COVID-19 AND IT''S LINK TO VAPING/SMOKING

 

Vaping and It's Link to Covid-19 Cases and Their Severity

Smoking, vaping, and the connection to COVID-19 severity is yet another developing link, adding to the dangers that e-cigarette users face. The vaping epidemic that dominated the news for a time has since resulted in severe lung injury and death for many users nationwide. However, while the vaping issue still exists, it has recently taken a back seat to other news stories. Studies and warnings are now emerging about the increased risk of severe COVID-19 reactions in individuals who vape or use traditional cigarettes. 

A newly released study from the Stanford School of Medicine, published on August 11, 2020, makes the connection between vaping and the likelihood of contracting COVID-19.1 Results reveal a startling increase in the odds of smokers contracting COVID-19 with more severe onset of symptoms. The study included 4,351 participants, ranging in age from 13 to 24, with all 50 states represented. A notable statistic is that individuals who had ever used e-cigarettes had a greater risk (by five times) of contracting COVID-19 than their nonsmoking counterparts. Further, those who smoked in the previous 30 days were 6.8 times more likely to contract the disease.1

Lead researcher Shivani Mathur Gaiha, PhD, states: “This study tells us pretty clearly that youth who are using vapes or are dual-using [e-cigarettes and cigarettes] are at elevated risk, and it is not just a small increase in risk; it’s a big one.”1

It has also been determined that vaping or smoking can increase the risk of disease severity if an individual contracts SARS-CoV-2. Multiple studies, including research from the University of Rochester Medical Center, confirm that, on average, COVID-19 affects all smokers worse than the general population.2 Irfan Rahman, who runs the lab at the university, goes on to state that use of tobacco and vaping products increases the receptors on cells in the lungs for an enzyme called ACE2. More receptors allow for a higher viral load exposure, which can lead to a more severe infection.2 This was also reiterated by Jason Sheltzer, a scientist at Cold Spring Harbor Laboratory, who has been studying the role of ACE2 enzymes as a correlation in disease progression.2

New York-Presbyterian is one of many hospitals that have issued warnings and statements that point to smoking and vaping as factors that increase the risk of complications from a COVID-19 infection.3 Notably, use of these products can lead to a malfunction of the immune system within the lungs.3 While the World Health Organization has yet to confirm this, it is well known that inhaling tobacco and vaping substances into the lungs causes inflammation, which can increase one’s susceptibility to disease.

Looking back over the past few years when vaping became widely popular, especially among teens and young adults, the boiling point came in 2019 when many began to fall seriously ill for reasons unknown at the time. To date, nearly 3,000 people have been hospitalized. The Centers for Disease Control and Prevention (CDC) stopped tracking cases of e-cigarette or vaping-associated lung injury (EVALI) in February 2020, as cases had drastically dropped off from their peak in September 2019.4

One contributor to the decrease in cases was identification of vitamin E acetate that had been added to tetrahydrocannabinol (THC)-containing e-cigarettes.4 We are still seeing a rise in vape users, but consumers are a little more aware of what is in the vaping e-liquids.

Vitamin E acetate additives were not the exclusive cause of EVALI, however. According to the CDC, tobacco is the leading cause of preventable disease and death in the US, with nearly 40 million Americans using cigarettes and nearly 4.7 million teens using at least one form of tobacco.4 Every day approximately 1,600 youths smoke for the first time, starting a potentially deadly habit.5

EVALI symptoms often mirror COVID-19–related symptoms. With a worldwide focus on the COVID-19 pandemic, multiple sources state that testing and reporting of vaping-associated lung disease have taken a back seat. Symptoms that both COVID-19 and EVALI may share include nausea, vomiting, shortness of breath, cough, headache, and dizziness.6

Side effects of e-cigarettes can lead to more than just acute or chronic lung injury. It has been well documented that vaping increases the risk of periodontal disease, similar to traditional smoking. Periodontal disease has been shown to have a correlation between multiple detrimental health concerns, including cardiovascular disease, chronic kidney disease, diabetes, insulin resistance, and, most recently, an association in the brains of Alzheimer’s patients.8

A large case study of more than 18,000 participants was conducted to assess the risk factor of e-cigarette use associated with periodontal disease diagnosis to reflect the national population.9 Study findings revealed an increased risk of periodontal disease associated with vaping, even when accounting for the use of tobacco and other confounding variables.9 Notably, in vitro studies have shown “e-cigarette vapor can lead to inflammation of gingival epithelial cells similar to that observed in cells exposed to conventional cigarette smoke.”9

The oral effects of vaping may also include stomatitis or evidence of burns, which is not surprising when you realize that the heat necessary to vaporize the liquid can reach up to 420 degrees Fahrenheit.10 The liquid does cool some before passing over the tongue and oral cavity, but high temperatures may explain why some e-cigarette users complain of a sore or burning tongue sensation. Xerostomia caused by smoking or vaping may also contribute to the oral irritation.

