Teens & Nicotine: The Influence of Flavoring on Teen Behaviors & Addiction

Carol A. Jahn, RDH, MS | cjahn@waterpik.com  | 708-899-1886

In the fall of 2015, I attended a conference where the general session speaker was a tobacco cessation specialist.  At the time, I was a neutral on the subject.  I didn’t think – wow, I can’t wait to hear this, but neither did I think it wouldn’t be worth my time.  I have a sense that a lot of my colleagues felt similarly.  However, when the speaker made his opening statement, the room grew quiet, and he had our undivided attention.

What did he say that was so compelling?  He opened with:

Tobacco is the only legal consumer product that kills at least 1 out of 2 of its regular users when used as intended by the manufacturer.”1

During my clinical dental hygiene years, I was no stranger to the detriments of tobacco on oral and general health. I had worked in a periodontal office in the 1980’s where every day six or seven of my eight patients either used or had used cigarettes.  I had also been in a general practice during the early 1990’s and had shockingly witnessed the resurgence of cigarettes among teens and young adults.  But by 2015, like many, I had naively thought, we were on the upside of the battle with cigarettes.

Little did I know how I wrong I was. Little did I know that earlier in 2015, a new type of e-cigarette called JUUL had been introduced.  Little did any of us know the enormous impact and influence it would have among youth.

In 2016, JUUL garnered about 5% of all e-cigarette sales.  By the end of 2017, it was the leading e-cigarette brand, and at its peak in late 2018-2019, it had more than 70% of the market.  The JUUL brand’s popularity with youth helped drive a 135% surge in youth vaping between 2017 (11.7%) and 2019 (27.5%).2

Three things helped drive its popularity with youth.  It has a sleek compact design resembling a USB device making it easy to use discreetly and conceal at school and home.  The nicotine formulation in JUUL is made from nicotine salts instead of free-base nicotine.  This does two things.  It provides the user with a better experience and more nicotine.  One JUUL pod has the nicotine equivalent of a pack of cigarettes.  When introduced, JUUL pods came in numerous different, youth appealing flavors.  Flavored nicotine is preferred by over 80% of youth vapers.2

Today’s JUUL popularity has declined to about 40%.2  The 2021 Monitoring the Future Study found that student vaping rates are declining nearly showing 1 in 5 high school students vaped in the past month.   However, vaping is still the predominate method for nicotine consumption in youth.  Rates of smoking for traditional cigarettes fell to an all-time low of 4.1% among high school seniors.3

What are the effects of vaping products on oral and general health?  While the long-term effects of vaping are unknown, nicotine is highly addictive.  Research has shown that teens who vape are six times more likely to begin using traditional cigarettes.4  Nicotine can harm the developing brain including affecting the parts of the brain that impact attention, learning, mood, and impulse control.5

E-cigarettes have been promoted as means for tobacco cessation. In the United Kingdom (UK), vaping is considered an effective tool to help people stop smoking. The European Union regulates vaping differently from the US; for example, JUUL vaping pods have half as much nicotine in the UK as the US.  Importantly, far fewer teens vape in the UK with 1.6% reporting weekly use.6

Smoking rates are down not just among teens but adults as well.  Yet the emergence of new products like e-cigarettes mean this is a subject we cannot take for granted.  A recent study conducted with Southern California teens found that while vaping is still the most popular nicotine product, flavored oral nicotine products such as gums, lozenges, and gummies are ranked second.7  As dental professionals, we need to be aware of the products beyond cigarettes and be able to talk knowledgeably about them with patients.


  1. Els C. Interrupting the disease of tobacco addiction. J Dent Hyg, 2015, 89(Suppl 1.): 16-19
  2. Campaign for Tobacco Free Kids: JUUL and Youth: Rising e-cigarette popularity.  Accessed Aug 9, 2022.  Available at: https://www.tobaccofreekids.org/assets/factsheets/0394.pdf
  3. Campaign for Tobacco Free Kids: 2021 Monitoring the future study shows youth e-cigarette use remains a serious problem.  Accessed on Aug 9, 2022.  Available at: https://www.tobaccofreekids.org/assets/factsheets/0394.pdf
  4. Barrington-Trimis JL, UrmanR, Berhane K, Unger J et a.  E-cigarettes and future cigarette use. Pediatrics, 2016; 138(!):e20160379
  5. Centers for Disease Control and Prevention.  Quick facts on the risks of e-cigarettes for kids, teens, and young adults.  Accessed on Aug 9, 2022.  Available at: https://www.tobaccofreekids.org/assets/factsheets/0394.pdf
  6. The US and UK see vaping very differently.  Here’s why.  CNN Health.  Access on Aug 9, 2022.  Available at: https://www.tobaccofreekids.org/assets/factsheets/0394.pdf
  7. Harlow AF, Vogel EA, Tackett AP, Cho J et al. Adolescent use of flavored non-tobacco oral nicotine products.  Pediatrics 2022; Aug 8; e2022056586

About the author: Carol Jahn, RDH, MS is the Director of Professional Relations & Education for Water Pik, Inc. She has been providing continuing education courses for more than 25 years. Carol is an author, speaker, and industry leader and has published numerous articles and contributed to several textbooks.

