Myth: Alternative nicotine products are as dangerous as smoking: Difference between revisions

='''Nicotine Pouches'''=

===2022: [https://f1000research.com/articles/9-1225#f1 Nicotine products relative risk assessment: an updated systematic review and meta-analysis [version 2; peer review: 1 approved, 1 approved with reservations<nowiki>]</nowiki> Previously titled: Nicotine products relative risk assessment: a systematic review and meta-analysis]===

*Citation: Murkett R, Rugh M and Ding B. Nicotine products relative risk assessment: an updated systematic review and meta-analysis [version 2; peer review: 1 approved, 1 approved with reservations]. F1000Research 2022, 9:1225 (https://doi.org/10.12688/f1000research.26762.2)

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='''Nicotine Replacement Therapy (NRT)'''=

*There was moderate‐certainty that NRT reduced weight at end of treatment and moderate‐certainty that the effect may be similar at 12 months, although the estimates are too imprecise to assess long‐term benefit.

*Citation: Hartmann-Boyce J, Theodoulou A, Farley A, Hajek P, Lycett D, Jones LL, Kudlek L, Heath L, Hajizadeh A, Schenkels M, Aveyard P. Interventions for preventing weight gain after smoking cessation. Cochrane Database of Systematic Reviews 2021, Issue 10. Art. No.: CD006219. DOI: 10.1002/14651858.CD006219.pub4. Accessed 17 March 2024.

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*Citation: Thiem, D.G.E., Donkiewicz, P., Rejaey, R. et al. The impact of electronic and conventional cigarettes on periodontal health—a systematic review and meta-analysis. Clin Oral Invest 27, 4911–4928 (2023). https://doi.org/10.1007/s00784-023-05162-4

*"In summary, the oral health evidence supports the general public health messages and guidance on e-cigarettes. E-cigarette use is far less harmful than tobacco cigarettes, although not risk free – we will likely see oral health consequences of long-term vaping (but less than from tobacco smoking). E-cigarettes are not recommended for non-users, especially young people. For existing smokers, e-cigarettes can be an effective quit aid and dental professionals should support patients who choose to use this method of cessation."

===2022: [https://www.cdhjournal.org/issues/39-2-june-2022/1124-electronic-cigarettes-an-update-on-products-regulation-public-health-approaches-and-oral-health Electronic cigarettes: an update on products, regulation, public health approaches and oral health]===

*Regulatory approaches vary considerably around the world but in the UK and Europe, e-cigarettes are regulated as consumer or medicinal product, and their use is permitted. In the UK, e-cigarettes have increasingly been supported by public health institutions for smoking cessation as part of a Tobacco Harm Reduction strategy.  

*The potential harms (including to oral health) from e-cigarette use are likely to be much less than from tobacco cigarettes.

*In summary, e-cigarettes have good evidence to support them as an effective smoking cessation aid for tobacco smokers. Smokers can expect to see substantial improvements in their oral health if they fully switch to an e-cigarette. Longer-term use is a balanced judgement between smoking relapse prevention against the small risk of any detrimental effects from the e-cigarettes themselves.

===2022: [https://journals.asm.org/doi/full/10.1128/mbio.00075-22 Electronic Cigarette Use Promotes a Unique Periodontal Microbiome]===

*Our results demonstrate that the e-cig user’s subgingival microbiome is a unique amalgamation of microbiota, containing similarities to those of both conventional smokers and nonsmokers. Due to many shared features with the conventional smoker’s microbiome and considering the widespread promotion of e-cigarettes as a “healthier” alternative to or replacement for conventional cigarettes, our results show that e-cigarette use may promote a healthier SGP [subgingival plaque] microbiome with respect to that of smokers but not compared to that found with never smoking in the first place.

===2019: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6888580/ Influence of Electronic Cigarettes on Selected Antibacterial Properties of Saliva]===

*Lowering the level of IgA in saliva may lead to a weakening of the specific immune response and cause earlier development of more severe periodontitis. In our research, it was observed that the tobacco smokers’ level of salivary IgA was statistically significantly lower in comparison to the values in both the control group and the group of e-cigarette users. IgA content in the saliva of e-cigarette users was not statistically significant lower compared to the control group. This indicates that electronic cigarettes compared to traditional cigarettes have less effect on IgA concentration in saliva.  

