CDA Essentials 2018 • Volume 5 • Issue 8

33 Issue 8 | 2018 | S upporting Y our P ractice Using a subset of data from the Population Assessment of Tobacco and Health Study, which involves collaboration between the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC), the study analysed data from roughly 6,000 adults who provided urine specimens and reported a history of their tobacco use behaviours over the prior 30 days. Participants were categorized according to the type of products they used: combustible (cigarettes, cigars, waterpipes, pipes, blunts), smokeless (moist snuff, chewing tobacco, snus), e-cigarettes and nicotine replacement products. The research team measured participants’ exposure to one type of harmful chemical in particular: carcinogens called tobacco-specific nitrosamines. One nitrosamine they measured, abbreviated NNK, is measured by its urinary metabolite, NNAL. “We found that, on average, all tobacco users had fairly high levels of nicotine in their system, regardless of the type of product they were using, which is what we would expect,” says Dr. Chaffee. “But, levels of NNAL were highest among individuals who were only using spit or chew tobacco, and lowest among individuals who were using only e-cigarettes.” In terms of this one measure (NNAL), e-cigarette use was associated with lower exposure levels than smoking. However, most people in the study who used e-cigarettes also smoked combustible tobacco, raising their NNAL exposure. “E-cigarettes are likely to be less harmful than smoking, but they’re certainly not harm- free. To achieve a significant reduction in risk from carcinogens, our results suggest there is a need to completely switch over from smoking to electronic cigarettes and that’s something that most users of electronic cigarettes did not achieve.” For dentists, the study findings highlight the need to talk to patients about all forms of tobacco, not just conventional cigarettes. “If a patient who is currently smoking is interested in trying e-cigarettes as a way to get away from combustible tobacco, the dentist should encourage that desire to improve health,” says Dr. Chaffee. “But dentists should emphasize that the healthiest option is to live completely tobacco and nicotine-free.” a “There’s a real demand from the public for answers about the health risks of e-cigarettes, and rightly so,” says Dr. Chaffee. “But sometimes I get a sense that there’s a tendency to draw simple conclusions: that e-cigarettes are either just as bad as smoking or they’re completely harmless. And the situation is more complicated than that.” Dr. Benjamin Chaffee is assistant professor in the department of preventive and restorative dental sciences at the University of California San Francisco. At the 2018 International Association for Dental Research (IADR) conference held in London, UK, he presented his research team’s findings from a study examining people’s exposure to potentially carcinogenic chemicals according to different tobacco products, alone in or combination. 1 Exposure to carcinogenic chemicals in different tobacco products Visit Oasis Discussions for Dr. Chaffee’s full interview: wp.me/p2Lv6A-65E Reference 1. Chaffee BW, Benowitz N. Nicotine and carcinogen exposure by tobacco product type and dual-use. J Dent Res. Vol 97 (Spec Issue A):2848, 2018. (abstract)