HPV & Vaping Tackling Dentistry's Oral Health & Communication Game Changers - Presented by Catrice Opichka, RDH, MS - PO Box 325, Bow WA, 98232 | ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
HPV & Vaping
Tackling Dentistry’s Oral Health &
Communication Game Changers
Presented by Catrice Opichka, RDH, MS
PO Box 325, Bow WA, 98232 | 920.246.4165 | catrice@pureeducation.orgE-Cigarettes
ENDS - Electronic Nicotine Delivery System ____________________________________
Developed: 2003 ~ Available in US: 2006
E-Cigarette Components
____________________________________
E-Cigarettes all contain a BATTERY, ATOMIZER & CARTRIDGE.
____________________________________
st
1 Generation ~ Cig-a-Likes
v Same size as a regular tobacco cigarette ____________________________________
v Heavier than a traditional cigarette.
v Manual – must hold button to operate. ____________________________________
v Typically disposable.
v Inexpensive. ____________________________________
v Good for about 200-300 puffs
nd
2 Generation ~ Mid-Size Electronic Cigarettes
____________________________________
v Slim pen like style.
v Manual or Automatic - press button or inhale to activate.
v Larger capacity battery (3-7 times larger). ____________________________________
v Good for one to two days.
3rd Generation ~ Advanced Personal Vaporizers. ____________________________________
v Many different sizes and shapes.
v Typically larger than Gen 1 & 2. ____________________________________
v Manual fire button.
v Advanced brain or power source. ____________________________________
v Two types of 3rd Gen Mods.
1. Mechanical Mods ____________________________________
§ Simple device.
§ No electronic circuitry.
§ Features a fire button, battery
____________________________________
compartment, connector.
2. Regulated Mods ____________________________________
§ Complex systems.
§ Allows vapor to modify the voltage and ____________________________________
wattage output.
§ Electrical resistance meters. ____________________________________
§ Reverse battery polarity protection.
4th Generation ____________________________________
v Automatic temperature control.
v Low ohm builds.
____________________________________
v Sub – ohm clearomizers (re buildable tanks)
Vaping Statistics ____________________________________
v 4o million Americans smoke E-cigarettes.
v 2019 study stated that 1 in 20 Americans use E-cigarettes. ____________________________________
v 1 billion users globally.
v E-Cigarettes today – 3 billion-dollar industry. ____________________________________
JUULS & JUULING ____________________________________
v Introduced in 2007.
v Developed by Stanford Grad Students.
v 500+ brands available today – in 2018 JUUL became the top
seller.v Popular because of their small size – about the size of a flash ____________________________________
drive.
v Popular due to low cost – Starter Kit $50. ____________________________________
v Each pod contains 40mg- 59mg of nicotine – about 200 puffs
– same nicotine as one pack of cigarettes.
____________________________________
VA21 – VAPING SMOKESCREEN ARTICLE ____________________________________
e-Cigar ____________________________________
v 1-cartridge = 20 cigars.
v Uses the same technology as e-cigarettes.
____________________________________
v Flavors include cherry, vanilla, Irish cream, coffee, chocolate,
rum.
One Coil vs Two Coils ____________________________________
v One coil releases more chemicals.
v Vapor temperature & density, flavor intensity, throat hit ____________________________________
increased with dual coils.
v Throat hit is the feeling in the back of the throat. ____________________________________
v Ranges from tingle to burn.
____________________________________
E-CIGARETTE INGREDIENTS
Suspension Ingredients ____________________________________
PROPYLENE GLYCOL (PG)
v Thick synthetic colorless liquid base in e-juice.
v Penetration enhancer – alters the structure of the skin.
____________________________________
v Increases the ability of the product to reach the
bloodstream. ____________________________________
VEGETABEL GLYCERIN / GLYCEROL (VG)
v Thick synthetic liquid. ____________________________________
v Thicker and sweeter than Propylene glycol.
v Decreases throat hit. ____________________________________
PG vs. VG
v PG and VG have different consistencies. ____________________________________
v Contribute different tastes to e-juice.
v Vapor plumes are less dense with PG but flavor sweeter.
____________________________________
v Many e-liquids use both.
DIETHYLENE GLYCOL
v FDA tests in 2009 found trace amounts. ____________________________________
v Colorless, odorless, poisonous liquid.
v Used as a solvent in antifreeze. ____________________________________
v Human Carcinogen.