===2019: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722047/ A lower impact of an acute exposure to electronic cigarette aerosols than to cigarette smoke in human organotypic buccal and small airway cultures was demonstrated using systems toxicology assessment]===

*Overall, the study demonstrated that exposure to undiluted test mix or base EC aerosols under the testing conditions (an acute 28-min exposure), even at a deposited nicotine concentration that is 200 times greater than that found in the saliva of EC users, had no impact on morphology of buccal and small airway cultures. In contrast, following the same puff number, the already diluted 3R4F CS resulted in overt tissue damage.

===2019: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6949915/ A Comparison of Flavorless Electronic Cigarette-Generated Aerosol and Conventional Cigarette Smoke on the Planktonic Growth of Common Oral Commensal Streptococci]===

*A potential implication of these results is that flavorless E-liquids and their generated aerosol induce less tooth decay and periodontal disease than traditional cigarette smoke.

*A case for improving oral health (and overall health) could be made by federal health regulatory agencies for promoting the use of electronic nicotine delivery systems over the use of traditional cigarettes as a means of harm reduction.

===2019: [https://pubmed.ncbi.nlm.nih.gov/30361795/ Impact of cigarette smoking and vaping on the outcome of full-mouth ultrasonic scaling among patients with gingival inflammation: a prospective study]===

*There are no studies that have assessed the oral soft tissue response to full-mouth ultrasonic scaling (FMUS) among cigarette-smokers (CS) (group 1), individuals vaping electronic-cigarettes (E-cigs) (group 2), and never-smokers (NS) (group 3). The aim was to assess the impact of cigarette smoking and vaping on periodontal tissues following FMUS.

*Following FMUS, gingival inflammation is worse in CS compared with individuals vaping E-cigs and NS.

===2019: [https://pubmed.ncbi.nlm.nih.gov/31078071/ Clinical periodontal status and gingival crevicular fluid cytokine profile among cigarette-smokers, electronic-cigarette users and never-smokers]===

*Periodontal status is poorer and GCF levels of proinflammatory cytokines are higher in cigarette-smokers compared with electronic-cigarette smokers and never-smokers. However, the probability of increased periodontal inflammation and GCF proinflammatory cytokine levels in electronic-cigarette users than never-smokers cannot be annulled.

===2018: [https://www.sciencedirect.com/science/article/abs/pii/S0278691518303491 Comparative study of the effects of cigarette smoke and electronic cigarettes on human gingival fibroblast proliferation, migration and apoptosis]===

*The damage to gingival fibroblasts was greater with conventional cigarette smoke condensate than with nicotine-rich e-vapor condensate.

===2018: [https://pubmed.ncbi.nlm.nih.gov/30346667/ Assessment of enamel discoloration in vitro following exposure to cigarette smoke and emissions from novel vapor and tobacco heating products]===

*For the first time, diverse NGPs [next generation tobacco and nicotine products] across the risk continuum were assessed in vitro for their impact on enamel staining. CS exposure significantly increased the level of bovine enamel sample discoloration, whereas THP1.0 [tobacco heated product] or NVP [nicotine vapor product] exposure resulted in values comparable to the controls.

===2018: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933315/ Effects of tobacco smoke and electronic cigarette vapor exposure on the oral and gut microbiota in humans: a pilot study]===

*In summary, we found that tobacco smoking significantly alters the bacterial profiles in feces, buccal, and saliva samples. Compared to controls, exposure to ECs had no effect on the oral or gut communities. Changes in the gut microbiota of tobacco smokers were associated with increased relative abundance of Prevotella and decreased relative abundance of Bacteroides. From a microbial ecology perspective, this study supports the perception that ECs represent a safer alternative to tobacco smoking.  

===2017: [https://aap.onlinelibrary.wiley.com/doi/abs/10.1902/jop.2017.170197 Comparison of Periodontal Parameters and Self-Perceived Oral Symptoms Among Cigarette Smokers, Individuals Vaping Electronic Cigarettes, and Never-Smokers]===

*To the authors’ knowledge, there are no studies that have compared periodontal parameters and self-perceived oral symptoms (OSs) among cigarette smokers (CSs) (group 1), individuals exclusively vaping electronic cigarettes (group 2), and never-smokers (NSs) (group 3).  

