Oral Trauma and Tooth Avulsion Following Explosion of E-Cigarette.

Electronic cigarettes (E-cigarettes), or personal vaporizers, were introduced in 2003 and have been available in the United States since 2007. In addition to the health and safety concerns of the aerosol delivery of nicotine through E-cigarettes, during the past 8 years, reports of explosions and fires caused by the E-cigarette devices have led the US Fire Administration to evaluate the safety of these devices. These explosions have been observed frequently enough that the US Department of Transportation has recently banned E-cigarette devices in checked baggage aboard airplanes. This report contributes to existing knowledge about the hazards related to E-cigarettes by describing oral hard and soft tissue injuries from an E-cigarette explosion.

Blast Injuries Caused by Vape Devices: 2 Case Reports.

Vaporizing devices have become a popular alternative to conventional nicotine products. They are thought to be safer as they produce aerosolized nicotine powered by a lithium ion battery. Many people have used these electronic devices as a tool to quit smoking; however, the batteries can be unstable and explode.We present 2 case reports where explosions of electronic vapor devices caused significant injuries. The first patient sustained a combustion injury to the maxilla resulting in bone and anterior maxillary tooth loss requiring reconstruction. The second patient had a severe blast injury to the hand which ultimately resulted in loss of a digit. Toxicology was consulted due to concerns for systemic absorption of metals in the soft tissue of the hand. Cobalt and manganese were initially elevated but decreased after surgical debridement. The patient did not have any systemic symptoms.Currently, there is no federal regulation of electronic cigarettes or vape devices in the United States. With the increasing use of these devices and no standard regulations, we anticipate more blast injuries occurring in the future. Medical providers will need to be able to be prepared to manage the devastating clinical injuries that ensue.

Cytotoxicity and apoptosis induction by e-cigarette fluids in human gingival fibroblasts.

OBJECTIVES: Electronic cigarettes (e-cigarettes) are generally acknowledged as a safer alternative to the use of combusted tobacco products. Nevertheless, there are increasing conflicting claims concerning the effect of these novel industrial products on the health of e-cigarettes users. The aim of this work was to investigate the effects of the liquids of e-cigarettes on human gingival fibroblasts (HGFs) and to compare the effects of nicotine-containing fluid to the fluid itself. MATERIALS AND METHODS: HGFs were treated with different concentrations (0-5 mg/mL) of fluids of e-cigarettes for different times (0-72 h) and cytotoxicity was analyzed by MTT assay. Fluids were administered also after being vaped (e.g., warmed into the cartomizer). Apoptosis occurrence and Bax expression were evaluated by flow cytometry; ROS production was analyzed by fluorescence optical microscopy. RESULTS: Both nicotine-containing and nicotine-free fluids induced an increased ROS production after 24 h, along with an increased Bax expression, followed by apoptosis occurrence after 48 h of exposure. CONCLUSIONS: The cytotoxicity exerted on HGFs by e-cigarettes fluids is not entirely ascribable to nicotine. Since the e-cigarettes are advertised as a safer alternative to traditional ones, especially for the possibility of "smoking" nicotine-free fluids, further studies are necessary to clarify the mechanism involved in the occurrence of cytotoxicity exerted by such compounds. CLINICAL RELEVANCE: Our results suggest a role for e-cigarette fluids in the pathogenesis of oral diseases, such as periodontitis.

Electronic cigarettes: assessing the efficacy and the adverse effects through a systematic review of published studies.

