E-Cigarette Usage May Complicate Oral Surgery

Dentistry Today


Electronic cigarettes often are marketed as a “safer” alternative to traditional tobacco products. Yet they are still packed with nicotine, which inhibits wound healing, increases the risks of anesthesia, and may lead to other complications during and after surgery, according to the American Association of Nurse Anesthetists (ANNA).

With these potential dangers in mind, ANNA encourages patients to be completely honest about their health history with their surgeons, anesthetists, and other healthcare providers. Cathy Harrison, DNAP, MSN, CRNA, who has been a dental anesthesia provider for more than 17 years, recently shared her insights about e-cigarettes and oral health with Dentistry Today.

Q: What effect does e-cigarette use have on anesthesia during dental procedures and subsequent healing?

A: Anesthesia providers need to be aware that smokers, whether cigarettes or e-cigarettes, have very reactive airways. When patients are sedated, they may start coughing during the procedure. This also presents a hazard for the dentist, particularly in invasive procedures, such as when using a drill. 

Smokers may have other underlying comorbidities, which can lead to complications. A thorough health history is important for the anesthesia provider to understand the patient’s health and adjust the anesthetic or sedation plan accordingly.  

Nicotine impacts the body’s ability to deliver oxygen to organs and tissues, which is very important to keeping organs viable. This also may lead to increased risk of infection. If your body is not using oxygen and promoting adequate circulation, this decreases the body’s capability to heal appropriately and increases the risk of infection.

Smoking also is a risk factor for periodontal disease, which can lead to bone loss and loose teeth. This is an important consideration for anesthesia providers who provide general anesthesia because there is a large population of smokers who need surgery.

Q: What guidelines should dentists give their patients for e-cigarette use before or after these procedures?

A: Though a longer period of cessation around anesthesia and surgery is most beneficial, even 12 to 24 hours can significantly increase the body’s ability to deliver oxygen to vital organs and tissues. Patients should be advised not to smoke or use e-cigarettes after dental procedures, particularly if they involved bone grafting, sinus lift, or extractions. The action of drawing on a vaping apparatus causes negative pressure, which can pull the clot from the extraction site and cause dry socket. This is extremely painful.

Q: What effects do e-cigarettes have on oral health overall?

A: Smoking is a significant risk factor for the development of periodontal disease and can lower the chances of successful dental treatment. Smokers have increased incidence of periodontal disease, which can lead to destruction of the gums, bleeding gums, tooth loss, and bone loss.

Patients with periodontal disease also have a higher incidence of cardiac disease, which is an important consideration for anesthetic management. Pregnant patients with periodontal disease also have a higher incidence of premature labor. Diabetics, who already have slowed wound healing, increase the risk of poor wound healing when they use cigarettes or e-cigarettes. 

Q: Should dentists advise patients to quit and provide assistance in doing so? 

A: It is always good practice for all healthcare providers, including dentists, periodontists, and anesthesia providers, to encourage their patients to quit smoking or vaping due to the correlation with periodontal disease, oral cancer, and many of the issues noted above. It is important to educate patients and involve them in the plan of care, thus helping then make better choices about their oral health.

Patient education is also critical, especially with e-cigarettes, because patients aren’t aware of the health effects. Vaping and e-cigarettes are perceived to be a safer alternative to smoking cigarettes. This is not the case. E-cigarettes contain nicotine and have many detrimental health effects on oral and overall health. The incidence of teenagers taking up vaping continues to increase, which is an unfortunate statistic that they are becoming addicted so early in their lives.  

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Patients can be encouraged to use methods such as the nicotine patch or nicotine gum to start weening themselves off of e-cigarettes. These methods will also work for e-cigarettes/vaping, as the patient needs to address the nicotine addiction.