People are Dying ____________________________________
E-Cigarette / Vaping Associated Lung Injury (EVALI)
v First Case: June 2019 ____________________________________
v Peak: September 2019
____________________________________
VA29 – CDC LINK
As of January 2021 ____________________________________
2800+ cases of lung injuries have been reported.
50 states and the District of Columbia have reported lung injuries.
3____________________________________
68 deaths have been confirmed (as of August 2020).
Ages affected from 17-75. ____________________________________
Bronchoalveolar Lavage (BAL) fluid from lung injury patients have
____________________________________
been collected.
Findings:
v THC found in 82% of the samples. ____________________________________
v Nicotine found in 62% of the samples.
v Vitamin E acetate found in nearly all of the samples (48 of ____________________________________
51).
Conclusion is that Vitamin E acetate is at least in part the reason for ____________________________________
the lung injury. More investigation to see if other chemicals are
involved. ____________________________________
Vitamin E acetate is naturally found in foods like: ____________________________________
v Vegetable Oils
v Cereals
____________________________________
v Meat
v Fruits
v Vegetables ____________________________________
Vitamin E acetate is added to:
v Dietary Supplements ____________________________________
v Cosmetics
v Skin Creams ____________________________________
Vitamin E acetate does not cause harm when ingested or applied to
the skin: however, it can be toxic when inhaled. ____________________________________
Product Findings
152 different THC-containing products were reported by EVALI
____________________________________
patients.
v Dank Vapes most reported @ 56% (Northeast and South)
v TKO @ 15% and Smart Cart @ 13% most reported (West) ____________________________________
v Rove @ 12% most reported (Midwest)
Chronic medical conditions can increase the risk of EVALI, re- ____________________________________
hospitalization, and death.
v Cardiac disease. ____________________________________
v Chronic pulmonary disease.
v Diabetes. ____________________________________
Flavoring Ingredients ____________________________________
DIACETYL
v Chemical used to create intense buttery flavor microwave
____________________________________
popcorn.
v Hazardous when heated.
v Added to e-juice to strengthen flavor. ____________________________________
v Found in 39 of 51 tested e-liquid brands in a 2015 study.
v Commonly found in vanilla, caramel, and coconut flavor. ____________________________________
4v American Lung Association states that vaping can cause ____________________________________
popcorn lung.
v Popcorn lung is a condition otherwise known as Bronchiolitis ____________________________________
Obliteranes (BO).
v It is an obstruction of the smallest airways in the lungs.
____________________________________
v Symptoms - dry cough, shortness of breath, wheezing, tired.
v This is an irreversible condition.
____________________________________
VA21 – AMERICAN LUNG ASSOCIATION LINK
____________________________________
Chemicals Possibly Released in the Vapor Production
Latest E-cigarette Research
____________________________________
v Vaped e-liquids undergo pyrolysis and generate oxidative
species.
v Can lead to the formation of additional toxic components. ____________________________________
v Can lead to the formation of formaldehyde, acetaldehyde ____________________________________
and acrolein.
____________________________________
VA26 – AMERICAN LUNG ASSOCIATION ARTICLE
FORMALDEHYDE ____________________________________
v Colorless, odorless, poisonous gas.
v Released when Propylene glycol (PG) is heated. ____________________________________
v Exposure is known to cause nasopharyngeal cancer.
v Human carcinogen. ____________________________________
Says Who???
§ 1987 – US Environmental Protection Agency (EPA). ____________________________________
§ International Agency for Research on Cancer.
§ 2011 National Toxicology Program.
____________________________________
§ National Cancer Institute.
§ National Institute of Health.
§ Occupational Safety and Health (OSHA).
____________________________________
ACETALDEHYDE
v Chemical byproduct of vapor production. ____________________________________
v Toxic irritant.
v Breaks down in the kidneys. ____________________________________
v Human carcinogen.
v With alcohol – increased risk of upper GI and liver cancers. ____________________________________
ACROLEIN
v Chemical byproduct of vapor production. ____________________________________
v Also found in tobacco cigarettes.
v Proven to contribute to lung cancer.