BACKGROUND: To investigate the efficacy and the adverse effects (AEs) of the electronic cigarette, we performed a systematic review of published studies. METHODS: We selected experimental and observational studies examining the efficacy (as reduction of desire to smoke and/or number of cigarettes smoked and/or quitting or as reduction of nicotine withdrawal symptoms) and the safety of EC (AEs self-reported or clinical/laboratory). The following search engines were used: PubMed, ISI Web of Knowledge and Cochrane Controlled Trials Register. RESULTS: Finally, six experimental studies and six cohort studies were included. In the prospective 12-month, randomized controlled trial, smoking reduction was documented in 22.3 and 10.3% at Weeks 12 and 52, respectively (P < 0.001 versus baseline). Moreover, two cohort studies reported a reduction in the number of cigarette/day (from 50 to 80%) after the introduction of the EC. 'Mouth and throat irritation', 'nausea', 'headache' and 'dry cough' were the most frequently AEs reported. CONCLUSIONS: The use of the EC can reduce the number of cigarettes smoked and withdrawal symptoms, but the AEs reported are mainly related to a short period of use. Long-term studies are needed to evaluate the effects of the EC usage after a chronic exposure.

E-cigarettes and smoking cessation. Similar efficacy to other nicotine delivery devices, but many uncertainties.

E-cigarettes, marketed as an alternative to conventional cigarettes, are designed to transform a solution of variable composition, with or without nicotine, into an aerosol that the user inhales. How effective are e-cigarettes as an aid to smoking cessation, and what are their known adverse effects? To answer these questions, we conducted a review of the literature using the standard Prescrire methodology. A randomised trial involving 657 individuals who wanted to stop smoking compared e-cigarettes (with or without nicotine) with nicotine patches. There was no difference between the groups after 6 months, with an overall quit rate of about 5%. A double-blind randomised trial including 300 smokers compared the impact of e-cigarettes with or without nicotine on tobacco consumption. After 3 months, 14% of those using e-cigarettes with nicotine had quit completely, compared to 4% of those using e-cigarettes without nicotine. Adverse events reported in these trials were mild and transient, and mainly included dry mouth, irritation of the mouth and throat, dizziness, and nausea. When the solution ("e-liquid") contains nicotine, the main adverse effects are those of nicotine. Bronchial disorders, neuropsychiatric disorders and ocular irritation have been reported with inhaled propylene glycol. The effects of propylene glycol and glycerol, when heated and inhaled over long periods, are not known. The addictive effect is difficult to determine. Long-term use of e-cigarettes has been observed in about one-third of people who stopped smoking. Toxic or carcinogenic substances have been found in some e-cigarette aerosols, but at lower concentrations than in tobacco smoke. The diversity in the composition of e-liquids and the lack of proper controls make it difficult to assess the associated dangers. In early 2015, e-cigarettes containing nicotine appear to have efficacy similar to that of other nicotine delivery systems as an aid to smoking cessation. Apart from the effects of nicotine, there are few known adverse effects. However, there are many uncertainties as to the composition of the different e-liquids and the long-term effects of the substances when they are heated and inhaled. There is no reason to discourage smokers from substituting the proven, serious harms of tobacco smoke with the potential and poorly defined harms associated with e-cigarettes.

Cigarettes vs. e-cigarettes: Passive exposure at home measured by means of airborne marker and biomarkers.

