“Don’t be a butthead.”

“Smoke free is the way to bee.”

The ugly truth.

Even with decades of memorable warnings and data, people are still taking up the deadly habit of smoking, still facing the same — and even new — health risks. February marks Children’s Dental Health Month, a perfect time to call out the prevalence of vaping (using e-cigarettes) among adolescents.

More than 2 million middle school- and high school-aged U.S. teens reported vaping in 2021. In Oregon, just more than 25% of 11th graders and 13% of eighth graders said vaping was their entry into smoking. The most recent Oregon Healthy Teens Survey report also shows that roughly 60% of students believe that vaping every day poses only a moderate, slight or no risk at all of general harm.

As a leader in the oral health field, I suppose that doesn’t surprise me. I mostly remember the anti-tobacco campaigns that featured a smoker with yellow teeth or a hole in the throat. Traditional cigarettes in the past few decades haven’t seemed to be mistaken for a low-risk habit, perhaps because of those campaigns.

Today, e-cigarettes have health risks just as deserving of public health campaigns and just as serious for young people, including risks of mood disorders and addiction, as well as serious impacts on oral health.

Clearly, there is a need to raise awareness about just how harmful it is to vape.

We know COVID-19 has intensified the problem.

“Adolescents who experienced pandemic-related severe stress, depression or anxiety, or whose families experienced material hardship during the pandemic were most likely to use substances,” researchers note. Though national data indicates teen substance abuse remained the same or declined overall during the pandemic, the number of kids using nicotine products jumped.

Life changes from COVID-19 may have reinforced vaping as the predominant method of nicotine consumption among young people because vape pens are easier to conceal at home than alcohol and have a false reputation for being safer than regular cigarettes. But nicotine isn’t the only cause of adverse health effects we need to worry about.

Research shows vaping increases inflammation throughout the body, raising the risk for life-threatening health issues such as stroke and cardiovascular disease. A study published in the Journal of Adolescent Health suggests young adults who only vape are five times more likely to get COVID-19 than their peers who smoke traditional cigarettes or do not use either product. Vaping also severely impacts oral health, which is directly related to increased risk for long-term threats of dental decay, gum disease and cancer, and compounds many of the other health issues mentioned.

E-cigarettes contain toxins including formaldehyde, cadmium, nickel and lead that damage the skin and make it more prone to infections and acne, as well as worsen psoriasis and rosacea. Chemicals in e-cigarettes, like propylene glycol, vegetable glycerin and acetaldehyde, can harm both hard and soft tissue in the mouth, while nicotine reduces blood flow in the mouth, resulting in gum disease and even permanent loss of teeth.

The majority of teenagers report that candy flavors were the reason they first tried an e-cigarette. Perhaps ironic, these flavored vapes, such as “tutti frutti,” “bubblegum” and “cotton candy,” increase risk for cavities and other oral disease just like actual candies. Vape flavor additives double the growth of bacteria in the mouth that cause tooth decay, while also decreasing the hardness of tooth enamel by 27%, limiting natural protection against that bacteria.

Poor oral and overall health in adolescence frequently leads to even worse oral and overall health during adulthood.

Educating youth and empowering them with refusal skills to resist marketing and peer pressure ensures fewer young people are harmed by e-cigarettes. It’s why we must support the national, evidence-based CATCH My Breath school program, which reduces students’ likelihood to experiment with vaping by 45%.

But it’s time to bring in reinforcements. Open conversation with adults outside of school is key to helping teens make healthier decisions for their future. Take the time to educate yourself and then talk about vaping with the teens in your life.

The health of a generation depends on it.

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