Sir, we read with interest a recent research paper1 and 'Research Insights' summary2 on the erosive potential of 'vapes'.
We were disappointed to see several basic errors and misrepresentations. We would like to correct the five most major errors:
E-cigarettes do not contain tobacco and should not be categorised as such3
The authors incorrectly claim that nicotine causes a 'high risk of oral and whole-body health complications'. They cite a WHO poster which presents the effects of whole tobacco smoke on health, not the effect of nicotine. Nicotine has been used in the form of NRT for over 30 years, including in pregnant women, and is regarded as extremely safe, even for long-term use
The authors claim that e-cigarettes are associated with cancer. The supporting reference does not make this claim and in fact states 'no long-term evidence related to oral and systemic health effects exist'
The authors state that 'diacetyl is found in most flavoured vapes'. Again, the supporting reference is inappropriate and did not assess diacetyl levels in any way. Moreover, diacetyl is banned as an ingredient from e-cigarettes and e-liquids in the UK
The authors grossly misrepresent the public health guidance on e-cigarette use as a smoking cessation device. For example, they cite a 12-year-old WHO document (a lifetime in e-cigarette policy!) There is a lack of balance in the material cited; the positions of PHE and NICE on the usefulness of e-cigarettes in smoking cessation, and their relative safety compared to tobacco cigarettes, are not acknowledged.
The experiment itself appeared technically sound. It was encouraging that the nicotine containing e-liquids (used by the vast majority of vapers) had an alkaline pH.
A major limitation of the study is that it is not representative of the real-life scenario. The data should not be over-interpreted, and further in vitro modelling studies and clinical studies are needed. Our research group has previously explored this subject using a state-of-the-art research vaping machine, designed to simulate human use. Preliminary data showed minimal changes in pH even after prolonged vaping sessions (data unpublished).
We would point UK dental professionals to the well-considered public health guidance which basically concludes that, for the best chances of quitting smoking, one should use support and pharmacotherapy and that e-cigarettes can be part of that package. Several recent reviews on this topic are available4,5,6which provide references to guidance documents.
References
Fairchild R, Setarehnejad A. Erosive potential of commonly available vapes: a cause for concern? Br Dent J 2021; 231: 487-491.
Bartlett D. Expert view: David Bartlett. Br Dent J 2021; 231: 700.
Munafò M. Are e-cigarettes tobacco products? Nicotine Tobacco Res 2018; 21: 267.
Holliday R, Chaffee B W, Jakubovics N S, Kist R, Preshaw P M. Electronic cigarettes and oral health. J Dent Res 2021; 100: 906-913.
Chaffee B W, Couch E T, Vora M V, Holliday R S. Oral and periodontal implications of tobacco and nicotine products. Periodontol 2000 2021; 87: 241-253.
Weke A, Holliday R. Electronic cigarettes: an update on products, regulation, public health approaches and oral health. Community Dent Health 2022; 39: 68-73.
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Holliday, R., McColl, E., Weke, A. et al. Vaping misrepresentations. Br Dent J 232, 840–841 (2022). https://doi.org/10.1038/s41415-022-4409-1
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DOI: https://doi.org/10.1038/s41415-022-4409-1