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Yan X, Chen Z, Rong X, Chen Z, Wu G, Dong Z, Fu Y, Hai T. The impact of sucralose and neotame on the safety of metal precipitation in electronic cigarettes. Front Physiol 2024; 15:1437042. [PMID: 39234311 PMCID: PMC11371770 DOI: 10.3389/fphys.2024.1437042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/09/2024] [Indexed: 09/06/2024] Open
Abstract
This study investigated the impact of sweeteners on the release of heavy metals during the heating and atomization processes in electronic cigarettes. Based on a PG/VG base e-liquid with the addition of 2% and 5% neotame or sucralose, we quantitatively analyzed the impact of sweetener content on the levels of heavy metals such as Ni, Cr, and Fe in the e-liquid and aerosol after heating and atomization. Additionally, the heated e-liquid samples were used to culture SH-SY-5Y and Beas-2B cells, and their cytotoxic effects were assessed using the CCK-8 assay. The results indicated that the e-liquid with 5% sucralose had the highest average levels of heavy metals after heating and atomization, particularly nickel (13.36 ± 2.50 mg/kg in the e-liquid and 12,109 ± 3,229 ng/200 puffs in the aerosol), whereas the e-liquid with neotame had significantly lower average heavy metal content in comparison. Additionally, it was measured that the chloride ion concentration in the e-liquid with 5% sucralose reached 191 mg/kg after heating at 200°C for 1 h, indicating that heating sucralose generated chloride ions, Which might corrode metal parts components leading to heavy metal release. Cytotoxicity tests revealed that the base e-liquid without sweeteners exhibited the highest average cell viability after heating, at 64.80% ± 2.84% in SH-SY-5Y cells and 63.24% ± 0.86% in Beas-2B cells. Conversely, the e-liquid variant with 5% sucralose showed a significant reduction in average cell viability, reducing it to 50.74% ± 0.88% in SH-SY-5Y cells and 53.03% ± 0.76% in Beas-2B cells, highlighting its more pronounced cytotoxic effects compared to other tested e-liquids. In conclusion, sucralose in e-liquids should be limited preferably less than 2%, or replaced with neotame, a safer alternative, to minimize health risks.
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Affiliation(s)
- Xinyang Yan
- Research and Development Center, IMiracle (Shenzhen) Innovation Technology Co., Ltd., Shenzhen, China
| | - Zheng Chen
- Research and Development Center, IMiracle (Shenzhen) Innovation Technology Co., Ltd., Shenzhen, China
| | - Xianfang Rong
- Research and Development Center, IMiracle (Shenzhen) Innovation Technology Co., Ltd., Shenzhen, China
| | - Zhichao Chen
- Research and Development Center, IMiracle (Shenzhen) Innovation Technology Co., Ltd., Shenzhen, China
| | - Guanlin Wu
- Research and Development Center, IMiracle (Shenzhen) Innovation Technology Co., Ltd., Shenzhen, China
| | - Zeyi Dong
- Research and Development Center, IMiracle (Shenzhen) Innovation Technology Co., Ltd., Shenzhen, China
| | - Yao Fu
- Research and Development Center, IMiracle (Shenzhen) Innovation Technology Co., Ltd., Shenzhen, China
| | - Tao Hai
- Research and Development Center, IMiracle (Shenzhen) Innovation Technology Co., Ltd., Shenzhen, China
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Garcia BDFS, Nascimento BDB, Marques EF, Jesus CBDD, Santana Neto IC, Rocha LST, Oliveira GMSD, Bazaglia da Silva MI, Kasai MLHI, Takahama Junior A. The use of electronic cigarettes and other tobacco products among university students and their potential relationship with oral health: A cross-sectional study. J Am Dent Assoc 2024; 155:647-656. [PMID: 38878025 DOI: 10.1016/j.adaj.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 03/20/2024] [Accepted: 04/19/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND The aim of this study was to evaluate oral alterations among university students and explore possible associations with tobacco consumption in its various forms. METHODS A cross-sectional study was conducted in 2 phases: the first phase involved administering an electronic questionnaire to participants determine the prevalence of tobacco use and the second phase involved a physical examination of the participants. The participants were grouped on the basis of their reported habits and compared using statistical analysis (P < .05). RESULTS Of the 620 participants, 57.1% reported using tobacco in some form, with 47.4% reporting electronic cigarette (e-cigarette) use. In the clinical phase, comparing the presence of oral changes in tobacco users vs nonusers, e-cigarette users had a higher proportion of white-spot caries lesions (P = .041) and gingivitis (P = .012). When e-cigarette use was combined with other forms of tobacco use, additional oral changes were more prevalent, including coated tongue and nicotinic stomatitis (P < .05). CONCLUSIONS The use of alternative forms of tobacco consumption is common among university students, with e-cigarette use being the most prevalent form, and may lead to detrimental effects on the oral cavity, such as caries and gingivitis, particularly when used in conjunction with other tobacco products. PRACTICAL IMPLICATIONS The use of tobacco in alternative forms, such as e-cigarettes, can affect oral health directly or indirectly. Dentists should be familiar with the characteristics of this population and the potential oral repercussions associated with tobacco use to address the impact on health and raise awareness of the associated risks.