____________________________________
v Mutates tumor suppressor gene p53.
v Cytotoxicity in the airways.
v 2014 report in Addiction Review states PG releases Acrolein ____________________________________
when heated.
____________________________________
VA23 – CONTENT & SAFETY ARTICLE
Other Ingredients
METAL
5v Released when heating coils are activated. ____________________________________
v Lead, chromium, nickel, manganese.
v Potential to cause lung tissue damage ____________________________________
VA21 – VAPING SMOKESCREEN ARTICLE
____________________________________
NICOTINE
v Stimulant. ____________________________________
v Reaches the brain within 20 seconds of inhalation.
v Increases blood pressure. ____________________________________
v Increases blood sugar levels.
v Addictive.
____________________________________
Nicotine Levels in E-cigarettes
v High – 36 mg.
v Medium – 24 mg. ____________________________________
v Low – 12 mg.
v Zero – No nicotine. ____________________________________
§ (a dozen independent studies found nicotine in zero
nicotine e-cigarettes) ____________________________________
§ Nicotine Levels in tobacco cigarettes
§ 8 mg. – 20mg. ____________________________________
§ Average tobacco cigarette is 12 mg.
v 2017 Psychopharmacology study tested 8 different brands of ____________________________________
vaping devices.
v Discovered that despite similar nicotine levels, different
amounts of nicotine were delivered.
____________________________________
VA22 – NICOTINE DELIVERY DIFFERENCES ARTICLE ____________________________________
v 2016 study showed that consumption of e-liquid was
____________________________________
doubled in low vs. high nicotine condition.
v Conclusion was that individuals self-titrate by adjusting
puffing behavior to maximize nicotine delivery.
____________________________________
VA24 – SELF-TITRATION ARTICLE ____________________________________
Smoking Cessation
____________________________________
v The American Cancer Society states that 80.5% of all
smokers trying to quite using e-cigarettes use both cigarettes
and e-cigarettes at the same time. ____________________________________
v A 2015 study suggests a positive correlation between e-
cigarette use and deduced nicotine withdrawal symptoms. ____________________________________
VA25 – SMOKING CESSATION ARTICLE
____________________________________
VL13 – CDC LINK
VA27 – CDC ARTICLE ____________________________________
VL12 – CNBC REPORT ____________________________________
E-cigarette Explosions
____________________________________
v Increasing reports of lithium ion battery explosions injuring
mouth, face and hands.
6Vaping Regulations ____________________________________
v Tobacco is regulated by the Federal Government.
v In 2017 the FDA mandated several new regulations. ____________________________________
§ Nicotine is addictive warning on labeling.
§ Nicotine is addictive sheets in stores.
____________________________________
§ New labeling of “Manufacturer” for shops that mix
their own e-liquid.
v In 2018 the FDA begins creating & implementing regulations. ____________________________________
§ Manufacturing, Import, Packaging, Labeling,
Advertising, Promotion, Sales, Distribution. ____________________________________
§ As of March, 2018 none of these policies have been
completed. ____________________________________
§ www.FDA.gov Search for latest guidelines and
regulations under the “guidance” tab. ____________________________________
v FDA Regulation Delays
§ New regulation that E-cigarette companies must submit ____________________________________
product ingredients has been delayed from the initial
proposal of 2018 to 2020.
____________________________________
VL11 – AMERICAN LUNG ASSOCIATION LINK
____________________________________
v FDA Regulations (Active)
§ April 6, 2018 – “Large-scale undercover nationwide blitz” ____________________________________
on illegal sales of e-cigarettes to minors for both online
and in-store sales.
§ Working with eBay to prevent future listing of JUUL
____________________________________
products on its website.
____________________________________
VA20 – FDA CRACKDOWN
____________________________________
Smoking Today
CDC Report states that there are less smokers today than in the last
22 years.
____________________________________
v Youth Risk Behavior Survey of Adolescents Experimenting
with Tobacco: ____________________________________
§ 70% - 1991
§ 58.4% - 2003 ____________________________________
§ 28.9% - 2017
VA21 – VAPING SMOKESCREEN ____________________________________
Vaping Today ____________________________________
§ 28.9% adolescents reported trying smoking in 2017.