BACKGROUND: There is scarce evidence about passive exposure to the vapour released or exhaled from electronic cigarettes (e-cigarettes) under real conditions. The aim of this study is to characterise passive exposure to nicotine from e-cigarettes' vapour and conventional cigarettes' smoke at home among non-smokers under real-use conditions. METHODS: We conducted an observational study with 54 non-smoker volunteers from different homes: 25 living at home with conventional smokers, 5 living with nicotine e-cigarette users, and 24 from control homes (not using conventional cigarettes neither e-cigarettes). We measured airborne nicotine at home and biomarkers (cotinine in saliva and urine). We calculated geometric mean (GM) and geometric standard deviations (GSD). We also performed ANOVA and Student's t tests for the log-transformed data. We used Bonferroni-corrected t-tests to control the family error rate for multiple comparisons at 5%. RESULTS: The GMs of airborne nicotine were 0.74 µg/m(3) (GSD=4.05) in the smokers' homes, 0.13 µg/m(3) (GSD=2.4) in the e-cigarettes users' homes, and 0.02 µg/m(3) (GSD=3.51) in the control homes. The GMs of salivary cotinine were 0.38 ng/ml (GSD=2.34) in the smokers' homes, 0.19 ng/ml (GSD=2.17) in the e-cigarettes users' homes, and 0.07 ng/ml (GSD=1.79) in the control homes. Salivary cotinine concentrations of the non-smokers exposed to e-cigarette's vapour at home (all exposed ≥ 2 h/day) were statistically significant different that those found in non-smokers exposed to second-hand smoke ≥ 2 h/day and in non-smokers from control homes. CONCLUSIONS: The airborne markers were statistically higher in conventional cigarette homes than in e-cigarettes homes (5.7 times higher). However, concentrations of both biomarkers among non-smokers exposed to conventional cigarettes and e-cigarettes' vapour were statistically similar (only 2 and 1.4 times higher, respectively). The levels of airborne nicotine and cotinine concentrations in the homes with e-cigarette users were higher than control homes (differences statistically significant). Our results show that non-smokers passively exposed to e-cigarettes absorb nicotine.

Electronic cigarettes: human health effects.

OBJECTIVE: With the rapid increase in use of electronic nicotine delivery systems (ENDS), such as electronic cigarettes (e-cigarettes), users and non-users are exposed to the aerosol and product constituents. This is a review of published data on the human health effects of exposure to e-cigarettes and their components. METHODS: Literature searches were conducted through September 2013 using multiple electronic databases. RESULTS: Forty-four articles are included in this analysis. E-cigarette aerosols may contain propylene glycol, glycerol, flavourings, other chemicals and, usually, nicotine. Aerosolised propylene glycol and glycerol produce mouth and throat irritation and dry cough. No data on the effects of flavouring inhalation were identified. Data on short-term health effects are limited and there are no adequate data on long-term effects. Aerosol exposure may be associated with respiratory function impairment, and serum cotinine levels are similar to those in traditional cigarette smokers. The high nicotine concentrations of some products increase exposure risks for non-users, particularly children. The dangers of secondhand and thirdhand aerosol exposure have not been thoroughly evaluated. CONCLUSIONS: Scientific evidence regarding the human health effects of e-cigarettes is limited. While e-cigarette aerosol may contain fewer toxicants than cigarette smoke, studies evaluating whether e-cigarettes are less harmful than cigarettes are inconclusive. Some evidence suggests that e-cigarette use may facilitate smoking cessation, but definitive data are lacking. No e-cigarette has been approved by FDA as a cessation aid. Environmental concerns and issues regarding non-user exposure exist. The health impact of e-cigarettes, for users and the public, cannot be determined with currently available data.

Success rates with nicotine personal vaporizers: a prospective 6-month pilot study of smokers not intending to quit.

BACKGROUND: Electronic cigarettes (e-Cigs) are an attractive long-term alternative nicotine source to conventional cigarettes. Although they may assist smokers to remain abstinent during their quit attempt, studies using first generation e-Cigs report low success rates. Second generation devices (personal vaporisers - PVs) may result in much higher quit rates, but their efficacy and safety in smoking cessation and/or reduction in clinical trials is unreported. METHOD: We conducted a prospective proof-of-concept study monitoring modifications in smoking behaviour of 50 smokers (unwilling to quit) switched onto PVs. Participants attended five study visits: baseline, week-4, week-8, week-12 and week-24. Number of cigarettes/day (cigs/day) and exhaled carbon monoxide (eCO) levels were noted at each visit. Smoking reduction/abstinence rates, product usage, adverse events and subjective opinions of these products were also reviewed. RESULTS: Sustained 50% and 80% reduction in cigs/day at week-24 was reported in 15/50 (30%) and 7/50 (14%) participants with a reduction from 25cigs/day to 6cigs/day (p < 0.001) and 3cigs/day (p < 0.001), respectively. Smoking abstinence (self-reported abstinence from cigarette smoking verified by an eCO ≤10 ppm) at week-24 was observed in 18/50 (36%) participants, with 15/18 (83.3%) still using their PVs at the end of the study. Combined 50% reduction and smoking abstinence was shown in 33/50 (66%) participants. Throat/mouth irritation (35.6%), dry throat/mouth (28.9%), headache (26.7%) and dry cough (22.2%) were frequently reported early in the study, but waned substantially by week-24. Participants' perception and acceptance of the products was very good. CONCLUSION: The use of second generation PVs substantially decreased cigarette consumption without causing significant adverse effects in smokers not intending to quit. TRIAL REGISTRATION: (ClinicalTrials.gov Identifier: NCT02124200).

