Implications of Electronic Cigarettes on the Safe Administration of Sedation and General Anesthesia in the Outpatient Dental Setting
Today the number of electronic cigarette users continues to rise as electronic cigarettes slowly, yet steadily overtake conventional cigarettes in popularity. This shift is often attributed to the misconception that electronic cigarettes are “safer” or “less dangerous” than conventional cigarettes. Recent studies have shown that electronic cigarettes are far from safe and that the inhaled agents and byproducts within vaping aerosols can have adverse effects on systemic and oral health like combustible tobacco products. The first electronic cigarettes were originally introduced as a tool for smoking cessation. However, newer iterations of electronic cigarette devices have been modified to allow the user to consume tetrahydrocannabinol (THC), the psychoactive component of cannabis, in addition to nicotine. As the popularity of these devices continues to rise, the number of patients seeking dental treatment who also consume electronic cigarettes will too. This article aims to shed light on the deleterious effects electronic cigarettes can have on systemic and oral health, as well as the special considerations for sedation and anesthesia providers treating patients who use electronic cigarettes.
Reusable electronic cigarette components. Reusable e-cigarettes are composed of a plastic or glass tank which allows the user to store a greater volume of e-liquid. The heating element is typically an atomizer which allows for greater generation of aerosols. Reusable e-cigarettes contain a larger battery compared with disposable ones. A larger power supply to the heating element allows for a greater volume of aerosol to be generated with each puff.
Components of a disposable electronic cigarette. Disposable e-cigarettes do not contain a tank and instead store their e-liquid in a saturated piece of cotton. Aerosols are generated by a rudimentary wick and coil which is heated by a low voltage battery. The processor recognizes when the user is taking a puff and triggers the battery to supply power to the coil. The processor is set to a predetermined number of puffs. The device will stop generating aerosols once that number is reached or the battery runs out of power, whichever comes first.
Bronchiolitis obliterans or “popcorn lung.” Axial view of a CT chest in a patient who chronically used electronic cigarette devices, suffering from bronchiolitis obliterans. Image provided courtesy of Dr Jeremy S. Breit, MD.
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