§ 42.2% of the same age group reported vaping in 2017. ____________________________________
VA21 – VAPING SMOKESCREEN
____________________________________
Side Effects
v Dry skin, xerostomia, rash or burning sensation on face, ____________________________________
caffeine sensitivity, minor bloody nose issues, puffy and dry
eyes, throat irritation, dry cough, hoarseness, oral ulcers, ____________________________________
dizziness.
7What the heck is vaping? ____________________________________
Vape – verb – inhale and exhale the vapor produced by an electronic
cigarette or similar devices. ____________________________________
Teens & Vaping
____________________________________
v Teens prefer vaping over smoking.
v Vape pens can be customized.
____________________________________
What is dabbing?
Dabbing – verb – to inhale vapor of highly concentrated ____________________________________
cannabinoids.
v Called oil, wax, budder, BHO (butane has oil), shadder. ____________________________________
What is dripping? ____________________________________
Dripping – verb – to drip liquid nicotine directly on the heating coils
of the e-cigarette. ____________________________________
v Generates higher coil temps.
v Greater release of chemicals.
____________________________________
v Increased “shots” of nicotine.
Hookah Bar Bonus ___________________________________
v Shisha is soaked in molasses or honey and mixed with fruit.
v Shisha contains nicotine and other similar chemicals to ____________________________________
cigarette smoke.
v Smoking tobacco through water does not filter out cancer ____________________________________
causing chemicals.
v Ina 60 minute Hookah session, smokers are exposed to 100- ____________________________________
200 times the volume of smoke inhaled from a single
cigarette.
____________________________________
____________________________________
Smoking Cessation Resources
Centers for Disease Control and Prevention | cdc.gov
American Heart Association | heart.org ____________________________________
Smoke Free | smokefree.gov
____________________________________
Additional Resources ____________________________________
FDA REGULATIONS & VAPING TIMELINE ____________________________________
VL15 – FDA REGULATIONS
___________________________________
VL18 – VAPING TIMELINE
8HPV and Oral Cancer
2021 Cancer Statistics ____________________________________
14 million people have cancer in the United States alone.
Worldwide cancer rates are estimated to jump 75% by the year
2030.
____________________________________
HL50 – CANCER STATISTICS LINK ____________________________________
Why?
v Aging population.
____________________________________
v Lifestyle cancers.
Lifestyle Cancer
A cancer that increases in risk due to behavioral factors based on ____________________________________
lifestyle choices.
1. Sun Exposure ____________________________________
§ Malignant skin cancer is the largest diagnosed lifestyle
cancer in the U.S. and abroad. ____________________________________
§ 3.5 million skin cancers are diagnosed annually in the
United States. ____________________________________
§ Skin cancer makes up for more than breast cancer, colon
cancer, and lung cancer combined. ____________________________________
§ 1 in 5 Americans will be diagnosed this year alone.
____________________________________
Skin Cancer Resources | Skin Cancer Foundation
www.skincancer.org
/cancer-information/skin-cancer-facts ____________________________________
2. Drinking Alcohol ____________________________________
§ Mouth, pharynx, larynx, esophagus, liver, colon, rectum,
breast. ____________________________________
3. Obesity
§ Esophagus, pancreas, ovarian, colon, rectum, ____________________________________
endometrial, kidney, thyroid, breast.
4. Cigarette Smoking ____________________________________
§ Mouth, throat, lung, kidney, bladder, pancreas, stomach,
cervix. ____________________________________
Oral cancer is a “lifestyle cancer” because lifestyle behaviors or
choices influence the percentage of risk an individual has for cancer.
____________________________________
2020 Oral Cancer Statistics
v 53,000 Americans will be diagnosed in 2018 with oral cancer. ____________________________________
v 9,000 people will lose their battle with oral cancer this year.
v Someone dies from oral cancer every hour. ____________________________________
HL51 – ORAL CANCER STATISTICS LINK
____________________________________
Our Role in Oral Cancer Prevention and Care
v HPV Communication ____________________________________
v Oral Cancer Exam / Early Cancer Detection
§ According to the American Dental Association, 53% of ____________________________________
the US population (adults) visits a dentist every year.
