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Tobacco, E-Cigarettes, and Cannabis: What Oral Health Providers Should Know

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Tobacco, E-Cigarettes, and Cannabis: What Oral Health Providers Should Know 3:45 – 4:45 PM - ET Tobacco, E-cigarettes, and Cannabis: What Oral Health Providers Should Know Abrey Daniel, DDS Lin Chan, DDS • OPEN POLLING QUESTION 1 2 • OPEN POLLING QUESTION 2 3 Disclosure We have no actual or potential conflict of interest in relation to this program/presentation. 4 Tobacco, E-Cigarettes, and Cannabis: What Oral Health Providers Need to Know By: Abrey Daniel, DDS Lin Chan, DDS Funded by the CDPH under Contract # 17-10698 Objectives: • Learn about the evolution of tobacco and the new trends of e-cigarettes and cannabis products. • Learn the negative effects including oral health risks of tobacco, e-cigarettes, and cannabis products. • Acquire information on brief interventions and available resources for dental offices. 6 Tobacco • A plant grown for it’s leaves that is smoked, chewed or sniffed • Contains an addictive chemical, Nicotine • Nicotine acts as a pesticide for the plant • Smoked tobacco: cigarettes, cigars, bidis, kreteks • Loose tobacco: in a pipe or hookah • Chewed tobacco: chewing tobacco, snuf, dip, snus, 7 Types of Tobacco Products www.cdph.ca.gov 8 History of Tobacco • 6000 BC – Native Americans first start cultivating the tobacco plant • Circa 1 BC – Indigenous American tribes start smoking tobacco in religious ceremonies and medicinal purposes • 1612 – First successful commercial crop was cultivated by John Rolfe; tobacco used as cash-crop Source: Tobacco Free Life 9 History of Tobacco (Continued) • 1730 – First American tobacco companies in Virginia • 1847 - Philip Morris (UK) start selling hand-rolled Turkish cigarettes • 1880 – James Bonsack develops first cigarette- rolling machine • 1890 – American Tobacco Company opens its doors • 1902 – Philip Morris start selling cigarettes in the US - Marlboro 10 Glamorization of Smoking • Tobacco industry had a lot of product placement deals from the 1920’s to the 1950’s • Movie stars were in cigarette advertisements • Stars were seen as “cool” when they would light their cigarettes 1.Resource: Tobacco settlement endowment trust and CDC 11 Lucille Ball in a Chesterfield cigarette ad. Ronald Reagan in a 1949 Chesterfield cigarette ad. 12 Smoking and Hollywood • In the 1980s, 4 tobacco companies worked with Hollywood for product placement • Companies: Philip Morris, RJ Reynolds, American Tobacco Company, and Brown and Williamson • One company offered free monthly cigarettes to actors • 1998 Master Settlement Agreement Tobacco companies could not receive payment for advertising tobacco products on motion pictures, television, theatrical productions, or live performance 1.“How the tobacco industry built its relationship with Hollywood” 13 1964 Surgeon General’s Report • First report of the Surgeon General’s Advisory Committee on Smoking and Health • Addressed the health effects of smoking in 1964 • Based on over 7,000 articles relating to smoking and disease – Cause of lung cancer and laryngeal cancer in men – Cause of chronic bronchitis Source: CDC “History of the Surgeon General’s Reports on Smoking and Health” 14 Bans and Policies Federal Cigarette Labeling and Advertising Act of 1965 • Require health warning on cigarette packages • Called for the Department of Health, Education, and Welfare to annually report the health consequences of smoking Public Health Cigarette Smoking Act of 1969 • Banned cigarette advertising in the broadcasting media Source: CDC 15 Bans and Policies • In 1995, smoking was banned in all enclosed workplaces in California • In 2000, inflight smoking was banned on all domestic and international flights in the United States • 2004, CA banned smoking within 20 feet of the entrance of a public building • As of 2016, 28 states have statewide bans on smoking in enclosed workplaces, bars, and restaurants 16 Local Southern California Smoking Bans Calabasas • In March 2006, Calabasas, California passed the strictest smoking ban Beverly Hills • On June 4, 2019, Beverly Hills outlawed the sale of tobacco products • Exemptions: Cigar lounges and hotels • In effect January 1, 2021 17 Proposition 56 • California Ballot passed November 8, 2016 • Increase cigarette tax by $2.00 • Prior to this, cigarette tax was $0.87 • Revenue going towards: 1. Enforcing tobacco laws 2. Physician training to increase the number of primary care and emergency physicians in the state 3. Tobacco-use prevention 18 Health Effects of Smoking • Heart Disease • Stroke • Lung Cancer • Decreased Immune Function • Respiratory Disease – Asthma – Chronic Obstructive Pulmonary Disease 19 Smoking Tobacco and Oral Health • Tooth Staining • Oral cancer • Impaired healing • Gingival recession • Oral leukoplakia • Nicotine