Did you know that the use of vaping products increases caries risk and decreases enamel hardness by 27%?11 In addition to the increased caries risk, one study states that “certain e-liquid ingredients interact with hard tissues of the oral cavity in such a way that resembles high-sucrose candies and acidic drinks.”11 The e-liquids made with propylene glycol and glycerin increase attachment and provide additional food sources for bacteria, including Streptococcus mutans.

E-cigarette users show an increase in biofilm formation over those who do not use e-cigarettes, and vaping is noted to increase the microbial adhesion by four times.11 Combined with less-than-stellar home care, this combination can create an atmosphere primed for decay, along with an expensive restorative bill for the patient.

January 2020 brought a new national ban on flavored refillable cartridges and raised the minimum age of those who can purchase tobacco from 18 to 21.12 However, that did little to curb the way teens were still getting the attractive flavored devices. Going from the popular replaceable cartridges like JUUL, teens turned toward disposable cigarettes like Puff Bar that could still be sold in various flavors. This continued until July 20, 2020, when the FDA issued a warning letter to remove flavored disposable e-cigarettes and e-liquids from the market for illegal marketing.13

Excerpts of Article published in RDH magazine Nov 4, 2020 

By Jamie Collins, BS, RDH, EA

References

1. Digitale E. Vaping linked to COVID-19 risk in teens and young adults. Stanford School of Medicine. August 11, 2020. https://med.stanford.edu/news/all-news/2020/08/vaping-linked-to-covid-19-risk-in-teens-and-young-adults.html
2. Dahlberg B. Researchers uncover links between COVID-19 and smoking, vaping. WBFO NPR. June 30, 2020. https://news.wbfo.org/post/researchers-uncover-links-between-covid-19-and-smoking-vaping
3. Vaping and COVID-19: Can vaping increase complications? New York-Presbyterian Health Matters. https://healthmatters.nyp.org/vaping-and-covid-19-can-vaping-increase-complications/
4. Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. Centers for Disease Control and Prevention. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. Updated February 25, 2020. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
5. Youth and tobacco use. Centers for Disease Control and Prevention. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. Updated September 9, 2020. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm
6. Armatas C, Heinzerling A, Wilken JA. Notes from the field: e-cigarette, or vaping, product use—associated lung injury cases during the COVID-19 response—California, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(25):801-802. doi:10.15585/mmwr.mm6925a5
7. Betsaida A. A new sign of COVID-19: a rash in the mouth. News Medical. July 21, 2020. Accessed September 10, 2020. https://www.news-medical.net/news/20200721/A-new-sign-of-COVID-19-a-rash-in-the-mouth.aspx
8. .Kim J, Amar S. Periodontal disease and systemic conditions: a bidirectional relationship. Odontology. 2006;94(1):10-21. doi:10.1007/s10266-006-0060-6
9. Atuegwu NC, Perez MF, Oncken C, Thacker S, Mead EL, Mortensen EM. Association between regular electronic nicotine product use and self-reported periodontal disease status: population assessment of tobacco and health survey. Int J Environ Res Public Health. 2019;16(7):1263. doi:10.3390/ijerph16071263
10. Construction of electronic cigarettes. Wikipedia. Accessed September 10, 2020. https://en.wikipedia.org/wiki/Construction_of_electronic_cigarettes
11. Kim SA, Smith S, Beauchamp C, et al. Cariogenic potential of sweet flavors in electronic-cigarette liquids. PLoS ONE. 2018;13(9):e0203717. doi:10.1371/journal.pone.0203717
12. FDA finalizes enforcement policy on unauthorized flavored cartridge-based e-cigarettes that appeal to children, including fruit and mint. US Food and Drug Administration. January 2, 2020. https://www.fda.gov/news-events/press-announcements/fda-finalizes-enforcement-policy-unauthorized-flavored-cartridge-based-e-cigarettes-appeal-children
13. FDA notifies companies, including Puff Bar, to remove flavored disposable e-cigarettes and youth-appealing e-liquids from market for not having required authorization. US Food and Drug Administration. July 20, 2020. https://www.fda.gov/news-events/press-announcements/fda-notifies-companies-including-puff-bar-remove-flavored-disposable-e-cigarettes-and-youth

JAMIE COLLINS, RDH-EA, is a practicing clinical hygienist in Idaho and Washington states. She has been in the dental field for nearly 20 years, both as an assistant and hygienist. With a passion for patient care, especially for those with higher risk factors, she enjoys sharing the tips and tricks of the dental profession through speaking and writing. In addition to being in clinical practice, Collins is also an educator, has contributed to multiple textbooks and curriculum development, and is a key opinion leader. She can be contacted at jamiecollins.rdh@gmail.com.