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Majid OW. Preliminary evidence of impaired oral wound healing in e-cigarette users: a call for perioperative vaping cessation. Evid Based Dent 2024; 25:63-64. [PMID: 38279036 DOI: 10.1038/s41432-024-00982-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
DESIGN A prospective, parallel-arm, age- and gender-matched clinical study. OBJECTIVE To assess and compare palatal wound healing of orally and systemically healthy e-cigarette users with a matched group of non-vapers. METHODS Included were healthy adult volunteers (18-50 years), either e-cigarette users or never smokers, who agreed to use a study-specific e-cigarette device and e-liquids, and were willing to provide consent from. Exclusion criteria were: hypersensitivity to lidocaine, ASA grade >2, recent antibiotic therapy, history of periodontal surgery, active oral lesions, and carious cavities. E-cigarette users were instructed to use the device 2 times daily for more than 1 hour each, with 20 puffs per session. Bilateral 5 mm punch biopsy wounds were made palatally opposite to the 2nd premolar, and subjects were followed up at 1, 2, 4, 7, 14 and 21 days post-operatively. Throughout this period, 3 mm punch biopsies were harvested from the right and left healing wounds at 1- and 3- weeks respectively. All surgical procedures were conducted by the same operator. Pre-wounding palatal biofilms were collected by swabs for metabolomic profiling. Wound healing was evaluated by clinical assessment, metabolite profile, histology, and immunohistochemistry to quantify the following proteins: vimentin, keratin and filaggrin. RESULTS A total of 16 individuals were recruited: 8 e-cigarette users and 8 non-vapers. The average age was 27 years, and there were 4 men and 4 women in each group. The e-cigarette group tended to show a slightly lower total score of healing index in all visits compared to the control subjects, but the differences were not statistically significant. No site exhibited suppuration at any point, and no differences between groups were observed in the parameters of granulation. However, statistically significant differences were observed between groups for bleeding and swelling (p < 0.0001 and p = 0.0083, respectively), but not for epithelialization and redness (p = 0.0834 and p = 0.0967, respectively). Pain on palpation and difficulty in achieving hemostasis were more prevalent in e-cigarette group. The metabolic analysis between week 1 and 3 revealed significantly elevated carbohydrate and lipid metabolism in e-cigarette users, while protein metabolism was over-represented in the control group. For immunohistochemistry, significantly lower scores of vimentin, keratin, and filaggrin were shown in the e-cigarette group compared to controls at 1 and 3 weeks (p < 0.05 and p < 0.01, respectively). CONCLUSION E-cigarettes may significantly impair oral wound healing by impacting keratinization of epithelium and modifying the metabolic composition of the oral microbiome. Therefore, vaping cannot be regarded as safe for patients undergoing oral surgery.
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Affiliation(s)
- Omer Waleed Majid
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Mosul University, Mosul, Iraq.
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Yahya L, Mandoura N, Harere R. Nicotine Dependency Levels Among Adult Electronic Cigarette Smokers in Jeddah, Saudi Arabia: An Analytical Cross-Sectional Study. Cureus 2024; 16:e61038. [PMID: 38800771 PMCID: PMC11127123 DOI: 10.7759/cureus.61038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Electronic cigarettes (ECs) are a recent method to deliver nicotine with less harmful effects than traditional cigarettes. Studying nicotine dependence in adult EC users is a crucial area, but few measures are available to evaluate nicotine dependence induced by EC. Our study aims to estimate the levels of nicotine dependency among adult EC smokers using a modified Fagerström Test of Nicotine Dependence (e-FTND) in Jeddah, Saudi Arabia, and to identify EC-associated sociodemographic and smoking-related factors affecting nicotine dependency. METHODS An analytical cross-sectional study was conducted on adults 18 years of age and older in Jeddah, Saudi Arabia, from December 2023 to March 2024. Data were collected from the participants using a pre-tested structured self-administered questionnaire, and nicotine dependence was assessed using the modified e-FTND. Descriptive statistics such as frequency, mean, and standard deviation were applied. Chi-square was used to assess the association between categorical variables. Ordinal regression was used to predict the nicotine dependency levels with different variables. RESULTS A total of 344 participants were included in the study. The mean e-FTND score for EC users was 4.14 ± 2.45. Females had a lower likelihood of experiencing higher dependence compared to males (OR = 0.52, 95% CI: 0.32, 0.85). Using ECs for more than three years was associated with higher odds of increased dependence (OR = 3.18, 95% CI: 1.28, 7.98; p < 0.001). The use of Pod system devices lowered the odds of developing high nicotine dependence (OR = 0.32, 95% CI: 0.13, 0.75; p = 0.01) compared to Iqos device users, while mechanical Mod device users exhibited a trend towards higher dependence, although it was not statistically significant. Nicotine concentration in ECs had a significant impact on the degree of nicotine dependence. Higher concentrations were associated with increased odds of higher dependence (12-18 mg: OR = 3.26, 95% CI: 1.55, 6.91; >18 mg: OR = 4.53, 95% CI: 2.37, 8.75; p < 0.001). CONCLUSION Most exclusive EC users in the study developed a moderate nicotine dependence level. The EC device type and nicotine concentration were significant drivers of nicotine dependence. Additionally, the personal characteristics of the users, such as male gender and duration of use, were associated with a higher risk of dependence. An in-depth understanding of the magnitude of nicotine dependence among EC users will enhance the opportunity for tailored health-enhancing interventions and policies.
