Transcript E-Liquid Ingredients Are Not A Mystery

HNSCC, Vaping and HPV;
Enhancing our Diagnostic
Abilities and Knowledge Base
Bradley E Jones
CDR, DC, USN
Learning Objectives
At the conclusion of this activity, the
participant will be able to:
1. Improving our diagnostic abilities of premalignant and early stage HNSCC.
2. Developing an intelligent base of knowledge
regarding the use of electronic cigarettes and
their effects on the oral cavity.
3. 5 things every dentist should know about HPV
related HNSCC
White Patch Differential
(and red)
• Hyperkeratosis, acanthosis
• Epithelial dysplasia
• Squamous Cell Carcinoma
• Infectious and Inflammatory
HNSCC
• 95% of oral cavity cancers are squamous
cell carcinoma
• Usually ages 50-70 years, 90% men
• Represent 4% of malignant tumors in men
and 2% in women; 30,000 new cases
annually in US with 8,000 subsequent
deaths
• Recent trends show reduction overall in oral
cancer deaths but increase in black men,
black women and women overall
How do we find more intraoral
disease and disease at earlier
stages?
• A 43yo male presented
with a persistent white
patch on the ventral
tongue.
Epithelial Dysplasia – 26 yo M
Anterior
Middle
Posterior
Candidiasis – 65 yo M Hx of SCCa
Candidiasis – 36 yo M
• An 81 yo female with long history of oral leukoplakia
presented recent onset raised lesion of the right buccal mucosa.
Conventional Oral Squamous Cell Carcinoma
61 yo M
65 yo M
58 yo M
83 yo F
HPV-Associated Oropharyngeal Squamous
Cell Carcinomas
• HPV is associated with a specific subset of head and neck
cancer: Oropharyngeal SCCa (tonsil and BOT)
• Distinctive features include:
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Younger age (mean age 52-56 yrs)
Patients often have no risk factors (smoking/drinking)
HPV does not appear to act synergistically with tobacco or alcohol
May be clinically occult and present with neck mass as the first sign
> 80% of current cases are HPV positive
95% + HPV sub-types 16 or 18 (same HPV found in cervical cancer)
• Prognostically significant
Human Papilloma Virus (HPV) and
Oropharyngeal Squamous Cell Carcinoma
• The oropharynx
includes the following
sites
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Base of the tongue
Tonsillar region
Soft palate and uvula
Pharyngeal walls
HPV+ Oropharyngeal Squamous Cell Carcinoma
HPV+ Oropharyngeal squamous cell carcinoma
66 yo M
HPV 16/18
p16
Follow-up for overall survival began on the date of cancer diagnosis and ended at death or the
last day of follow-up (November 1, 2009, for Hawaii; December 31, 2007, for Iowa; and May 31,
2010, for Los Angeles). (Chaturvedi A K et al. JCO 2011;29:4294-4301)
©2011 by American Society of Clinical Oncology
Current News Items
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Oral cancer virus affects 7 percent of Americans, study finds; also linked
to cervical cancer (AP, Published: January 26/JAMA online 2012)
– “Millions may have oral HPV, but fewer than 15,000 Americans get HPVlinked oral cancer each year.”
Ask the ADA Question:
– Do the HPV vaccines (Cervarix and Gardasil*) protect against
oropharyngeal cancers caused by HPV?
– Answer:
The vaccines protect against HPV-16 and HPV-18, which have been
identified in approximately 90 to 95 percent of HPV-positive
oropharyngeal cancers. However, it will likely be decades before their
effectiveness in preventing oropharyngeal cancers is known.
• A 49yo female presented
with an incidental finding
of an exophytic lesion on
the ventral tongue.
Sq Papilloma
Heck’s Disease
Sq Papilloma
Heck’s Disease
• A 36 yo male presented
with a raised area on
the lower lip.
• Dx: Heck’s disease-like
verrucous epithelial
hyperplasia
Cigarette smoking is the leading cause of
preventable disease and death in the United States,
accounting for more than 480,000 deaths every year,
or 1 of every 5 deaths.1
In 2015, about 15 of every 100 U.S. adults aged 18
years or older (15.1%) currently* smoked cigarettes.
This means an estimated 36.5 million adults in the
United States currently smoke cigarettes.2 More than
16 million Americans live with a smoking-related
disease.2
Current smoking has declined from nearly 21 of
every 100 adults (20.9%) in 2005 to about 15 of
every 100 adults (15.1%) in 2015
Two Completely Different
Products Are Referred To As
"E-Cigs"
E-cigs, APVs, and Vape Mods
Vape ‘Mods’
E-Liquid Ingredients Are Not
A Mystery
• Juicemaster General
INGREDIENTS
• vegetable glycerin
• propylene glycol (not diethylene)
• Flavorings are food-grade, can be natural or
artificial, and are limited only by the
imagination of the juice maker
• pharmaceutical-grade nicotine
Many Vapors Use Very Little
To No Nicotine
• e-liquid in very low to zero nicotine
strength (6 mg per ml and below) outsells
medium-to-high strengths (12 mg and
above) by better than a two-to-one margin
The Vapor Is Far Less
Harmful Than Cigarette
Smoke
• "For all byproducts measured, electronic
cigarettes produce very small exposures
relative to tobacco cigarettes. The study
indicates no apparent risk to human health
from e-cigarette emissions based on the
compounds analyzed."
• "Absence of combustion and different
chemical composition, leading to less toxic
chemicals created and absorbed . . .
electronic cigarettes may be a safer
alternative to tobacco cigarettes."
Vaping Does Help Smokers
Quit