Dear valued patients:

Our office is committed to maintaining your oral health while safeguarding our community from the effects of the Corona Virus (COVID-19) pandemic. We want to provide direction to you regarding your ongoing care, and advise you of the steps we are taking to ensure the safety and well-being of our patients and staff.

•       We are following directives from the Centers for Disease Control and Prevention (CDC) as well as the American Dental Association (ADA) to limit patient and staff exposure to this virus. We are also monitoring information from our state dental board and other regulatory bodies regarding safe practice procedures.

•       Federal and state guidelines are changing daily.. We will try to keep you posted on our website as well,  www.stlouisdentalimplants.com

•       Patients will be seen only to address emergency dental needs.

•       We will contact you as soon as reasonable to reschedule routine hygiene, maintenance, and elective procedures.

•       If you are already scheduled for an urgent issue, we will contact you the day before your appointment to discuss your health status, confirm whether you should be seen, and explain our current patient safety protocol. Please contact us as soon as possible if you believe you have a dental emergency.

•       Please continue to follow the home care regimen that has been established for you.

Your health remains our primary concern. We will continue to monitor the status of COVID-19 in our community and notify you when it is safe to return to business as usual in our office.

	If you have any questions or concerns, please call my cell 314-795-5557 or email georgeduello@gmail.com We will respond as soon as we can. Please take care of yourself and your loved ones during this health crisis, and we look forward to a return to good health and normalcy for all.

Be well,

Dr. Duello

Osteoporosis and Oral Health!

Osteoporosis is an ailment that comprises of loss in bone density, resulting in weak bones, easily causing fractures. Our bodies regularly absorb and reconstruct bone tissue; Osteoporosis is caused when there is an imbalance in this process. This may occur when the body is unable to produce sufficient new bone or absorbing too much bone; it may also be a result of both.

HOW DOES OSTEOPOROSIS AFFECT ORAL AND DENTAL HEALTH?

While Osteoporosis hampers the overall health and well-being, it can also have a direct impact on oral and dental health. The disease can hamper or damage jawbones and trigger gum or Periodontal Diseases and cause loss of teeth. The dental and oral effects of Osteoporosis are inclined to affect more women than men, especially women who are already in their menopausal phase. For someone who doesn’t have teeth and wears dentures, the effects of Osteoporosis can still affect their dental and oral health. Bone weakness and damage may also disturb the body ridges that hold dentures in proper position, resulting in poor-fitting dentures.

SIGNS OF OSTEOPOROSIS ONE SHOULD WATCH OUT FOR: Your dentist may notice the first stage of Osteoporosis based on evaluation of your medical history, and the result of clinical and X-ray reports. Your medical record provides details about risk factors such as genetics, Calcium deficiency, smoking, Menopause, extreme caffeine or alcohol consumption and an inactive lifestyle. In addition, numerous other signs may alert your dentist to the possibility of Osteoporosis:

– Loss of the bone in the jaw and around the teeth

– Tooth loss as a result of prolonged decay

– Loose dentures

– Gum disease

HERE ARE A FEW TIPS TO PREVENT OSTEOPOROSIS: Osteoporosis was previously considered a normal part of aging, but it is now understood to be preventable and treatable. Many interventions reduce fracture risk in the general population and can be used for primary and secondary prevention. These strategies include adequate intake of combined Calcium and Vit-D intake (Calcium alone has not been shown to reduce fractures), Anti

resorptive Therapy, weight-bearing exercise, tobacco avoidance, moderate alcohol intake, and avoidance of trip or fall hazards.

HERE ARE A FEW TIPS TO PREVENT ORAL ILL-HEALTH RESULTING FROM OSTEOARTHRITIS: Eating a well-balanced diet fruits & vegetables – increasing evidence suggests a positive association between fruit and vegetable (FV) components and bone health. These components include Potassium, Manganese, Vit-B complex, Vit-C, E, and K, and Phytochemicals (e.g., Carotenoids). Dietary sources of Calcium are Milk, Cottage Cheese, Yogurt, hard Cheese, green vegetables, etc. The greater intake of FV is associated with an increase in bone mass, and decrease in bone loss and fracture risk.

– Eat food that includes high amounts of Vitamin D & calcium

– Perform regular physical activities

– Avoid excessive intake of alcohol and smoking

(Disclaimer: Dr Raghavendra KS, Consultant, Joint Replacement & Spine Surgeon, Fortis Hospital, Kalyan & Dr Ajay Mathur, HOD-Dentistry and Maxillofacial Surgery, Hiranandani Hospital Vashi- A Fortis Network Hospital. Views expressed are a personal opinion.)