More than 20 years ago, teen tobacco use in the United States was at an alarming rate with almost 35 percent of teenagers using tobacco. This statistic is particularly significant when you consider that 90 percent of adult smokers began smoking before turning 18.

To stem the tide, the Truth Campaign was launched, urging teens to reject tobacco products. The campaign began to make a difference, and over time, adjusted its messaging to resonate with each generation’s sensibilities.

Today, a new trend has emerged — e-cigarettes — and the Truth Campaign is responding to this escalating threat.

According to the 2018 National Youth Tobacco Survey, 20.8 percent of high school students had used e-cigarettes within the last 30 days, an increase of 78 percent compared to 2017. Only eight years ago, e-cigarette usage among high school students was just 1.5 percent.

In reaction to these startling trends, Virginia recently passed legislation raising the minimum age to buy tobacco products and e-cigarettes to 21.

To be clear, the use of e-cigarettes is not simply a trend among high schoolers. Nearly 11 million American adults use e-cigarettes. A trend that is threatening to erase the years of progress that has been made to curb tobacco use.

As a practicing dentist, who is also married to a practicing dentist, we regularly see patients whose oral health has been impacted by tobacco. And as parents of two sons in their early 20s, we have counseled them their whole lives about the adverse health outcomes and destructive results of smoking, smokeless tobacco and vaping and will continue to do so. We stress to them that vaping is not a healthy alternative to smoking.

While the long-term health effects of e-cigarettes are still largely unknown, extensive research is in the works and the first wave of disturbing findings are coming to light. Harvard researchers released a study that found popular vaping cartridges and e-liquid products contain bacteria or fungi previously linked to lung problems.

We know vaping sweet flavored e-cigarettes can increase a person’s risk of dental cavities. And because these devices contain nicotine, consistent use also can increase one’s risk of periodontal damage and can lead to addiction that can be difficult to recover from.

Further, there is early evidence that e-cigarette usage can be a gateway to cigarette smoking. We already have extensive research on the impacts of smoking tobacco long-term. Beyond the cardiovascular risks, smokers are impacted by a whole host of oral health issues including receding gums, oral cancer, lesions, periodontal disease and tooth staining.

If you are a regular e-cigarette or tobacco user, visiting your dentist consistently is extremely important. Just as you would make an appointment to see your physician for changes in your health, if you experience any noticeable changes in your oral health such as bleeding or swollen gums, changes in sensitivity to temperature, loose teeth, mouth ulcers or sores that don't seem to heal and toothache or mouth pain, make an appointment to visit your dentist before your regularly scheduled checkup.

Many currently view vaping as a safer alternative to traditional tobacco use, but the research around the safety of these devices is still in its infancy. We cannot yet fully understand the impact long term use of e-cigarettes will have on an individual’s overall and oral health.

As president of the Virginia Dental Association, my hope is to educate and inform Virginia citizens about the risks of all nicotine-based products. If you have questions about the impact of vaping and tobacco use on your oral health, I encourage you to have a conversation with your dentist. The VDA will continue to be at the forefront, working for all Virginians to be the go-to source of information on oral health.

Dr. Galstan is the president of the Virginia Dental Association and a practicing dentist who has served patients for nearly 30 years. He can be contact via email at