stomatitis • Periodontal disease • Gingival keratosis • Tooth loss • Dental Caries Photo: emedicine.medscape.com 20 E-Cigarettes History of E-Cigarettes • 1963: Herbert Gilbert patented the first smokeless, non-tobacco cigarette device • 2003: First commercially successful electronic cigarette is created in Beijing, China by Hon Lik, a pharmacist, inventor, and smoker. • 2006-2007: Electronic cigarettes introduced to the U.S. 22 Common Nicknames • E-cigs • E-hookahs • Hookah pens • Vapes • Vape pens • Mods • JUUL • ENDS (electronic nicotine delivery systems) 23 E-CIGARETTES COME IN MANY DIFFERENT SHAPES E-cigarettes are devices that heat a liquid into an aerosol that the user inhales. Source: CDC’s Office on Smoking and Health Design and Appearance • Traditional tobacco cigarettes • Cigars • Pipes • Everyday items like pens USB memory sticks 25 Components • Mouthpiece - to inhale • Cartridge or reservoir – holds liquid solution • Heating element (atomizer) • Power source (battery) 26 E-Liquids SOLVENT FLAVORING WATER NICOTINE (PROPYLENE GLYCOL AND/OR GLYCERIN) 27 USE OF FLAVORS IS PROMINENT AMONG YOUTH Source: U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General—Executive Summary. Source: CDC’s Office on Smoking and Health E-Cig Flavors • 15,500 e-cigarette flavors • Most are fruit • Presence of diacetyl, a flavoring chemical in flavored e-cigarettes. • Diacetyl was found to be associated with bronchiolitis obliterans or “popcorn lung” 1.Allen JG, Flanigan SS, LeBlanc M, Vallarino J, MacNaughton P, Stewart JH, Christani D. 2016. Flavoring Chemicals in E-Cigarettes: Diacetyl, 2,3-Pentanedione, and Acetoin in a Sample of 51 Products, Including Fruit-, Candy-, and Cocktail-Flavored E-Cigarettes. Environmental Health Perspectives. 29 Effects of Sweet Flavors in E-Cig • E-Cig sweet flavored aerosols have similar physio-chemical properties as high- sucrose, gelatinous candies and acidic drinks • May increase cariogenic potential – Promote S. mutans attachment on tooth enamel – Increase demineralization of enamel surface 1.Kim SA, Smith S, Beauchamp C, Song Y, Chiang M, Giuseppetti A, et al. (2018) Cariogenic potential of sweet flavors in electronic-cigarette liquids. Plos ONE 13 (9): e0203717 2.US Food and Drug Administration 30 E-cigarettes Make Aerosol, Not Vapor Source: CDC’s Office on Smoking and Health Same Players, New Products Source: CDC’s Office on Smoking and Health E-cigarette Poisonings 2011-2014 Source: American Association of Poison Control Centers Source: CDC’s Office on Smoking and Health Food and Drug Administration Rulings • Nicotine warning labels must be on vaping products and they must list all ingredients (in 2018) • Federal minimum age to purchase tobacco products increased from 18 to 21 years of age (Dec 2019) • FDA finalizes enforcement policy to cease manufacture, distribution and sale of flavored e-cigs (other than menthol and tobacco) (Jan 2020) 34 Nicotine • According to the CDC, 99% of e-cigarettes contain nicotine • Nicotine in e-liquids absorbed from the lungs into the bloodstream • Nicotine stimulates the adrenal glands to release hormone epinephrine (adrenaline) → stimulates CNS (increase BP, breathing and heart rate) • Nicotine activates the brain’s reward circuits and increases levels of chemical messenger in the brain (dopamine), which reinforces rewarding behaviors 35 HOW DOES NICOTINE IN E-CIGARETTES IMPACT THE BRAIN? Youth who use nicotine can harm the parts of the brain that control attention, learning, mood, and impulse control. Source: CDC’s Office on Smoking and Health Nicotine and Brain Development • Teen years are critical for brain development, which continues into young adulthood about 25 years old • Nicotine changes the way brain cell connections or synapses are formed, which can harm the parts of the brain that control attention and learning • Affects development of brain’s reward system, continued e-cigarette can lead to nicotine addiction and other drug (i.e. cocaine and methamphetamine) addiction 37 JUUL (“JUULing”) • Introduced in 2015 • E-cigarette that resembles a flash drive • Youth-friendly flavors i.e. mango, mint, and fruit-medley • Double the concentration of nicotine found in other e-cig • 1 JUUL pod = 59 mg/ml nicotine = 1 pack of 20 cigarettes = 200 puffs 38 JUUL Contains a High Amount of Nicotine Source: CDC’s Office on Smoking and Health JUUL- Resembles a Flash Drive 40 E-Cigarettes and Teens • E-cigarettes are the most commonly used tobacco product among youth • E-cigarettes may serve as introductory product for preteens and teens who tend to go on to use other tobacco products • Teens who used e-cigarettes are at greater risk for smoking cigarettes in the future Source: CDC 41 1.www.drugabuse.gov/related-topics/trends-statistics/infographics/monitoring-future-2019-survey-results-overall-findings 42 E-cigarettes
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