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Typically battery operated devices to deliver nicotine through a heated solution.

E-cigarettes are battery powered devices that heat liquids containing nicotine, flavoring, and other substances to create aerosols.

Most types consist of a rechargeable lithium battery operated heating element, a replaceable or refillable nicotine containing cartridge, and an atomizer that uses heat to convert the contents of the cartridge into a nicotine containing vapor that is inhaled .

Vaping is typically associated with the use of nicotine e-cigarettes.

The heated solution typically contains nicotine and other chemicals including flavorings, to produce an aerosol that users inhale or vape.

Each device structurally comprises for components: a battery, a reservoir with liquid formulation, and a vaporizing chamber with a heating element, along with a mouthpiece for inhalation.

More than 10% of high school students,, more than 4.5% of US adults, and 4.6% of middle school students report currently using E-cigarettes.

Closed system vaping devices have self contained E-liquids and are not meant for modifications whereas open system vaping devices can be modified, allowing users to insert a range of e-liquids, including cannabinoids.

The heating element vaporizes a humectant propylene glycol, vegetable glycerin, and or polyethylene glycol 400 that contains liquid nicotine.

Delivers vaporized nicotine.

The evaporation of the liquid at the heating element is followed by rapid cooling and forms the aerosol, which is inhaled or vaped.

E-cigarettes contain nicotine, which is highly addictive.

They also contain other chemicals with largely unknown long-term health effects.

E-cigarettes do not contain toxic products of combustion such as carbon monoxide, or the more than 70 carcinogens found in combusted cigarettes.

The health effects of vaping are likely to vary depending upon the device used, the substance being vaped, and the amount and type of exposure.

Within minutes to hours of E-cigarette use, acute physiological and cellular changes, have been observed, including increased heart rate and blood pressure, impaired endothelial function, increase oxidative stress, and evidence of airflow obstruction.

E-cigarettes have been associated with cardiovascular effects including increased odds of myocardial infarction, thermal injuries due to explosions, causing soft tissue and facial injury, and psychosocial effects secondary to addictive behavior.

Nicotine E-liquids vaped has been shown to deliver substantially lower concentrations of toxic substances per puff than conventional cigarette smoking.

This fact may not apply to modified E-liquids, but little is known about the health effects of vaping cannabinoids.

More than 10 million people in the United States currently use electronic cigarettes.

vaping nicotine has the main age of onset of approximate 14 years.

10% of US secondary school students currently vape, exceeding all other tobacco products combined.

About half of the users are under 35 years old, raising concerns about long-term health consequences.

E-cigarettes are considered safer than traditional cigarettes, but they are still not considered safe.

These devices are engineered to deliver higher and more addictive doses of nicotine with fruit, candy, and flavors and appeal to youth and reduce perception for harm.

Traditional tobacco products like cigarettes and cigars contain thousands of chemicals, about 70 of which are known to cause cancer.

Most vape liquids contain 5% nicotine (39–40 8 mg per pod) propylene glycol, glycerin, flavoring, carcinogens, such as aldehydes, heavy metals, such as nickel, tin, and lead and other chemicals, such as diacetyl, which you’ve been with serious lung disease.

Newer disposable devices with 10 mL well of 5% nicotine (5–600 mg per device) is the equivalent of more than 10 packs of cigarettes.

E-cigarettes are battery operated and are not burned, so they don’t emit all the cancer-causing compounds that are released when tobacco is smoked.

Currently unregulated and manufactured without strict safeguards.

E-cigarettes may contain other dangerous substances, such as heavy metals like nickel, tin, and lead.

Irritation and inflammation in the lungs may occur from ultrafine particles contained in the vapor from e-cigarettes.

Vaping associated with increases in prevalence and incidence ratios of asthma, COPD, periodontitis, cardiovascular disease, and stroke.

Harmful substances found in e-cigarettes come from the chemicals that provide on their flavors.

Nicotine at high doses causes addiction,and negative cardiovascular effects.

E-cigarettes are especially unsafe for kids, teens, and young adults, as nicotine can harm the parts of the developing brain that control attention, learning, mood, and impulse control.

Brain development is known to continue until someone is in their mid-20s.

E-cigarettes do not produce odor or smoke.

Can be used to deliver various substances including nicotine and tetrahydrocannabinol.

Americans will spend about $2.2 billion on E-cigarettes in 2014, a number that exceeds those for nicotine-replacement therapies.

Some E-Cigarettes can be reused and some are single use.

Some E-Cigarettes look like cigarettes and others vary in shapes.

Some E-Cigarettes contain propylene glycol, to create vapor, water, flavoring agents, and nicotine.

Some E-Cigarettes have been found to have contaminants, including carcinogens.

More than 250 types.

Increasing usage as people feel they are less harmful than cigarettes.

Clearly less harmful than cigarettes.

Not safe as nicotine is potentially harmful, addicting and can increase risk of health and developmental issues, particularly in teens and pregnant women.

Have the ability to deliver nicotine in a less harmful way than regular combusted cigarettes, which contain greater than 7000 other chemicals, and more than 60 carcinogens.