[Electronic cigarettes - effects on health. Previous reports]. / Elektroniczne papierosy - wplyw na zdrowie. Dotychczasowe doniesienia.

Currently very popular in the market of tobacco products have gained electronic cigarettes (ang. E-cigarettes). These products are considered to be potentially less harmful in compared to traditional tobacco products. However, current reports indicate that the statements of the producers regarding to the composition of the e- liquids not always are sufficient, and consumers often do not have reliable information on the quality of the product used by them. This paper contain a review of previous reports on the composition of e-cigarettes and their impact on health. Most of the observed health effects was related to symptoms of the respiratory tract, mouth, throat, neurological complications and sensory organs. Particularly hazardous effects of the e-cigarettes were: pneumonia, congestive heart failure, confusion, convulsions, hypotension, aspiration pneumonia, face second-degree burns, blindness, chest pain and rapid heartbeat. In the literature there is no information relating to passive exposure by the aerosols released during e-cigarette smoking. Furthermore, the information regarding to the use of these products in the long term are not also available.

The association between electronic-cigarette use and self-reported oral symptoms including cracked or broken teeth and tongue and/or inside-cheek pain among adolescents: A cross-sectional study.

BACKGROUND: Little is known about oral health related to electronic-cigarette (EC) use, even though EC use is increasing rapidly. The aim of this study is to assess the relationship between EC use and oral health, including 'gingival pain and/or bleeding', 'tongue and/or inside-cheek pain', and 'cracked or broken teeth' among adolescents. METHODS: A total of 65,528 students in 2016 were included in this cross-sectional study. RESULTS: For EC use, 0.5% (n = 297) students were daily users, 1.9% (n = 1259) were '1 to 29 days past month users', and 5.9% (n = 3848) were former users. Overall, 18.5% students reported they had experienced 'gingival pain and/or bleeding', 11.0% reported 'tongue and/or inside-cheek pain', and 11.4% reported a 'cracked or broken tooth' within the past 12 months. When comparing 'daily EC users', '1 to 29 days past month EC users', and 'former EC users' with 'never EC users', the adjusted ORs for 'cracked or broken tooth' were 1.65 (95% CI: 1.19-2.27), 1.26 (95% CI: 1.06-1.51), and 1.16 (95% CI: 1.04-1.30), respectively. Comparing 'daily EC users' with 'never EC users', the adjusted OR for 'tongue and/or inside-cheek pain' was 1.54 (1.05-2.26). However, EC use among adolescents was not associated with 'gingival pain and/or bleeding' when adjusted for the potential confounders. CONCLUSIONS: Based on the results, the odds of cracked or broken teeth among daily, '1 to 29 days past month', and former EC users were significantly higher than those among never EC users. The odds of tongue and/or inside-cheek pain among daily EC users were significantly higher than those among never EC users. In conclusion, the results suggest that daily EC use among adolescents may be a risk factor for cracked or broken teeth and tongue and/or inside-cheek pain.

Electronic cigarette solutions and resultant aerosol profiles.