9HL52 – ADA STATISTICS LINK
§ We have an abundance of opportunities to diagnose oral
____________________________________
cancer early.
v Patient Care – Before, During, After Cancer Treatment ____________________________________
HL54 – RDH MAGAZINE SCREENING LINK ____________________________________
Traditional Risk Factors
v Smoking, Chewing Tobacco & Heavy Alcohol are ____________________________________
traditional risk factors for oral cancer.
v Cancers are found in the floor of the mouth and the ____________________________________
lateral boarders of the tongue.
v 90& are squamous cell carcinomas. ____________________________________
v Cancers are typically diagnosed in stages 3-5.
v Average patient age of diagnosis is 62 years old. ____________________________________
v Smoking & Drinking together increases risk by 15%.
st
21 Century Oral Cancer Risk Factor ____________________________________
v Human Papilloma Virus has become a rapidly increasing
risk for throat cancers.
____________________________________
v HPV 16 & 18 are the most common strains that cause
oropharyngeal cancers.
v 79 million Americans are currently infected. ____________________________________
v CDC states that nearly everyone who is sexually active
will have an HPV infection within their lifetime. ____________________________________
v Cancers are found in posterior of mouth - tonsils,
tonsillar pillar, base of tongue and oropharynx. ____________________________________
v Cancers are often found in individuals who have never
smoked or used chewing tobacco. ____________________________________
HL53 – CDC STATISTICS LINK
____________________________________
Oral Cancer Studies
v Oral cancer has a higher death rate than: ____________________________________
§ Cervical Cancer
§ Hodgkin’s Lymphoma ____________________________________
§ Laryngeal Cancer
§ Testicular Cancer
____________________________________
§ Thyroid Cancer
Oral Cancer Epidemiology
v Men are twice as likely to get oral cancer than women. ____________________________________
Women’s risk has increased greatly in the last couple of
decades. ____________________________________
v The average age of oral cancer diagnosis has decreased
to under 40 years old. ____________________________________
HL56 – ORAL CANCER EPIDEMIOLOGY
____________________________________
HPV Strains
v There are over 200 strains of HPV.
v Most of the strains cause skin warts and non-cancerous
lesions.
10v 40 strains are mucosal strains and can affect the oral ____________________________________
cavity.
____________________________________
v Approximately a dozen strains have moderate or high
cancer-causing abilities.
____________________________________
The Human Papilloma Virus contributes to the following cancers:
Cervical Cancer 91%
____________________________________
Vulvar Cancer 69%
Vaginal Cancer 75% ____________________________________
Penile Cancer 63%
Anal Cancer 91% (93%, 89% Male) ____________________________________
Oropharyngeal Cancer 70% (63% Female, 72% Male)
____________________________________
Centers for Disease Control and Prevention 2021
____________________________________
Frequently Asked Questions About HPV
1. How do you know if you have HPV? ____________________________________
2. How long does it take to fight HPV?
3. Does HPV 16 & 18 always cause cancer?
____________________________________
4. How does HPV Cause Cancer?
Dental Oncology Professionals ____________________________________
Dr. Dennis Abbott
drdennisabbott@dopnt.com ____________________________________
214-240-4968
____________________________________
Who Gets Oral HPV
v Research collected and presented by professors at John ____________________________________
Hopkins Bloomberg School of Public Health show that men
have a greater risk of oral HPV. ____________________________________
v These studies show that risk is higher even when behaviors
are the same.
____________________________________
HA52 – CDC WEBINAR SLIDES
____________________________________
HPV Testing in the Dental Practice
v Research shows that Oral DNA testing is a reliable tool for ____________________________________
testing current HPV strains.
v Use in the dental setting can be risky due to lack of time and
dedicated personnel needed for proper consultation.
____________________________________
HA50 – SALIVA TESTING ARTICLE ____________________________________
HPV and Sexual Behavior ____________________________________
You can get the HPV virus in the following ways:
v Vaginal sex.
v Anal sex. ____________________________________
v Oral sex.
Not Getting Vaccinated & Multiple Sexual Partners increase the risk
of HPV.
11HPV Vaccine
Two companies provide three options for HPV vaccination.
Cervarix Gardasil Gardasil 9
____________________________________
HPV 16 & 18 HPV 6, 11, 16, 18 HPV 6, 11, 16, 18
31, 33, 45, 52, 58
____________________________________
June 2009 Girls June 2006 Girls
December 2010 December 2014
Boys Girls & Boys ____________________________________
HPV Vaccine Resistance ____________________________________
Common Side effects for HPV include: Pain, swelling, itching bruising,
nausea, dizziness, vomiting, pain in legs and muscles. ____________________________________
According to research done by Tierona Low Dog M.D. ____________________________________
67 million doses of the HPV vaccine were given between June 2006 -
March 2014, and in that time, 25,000 adverse events were reported.