Associated with absence of secondhand cigarette smoke, releasing only a vapor, reducing potential harm compared to combusted cigarettes.

Provides tactile and visual sensations that resemble cigarettes that smokers are used to and may be dependent on.

Have potential to aid smoking cessation.

Insufficient data exists concerning long-term safety, ability to be an effective smoking cessation aid.

Electronic nicotine delivery systems (ENDS) exclusive use is less risky then the use of smoking combustible tobacco products there is concern that it’s use may lead to dual product use and reduce cessation of smoking.

There is concerned that ENDS may be used by non-smoking adolescents and young adults who might not otherwise have used nicotine products, and that dual use will follow.

Flavored products may appeal to adolescents and young adults and may generate use in a new population of nicotine-addicted users among never uses of combustible tobacco products.

Flavorings are a potential hazard of E-cigarettes and are designed to create an ultrafine aerosol penetrating deeply into the lungs.

It is felt that respiratory flavorings may pose a threat to the respiratory health of its users.

The rates of vaping among teenagers have increased at an alarming rate.

It is possible that a generation of nicotine addicted teenagers will increase the use of combustible tobacco in the decades to come and create a large cohort of nicotine addicted adults.

Nicotine is a gateway drug that lowers the threshold for addiction to other agents and the use of e- cigarettes could spawn more opioid addiction.

Nicotine is as addictive as heroin, so that once hooked most young e- cigarette users will become long-term users.

Vapor from e-cigarettes may contain up to 15 times higher levels of formaldehyde compared with regular cigarettes as ‘tank system’ e-cigarettes allow users to turn up the heat and deliver high amounts of vapor (Peyton D).

When heated at higher temperatures, e-cigarette juices can vaporize and form large amounts of hidden formaldehyde, five to 15 times higher than the amount of formaldehyde in traditional cigarettes.

In a randomized study of nicotine replacement products versus e-cigarettes: E cigarettes is more effective for smoking sensation than the nicotine replacement therapy (Hajek P).

There is an association between e-cigarette use in non-smoking adolescents and subsequent cigarette smoking in young adults.

Adolescence with nicotine vaping subsequently try cigarettes at a higher percentage than those not smoking cigarettes in the past.

Nicotine exposure, particularly in adolescence, increases transcription of proteins that potentiates reward from other addictive substances, such as cocaine, opioids, alcohol, methamphetamine, accelerating addictive processes with these drugs, consistent with the gateway drug effect.

Adolescent nicotine use alters acetylcholine, and glutamate receptor signaling in the maturing prefrontal cortex that results, and increases in impulsivity and impaired attention.

Nicotine exposure increases brain concentrations of serotonin and endorphins, important for mood regulation.

Youth nicotine vaping is associated with higher symptoms of suicide thoughts, depression, anxiety, attention/hyperactivity, in a dose dependent way.

E-cigarettes have a greater decline in the incidence of cough and phlegm than nicotine replacement therapies, no excess wheezing or dyspnea, and only a small incidence of oropharyngeal irritation

Significantly higher odds of cardiovascular disease occurs among dual users of e-cigarettes plus combustible cigarettes compared with smoking alone.

Vaping associated lung injury is overwhelmingly related to the use of tetrahydrocannabinol, the psychoactive ingredient in marijuana.

Multiple patterns of lung injury have been reported with vaping associated lung injury suggestive of acute lipoid pneumonia.

As of January 7, 2020 a total of 2602 cases of EVALI (E-cigarette, or vaping, associated lung injury) had been reported, with 57 deaths.

Vitamin E acetate has been identified in BAL (bronchoalveolar-lavage) fluid obtained from 94% of patients with EVALI.

Vitamin E acetate has been added to THC products.

Most of these deaths occurred in patients reporting using THC, but some used exclusively nicotine containing products.

The median age of patients was 24 years primarily between ages 18 and 34, but 60% of patients were under 18.

Electronic cigarette aerosol alters the oral microbiome in a way that increases the risk of infection and inflammation.

E-cigarette vapor or aerosol may enhance infection and increase the abundance of opportunistic pathogens.

Liquids contained in e-cigarette vaping delivery systems can induce inflammatory responses, alter innate immune defenses, and impair pulmonary bacterial and viral clearance.

The influence of smoking on microbial profiles study: the severity of periodontal disease or infection is highest among cigarette smokers (72.5%), followed by e-cigarette users (42.5%) and non-smokers (28.2%).

The e-cigarette users had higher levels of Proteobacteria and both the cigarette smokers and e-cigarette users had higher levels of Actinobacteria, compared with never smokers.

Cigarette smokers also showed enrichment of Firmicutes and depletion of Fusobacteria, compared with e-cigarette users and never smokers.

The presented data suggest that vaping e-cigarettes causes oral environmental shifts and highly influences the colonization of complex heterogeneous microbial biofilms.

Oral diseases contribute to the severity and progression of several systemic diseases, like rheumatoid arthritis, diabetes, cardiovascular diseases, and Alzheimer’s.

E-Cigarette Aerosol Adversely Affects Oral Microbiome.