Electronic cigarettes (e-cigarettes) are growing in popularity exponentially. Despite their ever-growing acceptance, their aerosol has not been fully characterized. The current study focused on evaluating e-cigarette solutions and their resultant aerosol for potential differences. A simple sampling device was developed to draw e-cigarette aerosol into a multi-sorbent thermal desorption (TD) tube, which was then thermally extracted and analyzed via a gas chromatography (GC) mass spectrometry (GC-MS) method. This novel application provided detectable levels of over one hundred fifteen volatile organic compounds (VOCs) and semivolatile organic compounds (SVOCs) from a single 40mL puff. The aerosol profiles from four commercially available e-cigarettes were compared to their respective solution profiles with the same GC-MS method. Solution profiles produced upwards of sixty four unidentified and identified (some only tentatively) constituents and aerosol profiles produced upwards of eighty two compounds. Results demonstrated distinct analyte profiles between liquid and aerosol samples. Most notably, formaldehyde, acetaldehyde, acrolein, and siloxanes were found in the aerosol profiles; however, these compounds were never present in the solutions. These results implicate the aerosolization process in the formation of compounds not found in solutions; have potential implications for human health; and stress the need for an emphasis on electronic cigarette aerosol testing.

Patients are asking about e-cigarettes. What do we tell them?

E-cigarettes are electronic devices that deliver vaporised nicotine liquid into the lungs. Since the introduction of e-cigarettes in 2004, the market in the UK has rapidly expanded and increasingly people are asking health professionals about them. This article gives an overview of e-cigarettes, their use, their regulatory status and evidence for their safety, quality and efficacy. Advice about e-cigarettes for dental health professionals to give patients is provided, as well as the five questions, proposed by Action on Smoking and Health, to consider when deciding whether to permit or prohibit use of e-cigarettes on premises.

Effectiveness and tolerability of electronic cigarette in real-life: a 24-month prospective observational study.

Electronic cigarettes (e-Cigarette) are battery-operated devices designed to vaporise nicotine that may aid smokers to quit or reduce their cigarette consumption. Research on e-Cigarettes is urgently needed to ensure that the decisions of regulators, healthcare providers and consumers are evidence based. Here we assessed long-term effectiveness and tolerability of e-Cigarette used in a 'naturalistic' setting. This prospective observational study evaluated smoking reduction/abstinence in smokers not intending to quit using an e-Cigarette ('Categoria'; Arbi Group, Italy). After an intervention phase of 6 months, during which e-Cigarette use was provided on a regular basis, cigarettes per day (cig/day) and exhaled carbon monoxide (eCO) levels were followed up in an observation phase at 18 and 24 months. Efficacy measures included: (a) ≥50% reduction in the number of cig/day from baseline, defined as self-reported reduction in the number of cig/day (≥50%) compared to baseline; (b) ≥80% reduction in the number of cig/day from baseline, defined as self-reported reduction in the number of cig/day (≥80%) compared to baseline; (c) abstinence from smoking, defined as complete self-reported abstinence from tobacco smoking (together with an eCO concentration of ≤10 ppm). Smoking reduction and abstinence rates were computed, and adverse events reviewed. Of the 40 subjects, 17 were lost to follow-up at 24 months. A >50% reduction in the number of cig/day at 24 months was shown in 11/40 (27.5%) participants with a median of 24 cig/day use at baseline decreasing significantly to 4 cig/day (p = 0.003). Smoking abstinence was reported in 5/40 (12.5%) participants while combined >50% reduction and smoking abstinence was observed in 16/40 (40%) participants at 24 months. Five subjects stopped e-Cigarette use (and stayed quit), three relapsed back to tobacco smoking and four upgraded to more performing products by 24 months. Only some mouth irritation, throat irritation, and dry cough were reported. Withdrawal symptoms were uncommon. Long-term e-Cigarette use can substantially decrease cigarette consumption in smokers not willing to quit and is well tolerated. ( http://ClinicalTrials.govnumberNCT01195597 ).