Sir, we would like highlight an interesting case of a severe, necrotic looking oral ulcer attributed to the use of an electronic cigarette (e-cigarette).

A 72-year-old Caucasian male was referred by his GP as a two week wait referral to the oral and m axillofacial clinic. He had previously been smoking 20 cigarettes a day for 30 years before starting to use electronic cigarettes to aid his smoking cessation. He gave a history of a painful area appearing after inhaling strongly on his e-cigarette and suffered extreme discomfort immediately afterwards.

On examination a 2 cm × 1 cm necrotic ulcer was clearly visible (Fig. 1). An incisional biopsy confirmed no evidence of malignancy and suggested the diagnosis of non-specific ulceration. The ulcer was managed conservatively and after a prolonged period of regular reviews the area eventually healed completely.

Figure 1
figure 1

Necrotic ulcer clearly visible in the mouth of a 72-year-old man

Full size image

The e-cigarette device consists of a heating element and a container that holds the vapour solution. It vaporises the liquid solution into an aerosol mist that contains varying amounts of nicotine.1 The role of the e-cigarette in smoking cessation is widely accepted and its usage is rapidly increasing worldwide.2

Despite the availability of research on the direct physiological effects of the e-cigarette, there is a paucity of data available on the physical effects and safety concerns of the e-cigarette on human health.1 The potential for intra oral burns and injuries may present a challenge to the oral healthcare provider. Burns in particular, as in the above case, should be considered as a differential diagnosis of non-healing oral ulceration. Burns and explosions from e-cigarettes are thought to be under reported, although cases of fires and explosions of e-cigarette do exist in the literature.3,4,5

With the increasing use of the electronic cigarette worldwide, we aim to make healthcare professionals aware of the potential harm these items can cause. We also highlight the importance of including burn injuries in the differential diagnosis of soft tissue oral ulceration. Potential hazards and safety concerns associated with the e-cigarette requires further research.