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Affiliation(s)
- Lama Yahya
- Preventive Medicine Postgraduate Program, Saudi Ministry of Health, Jeddah, SAU
| | - Najlaa Mandoura
- Preventive Medicine Postgraduate Program, Saudi Ministry of Health, Jeddah, SAU
| | - Rania Harere
- Family and Community Medicine, Saudi Ministry of Health, Jeddah, SAU
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Santos-Silva AR, Martins BNFL, Lopes MA, Migliorati CA. Integrating e-cigarette (vaping) questions into medical and dental charts: a critical need. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:93-94. [PMID: 38114404 DOI: 10.1016/j.oooo.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
| | - Beatriz Nascimento Figueiredo Lebre Martins
- Oral Diagnosis Department, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; College of Dentistry, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida, Gainesville, Florida
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, State University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Cesar Augusto Migliorati
- College of Dentistry, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida, Gainesville, Florida
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Goel S, Shabil M, Kaur J, Chauhan A, Rinkoo AV. Safety, efficacy and health impact of electronic nicotine delivery systems (ENDS): an umbrella review protocol. BMJ Open 2024; 14:e080274. [PMID: 38286688 PMCID: PMC10826537 DOI: 10.1136/bmjopen-2023-080274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/07/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Electronic nicotine delivery systems (ENDS), commonly known as e-cigarettes or vapes, have witnessed a rise in popularity, particularly among the youth. Although they were initially introduced as an alternative to traditional smoking, the design and function of ENDS vary. The potential health effects of ENDS, especially in comparison to traditional cigarettes, are a matter of ongoing debate. Given the increasing number of clinical studies and systematic reviews on this topic, there exists a demand for an umbrella review that offers a comprehensive assessment. The goal of this study is to perform an umbrella review of systematic reviews and meta-analyses to assess the safety, efficacy, health implications and potential gateway effect associated with ENDS. METHODS AND ANALYSIS This umbrella review will adhere to the Joanna Briggs Institute (JBI) framework and the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A planned literature search will be executed across databases such as OVID, PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science. The inclusion criteria are systematic reviews that discuss ENDS and e-liquids in the context of safety, efficacy and health outcomes. The exclusion criteria include narrative reviews, non-systematic reviews and studies not in English. Quality of the selected studies will be evaluated using the AMSTAR V.2 Scale. An overlap assessment will be done using the Corrected Covered Area, and data synthesis will be presented both narratively and in tabulated forms ETHICS AND DISSEMINATION: Ethics approval is not required for this study, as it does not involve the collection of original data. The results will be disseminated through peer-reviewed publication. The findings will offer crucial insights for stakeholders, policy-makers and the general public, underlining the health implications and the role of ENDS in tobacco cessation.
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Affiliation(s)
- Sonu Goel
- University of Limerick, Limerick, Ireland
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Muhammed Shabil
- Department of Pharmacy Practice, M. S. Ramaiah University of Applied Sciences, Banglore, India
| | - Jagdish Kaur
- World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Anil Chauhan
- Department of Telemedicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Scott JG, McKeon G. Author reply to Letter to the Editor regarding 'Smoke and Mirrors: Support from psychiatrists for nicotine e-cigarette availability in Australia'. Aust N Z J Psychiatry 2023; 57:1497-1498. [PMID: 37642140 DOI: 10.1177/00048674231195948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- James G Scott
- Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
- Child and Youth Mental Health Service, Queensland Children's Hospital, South Brisbane, QLD, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Gemma McKeon
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
- Psychology, West Moreton Health, Wacol, QLD, Australia
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