*Periodontal inflammation and self-perceived OSs were poorer among CSs than among vaping individuals and NSs.

===2016: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5068504/ Electronic Cigarette: Role in the Primary Prevention of Oral Cavity Cancer]===

*Cigarette smoke has been identified as the main cause of oral cavity carcinoma. ...in our in vivo study, the oral cavity cells of e-cigarette smokers showed CMN and TMN values similar to those of healthy controls, indicating the safety of e-cigarettes.  The use of electronic cigarettes seems to be safe for oral cells and should be suggested as an aid to smoking cessation.

*"Smoking is the cause of many serious oral health problems, including worsening gum disease, which is one of the most common causes of caries in UK adults. It is also responsible for the majority or mouth cancers and is the direct cause of thousands of deaths every year. Every year almost seven thousand people in the UK are diagnosed with mouth cancer, and it leads to more deaths than testicular and cervical cancer combined."

*"We need to spread the message that e-cigarettes, while not risk free, are much less harmful than smoking, as currently nearly half the population are not aware of this… The British Dental Health Foundation believe that there is a long way to go to before we get to a smoke-free lifestyle but any way which smoking numbers can be cut, and therefore lives saved, is positive and one which we will support.”

==Respiratory System==

===2022: [https://pubs.rsna.org/doi/10.1148/radiol.211327 MRI Shows Lung Perfusion Changes after Vaping and Smoking]===

*MRI Shows Lung Perfusion Changes after Vaping and Smoking. MRI shows that the lungs of vapers have better blood circulation than those of smokers.

===2021: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8371723/ Impact of exclusive e-cigarettes and heated tobacco products use on muco-ciliary clearance]===

*...we are now confident that current vaping products are much less harmful than conventional cigarettes as well as earlier EC designs.

*[https://www.tandfonline.com/doi/pdf/10.1080/17476348.2019.1649146?needAccess=true PDF]

===2018: [https://www.dovepress.com/health-effects-in-copd-smokers-who-switch-to-electronic-cigarettes-a-r-peer-reviewed-fulltext-article-COPD Health effects in COPD smokers who switch to electronic cigarettes: a retrospective-prospective 3-year follow-up]===   

*Although ECs are not risk free, they are much less harmful than conventional tobacco smoking. The emerging clinical evidence suggests that ECs are unlikely to raise significant health concerns for the respiratory tract under normal conditions of use, even in smokers with preexisting lung disease. In particular, recent studies in COPD and chronic asthma suggest that substitution of conventional tobacco cigarettes for ECs can ameliorate subjective and objective disease-related outcomes and exacerbation rates as well as improving success in abstaining from smoking long term.

*[https://acrobat.adobe.com/link/track?uri=urn%3Aaaid%3Ascds%3AUS%3Aaa3f75b1-853a-484c-b692-f9ca7a5ee2d2&viewer%21megaVerb=group-discover PDF]

===2017: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5429854/ Reduced biological effect of e-cigarette aerosol compared to cigarette smoke evaluated in vitro using normalized nicotine dose and RNA-seq-based toxicogenomics]===   

** In studies on ENDS, it may be beneficial to use a panel of biomarkers

* The biomarker levels of many tobacco-related toxicants measured in biological samples collected from ENDS users did not differ significantly from non-users, except for nicotine metabolites and a small number of biomarkers of exposure to volatile organic compounds and tobacco-specific tobacco nitrosamines. Several studies have shown that while exposed to nicotine, long-term exclusive ENDS users showed significantly lower levels of toxicant biomarkers than cigarette smokers.  

===2023: [https://www.nature.com/articles/s41598-023-44626-1 Cytotoxicity, mutagenicity and genotoxicity of electronic cigarettes emission aerosols compared to cigarette smoke: the REPLICA project]===

*The results showed high cytotoxicity, mutagenicity and genotoxicity induced by cigarette smoke, but slight or no cytotoxic, mutagenic and genotoxic effects induced by the e-cigarette aerosol. Although the two studies presented some methodological differences, the findings supported those previously presented by Rudd and colleagues.

===2022: [https://pubmed.ncbi.nlm.nih.gov/35858275/ Increased Levels of the Acrolein Metabolite 3-Hydroxypropyl Mercapturic Acid in the Urine of e-Cigarette Users]===