary drinks and candy, making certain e-juice flavors more likely to lead to cavities.
At this time, the most problematic ingredients known to be in vaping fluids are nicotine, propylene glycol, and menthol.
The hazards of waterpipes/hookahs were studied extensively with results printed in the October 2015 issue of the Journal of the American Dental Association.
As we already mentioned, a single waterpipe smoking session is considered by the World Health Organization to equal smoking 100 cigarettes. So, it should be no surprise to find that the study connected hookah smoking to lung cancer, heart disease, gum disease, esophageal cancer, dry sockets, and oral cancer (9).
The tobacco used in hookah smoking is often flavored, prompting users to inhale more of it due to its pleasant taste. Unfortunately, the nicotine levels in this flavored tobacco are completely unregulated. On top of that, many hookah cafes do not post or enforce age restrictions on who can enter, use their hookahs, or purchase their products.
This means people of almost any age can enter and inhale enough hookah smoke to equal 100 cigarettes -- an unhealthy amount for anyone, especially considering that nicotine (carcinogen) levels are unregulated.
Michael J. Glick, dentist and editor for the Journal of the American Dental Association puts it this way, “Whether you are smoking a cigarette, a cigar, or tobacco from a waterpipe, smoking is dangerous not only to your oral health but to your overall health” (9).
If you choose to smoke, vape, or smoke hookahs, it is vital to be impeccable with your oral hygiene.
Brush twice a day, plus at least 20 minutes after vaping.
Use toothpaste that contains fluoride every time you brush.
Clean between your teeth with dental floss or oral irrigators. Use a floss threader if necessary.
Avoid sticky or hard snacks like caramels, gummies, or hard pretzels that can damage orthodontic work.
Avoid sugary drinks when vaping but do keep water on hand to keep the mouth moist. Drink water after every time you vape.
Increase visits to the dentist/orthodontist if possible and go in at least every 4 - 6 months for checkups. Please let us know if you need to do this.
Limit your nicotine. Try the low-nicotine or nicotine-free vape juices whenever possible.
Red, swollen, or receding gums
Red or white spots on your gums or the insides of the cheeks
White spots on the teeth
Especially sensitive teeth
White patches on the tongue or mouth
Redness inside the mouth
These can be indicative of more serious problems and should be monitored carefully if you smoke, vape, or use waterpipes.
Overall, more research needs to be done to determine the extent of damage caused by vaping and waterpipe usage. However, there are plenty of reasons to quit or at least limit your participation in these activities, especially if you’ll be receiving orthodontic treatment in the near future.
As always, we welcome your questions and definitely encourage you to schedule any visits needed to assess your teen’s oral health. If you are considering starting, or are in the middle of orthodontic treatment, be sure to mention if you practice any of these habits at your orthodontic consultation or next appointment, so we can make sure the treatments we have planned will work for you. As stated, those who smoke, vape, or use hookahs may need to be seen more often, so don’t hesitate to let us know if you partake in either practice. We simply want to help you keep your mouth in the best health possible!