Policy Statement 2.2.11 - Community Oral Health Promotion: E-cigarettes

Position Summary

E-cigarettes may cause serious harm or injury and so should not be used. There should be further research to examine the health impact of the use of and exposure to E-cigarettes and the role of E-cigarettes in supporting smoking cessation.

1. Background

1.1. The use of E-cigarettes is commonly known as ‘vaping’.

1.2. Unless prescribed by a Medical Practitioner, it is illegal to use, sell or buy nicotine for use in e-cigarettes in Australia. Despite this, nicotine has been found in E-cigarette liquids claiming to be nicotine-free.1

1.3. Harmful substances have been found in E-cigarette liquids and the vapours produced could increase the risk of lung disease, heart disease and cancer.2

1.4. The use of E-cigarettes is expected to have adverse effects on the health of the oral cavity3 including higher risk of transformation of premalignant lesions and development of cancers comparable to those of non-smokers4, and a higher risk of fungal infections than non-smokers 5 . However, there is little current research that demonstrates E-cigarette use increases the risk of periodontal disease.6

1.5. E-cigarette use can cause serious injury and burns through fires and explosion of the device.7

1.6. E-cigarette use has a potential gateway effect that leads to cigarette smoking and normalising nicotine use, particularly among young people.8

1.7. The evidence for use of E-cigarettes to support smoking cessation is insufficient.

1.8. Some people continue to use tobacco products in combination with E-cigarettes.

1.9. The safety of E-cigarettes is hard to assess due to the variety of devices and liquids available, incomplete or inaccurate labelling, user ability to modify the device or liquids, and because many diseases take a long time to develop.9

1.10. Research on the health impact of long-term use of and exposure to E-cigarettes is lacking.10

Definitions

1.11. DENTAL PRACTITIONER is a person registered by the Australian Health Practitioner Regulation Agency via the Board to provide dental care.

1.12. E-CIGARETTES are battery-operated devices resembling cigarettes or pens that heat up a liquid which is then vaporised and inhaled by users.

1.13. MEDICAL PRACTITIONER is a person registered by the Medical Board of Australia to be able to use the title Medical Practitioner and be recognised to receive Medicare and other benefits.

2. Position

2.1. No one should use E-cigarettes.

2.2. Health professionals should not use E-cigarettes in public when they are identifiablein their occupational role.

2.3. The packaging or flavours of E-cigarette liquids should not be made to appeal to children or teenagers.

2.4. Public awareness programs on the health issues related to E-cigarette use should be encouraged and maintained.

2.5. Smokers wishing to quit should be encouraged to discuss smoking cessation methods with a Dental or Medical Practitioner.

2.6. Governments should consider the evidence base and cost-effectiveness of preventive strategies when making decision about public funding.

2.7. Governments should ensure appropriate funding and access to nicotine replacement therapies and quit nicotine programs.

2.8. There should be further research to examine the impact of the use of and exposure to E-cigarettes and the role of E-cigarettes in supporting smoking cessation.

 

References
1 Australian Government. About E-cigarettes [Internet]. Canberra (ACT): Department of Health; 2020 [updated 2020
March 17; cited 2020 July 19]. Available from: https://www.health.gov.au/health-topics/smoking-and-tobacco/aboutsmoking-and-tobacco/smoking-and-tobacco-laws-in-australia#ecigarette-laws
2Australian Government. About E-cigarettes [Internet]. Canberra (ACT): Department of Health; 2020 [updated 2020
March 17; cited 2020 July 19]. Available from: https://www.health.gov.au/health-topics/smoking-and-tobacco/aboutsmoking-and-tobacco/smoking-and-tobacco-laws-in-australia#ecigarette-laws
3 Ebersole J., Samburova V., Son Y, et al. Harmful chemicals emitted from electronic cigarettes and potential deleterious
effects in the oral cavity. Tob Induc Dis [Internet]. 2020 May 8 [cited 2020 July 19];18:4. Available from:
http://www.tobaccoinduceddiseases.org/Harmful-chemicals-emitted-from-electronic-cigarettes-and-npotentialdeleterious-effects,116988,0,2.html.
DOI:10.18332/tid/116988
4 Ramoa CP, Eissenberg T, Sahingur SE. Increasing popularity of waterpipe tobacco smoking and electronic cigarette
use: Implications for oral healthcare. J Periodontal Res. 2017 Oct;52(5):813-823. DOI:10.1111/jre.12458
5 Bardellini E, Amadori F, Conti G, et al. Oral mucosal lesions in electronic cigarettes consumers versus former smokers.
Acta Odontol Scand. 2018 Apr;76(3):226-228. DOI:10.1080/00016357.2017.1406613
6 Ebersole J., Samburova V., Son Y., Cappelli D., Demopoulos C., Capurro A. et al. Harmful chemicals emitted from
electronic cigarettes and potential deleterious effects in the oral cavity. Tob Induc Dis [Internet]. 2020 May 8 [cited 2020
July 19];18:5. Available from: http://www.tobaccoinduceddiseases.org/Harmful-chemicals-emitted-from-electroniccigarettes-and-npotential-deleterious-effects,116988,0,2.html.
DOI:10.18332/tid/116988
7 World Health Organization [Internet]. 2020 January 29 [cited 2020 July 19]. Available from: https://www.who.int/newsroom/q-a-detail/e-cigarettes-how-risky-are-they
8 Greenhalgh, EM, Scollo, MM and Winstanley, MH. Tobacco in Australia: Facts and issues [Internet]. Melbourne (VIC):
Cancer Council Victoria; 2020 [updated 2020; cited 2020 July 19]. Available from:
https://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18b-e-cigarettes/18b-6-potential-negativeimpacts
9 Australian Government. About E-cigarettes [Internet]. Canberra (ACT): Department of Health; 2020 [updated 2020
March 17; cited 2020 July 19]. Available from: https://www.health.gov.au/health-topics/smoking-and-tobacco/aboutsmoking-and-tobacco/smoking-and-tobacco-laws-in-australia#ecigarette-laws
10 World Health Organization [Internet]. 2020 January 29 [cited 2020 July 19]. Available from: https://www.who.int/newsroom/q-a-detail/e-cigarettes-how-risky-are-they