____________________________________
“After careful review, none of these adverse events were any more
common after HPV vaccination than among comparison groups”.
____________________________________
For more information on HPV vaccination safety:
____________________________________
HL55 – CDC – Vaccine Adverse Event Reporting Systems
____________________________________
Frequently Asked Questions About HPV Vaccine
1. When should people get the HPV vaccine?
2. What if I already got myself/my child Gardasil…do I/they ____________________________________
need Gardasil 9?
3. Why can’t a person over 26 get vaccinated? ____________________________________
4. How much does it cost and does insurance cover the
vaccine? ____________________________________
Assessment of Vaccination Rates and Attitudes of the Future
v Millennials are the first group of future policy makers to ____________________________________
have been vaccinated.
v Studies show positive attitudes toward HPV vaccination, at ____________________________________
least among med students surveyed.
HA51 – MILLENNIAL MED STUDENT VACCINATION ARTICLE ____________________________________
Social Stigma / Sexual Behaviors ____________________________________
It is difficult for parents to imagine their children sexually active;
however, the changing sexual behaviors of our teens have made HPV ____________________________________
impossible to ignore.
Teens & Sex
Percentage of teens having sex in the United States:
____________________________________
7% by 12-13
28% by 15 ____________________________________
48% by 17
61% by 18
1280% of sexually active people ages 14-44 have had oral sex with an ____________________________________
opposite sex partner. ____________________________________
Individuals admit to not using condoms during oral sex.
____________________________________
Frequently Asked Questions About Oral HPV
v Do condoms prevent oral HPV?
v Can you get oral HPV from deep kissing? ____________________________________
____________________________________
HPV Education in the Dental Practice
“HPV education is like climbing a mountain” ____________________________________
Catrice Opichka, RDH
____________________________________
vChoose a Guide
§ Hire or choose a guide. ____________________________________
§ Doctor, member of the team, consultant.
§ Someone needs to be responsible for making the team
____________________________________
accountable for HPV education and follow-through.
vAssemble Your Team
§ The entire team needs to understand the importance of ____________________________________
oral cancer detection and be proficient in their HPV
communication. ____________________________________
vStart at Basecamp
§ Make decisions on how you want HPV education to look ____________________________________
in YOUR practice.
§ How much freedom will your team have to ____________________________________
decide when and how to educate patients?
§ Will you provide formal training for your
____________________________________
team?
§ Who will deliver the training?
v Create the Map ____________________________________
§ Create written protocol.
§ This should include adding health history ____________________________________
questions about HPV.
• Have you received the vaccination for ____________________________________
HPV?
• Have you had the Cervarix or Gardasil ____________________________________
vaccine?
• Have you ever been diagnosed with ____________________________________
HPV?
• Have you been treated for an HPV- ____________________________________
related cancer?
§ Educational materials provided for patients.
____________________________________
• Brochures for new patient packet.
• Brochures for after oral cancer (head
and neck) exam. ____________________________________
• Brochures in the waiting area.
§ Consent form (optional). ____________________________________
• Decide if you will use a consent form.
• Create the consent form.
13• Decide who will receive the
form (example: for all Cancer Resources
patients under 18 years Oral Cancer Foundation | www.oralcancerfoundation.org
old). American Cancer Society | www.cancer.org
§ Website list for patients to National Cancer Institute | www.cancer.gov/cancertopics
research on their own.
§ Create verbal protocol.
____________________________________________
§ This should include team
education on correct verbiage for
HPV education. ____________________________________________
vTrain and Practice
§ Doctors and Hygienist - pathology course ____________________________________________
every other
§ year. ____________________________________________
§ Team review on HPV education every year.
___________________________________________
For access to my research
Please visit my website www.pureeducation.org to access research articles and links.
To Learn More About HPV Training for your Dental Practice
www.pureeducation.org
(Click the Coaching tab on the main page for details)
If you have questions about this program, or just want to Reach Out
Phone ~ 920-246-4165
Email ~ Catrice@PureEducation.org
14You can also read