A Brief History of Why Pediatric Dentistry Needs Pediatric Anesthesiology

By: Dennis Stone M.D.

Anesthesiology in Great Britain and Europe developed during the Enlightenment almost exclusively as a medical subspecialty on equal footing with Surgery. American Anesthesiology has roots in three medical disciplines; Dentistry, Nursing and Medicine.  

In the 1840’s Dentists and others discovered anesthetic properties of N2O (Colton and Wells), Ether (Jackson, Long, Morton) and Chloroform (Simpson). It was the dentists who developed the first practical clinical applications when dentistry consisted mostly of extraction of painful, infected teeth. John Snow developed a directional valve apparatus for the administration of ether and became the first known full time medical anesthesiologist publishing a book on ether administration in 1847.     

The Civil War during the 1850’s spurred the advancement of trauma care.  Unfortunately, early in the war the skill of a surgeon was judged by 30 second amputations.  Later in the war, nurses were recruited to provide open drop ether allowing more skilled surgical treatment. Officers were given scarce anesthetics and the southern General Stonewall Jackson was an early victim of silent aspiration (Mendelson’s) syndrome during anesthesia. He died of aspiration pneumonia 3 days postop.

After the Civil War medical/surgical treatment advanced and intra thoracic and abdominal surgery became possible but with a high mortality.  Macewen in 1878 reported the first elective endotracheal intubation for anesthesia. Anesthesia care improved with the pioneering work of physicians and surgeons such as (Hewitt, Dragger, and Boyle) who developed safer anesthesia machines capable of titration of anesthetic gases.  Lewis Wright 1940 introduced curare for muscle relaxation and the era of modern anesthesia was begun.  Halothane (1954) was a significant improvement over ether and chloroform but there were problems with cardiac depression and rare instances of liver damage. Sevoflurane was introduced in 1971 replacing Halothane and Propofol in 1989 replaced Pentothal. Both agents were much safer than their predecessors.

Until the 1980’s there were incremental improvements in drugs supplies and equipment yet injury or death from anesthesia related causes remained high in the neighborhood of 1:10,000 anesthetics with anesthesiologists paying malpractice premiums similar to neurosurgeons , cardiovascular surgeons , general surgeons and obstetricians.

What happened in the 80’s? Three things; the invention and clinical use of pulse oximetry and capnography; and the establishment of the American Society of Anesthesiologists (ASA) Closed Claims Project (1984). The Anesthesia Closed Claims Project’s goal is to identify anesthesia-related major safety concerns, patterns of injury and prevention strategies in areas where anesthesiologists provide care. The idea of analyzing closed malpractice claims as a method of improving patient safety was that of Drs. Pierce (Chairman) and Richard J. Ward, M.D., (Professor Emeritus) , of Anesthesiology University of Washington in Seattle. Jeff Morray M.D. a pediatric anesthesiologist at the University of Washington in Seattle was one of the original committee members.

Lessons learned from the closed claims data were published in peer reviewed journals and incorporated into anesthesia training programs as well as Continuing Medical Education (CME) materials for practicing anesthesiologists. Patient safety became the central focus for the ASA leadership resulting in the eventual creation of subspecialty fellowship training and board certification of anesthesiologists in Critical Care Medicine (ICU), Obstetrical Anesthesia, Cardiovascular Anesthesia, Pain Management and Pediatric Anesthesia. Improved surgical and anesthesia care allowed some procedures to move from the hospital to more cost effective surgery centers and office based facilities. Safety Committees established by the ASA developed policies, procedures and guidelines to assist anesthesiologists in providing safe care in these new practice environments. Dr. Hector Vila (Cofounder of PDAA) was chairperson of the Office Based Safety committee and led the effort to provide practical safety guidelines.  Today thanks to these efforts injury or death from anesthesia related causes has improved 100 fold to 1:1,000,0000 anesthetics with anesthesiologists paying much lower malpractice premiums, similar to the low rates of pediatricians  and family practice.

Children sedated in dental offices by dentists have a higher risk of morbidity and mortality because of age (younger the patient the greater the risk), site of the procedure (dental care is in the patients airway), single operator model of dental sedation (dentist attention divided), and sedation effects are difficult to predict (some patients go completely to sleep others are not fazed). Pediatric sedation tragedies continue to occur, are highly publicized and someone on the news report will usually be quoted “No child should ever die in a dentist’s office”. Thus the community standard set by the media is a fantasy of PERFECTION.

Dentistry should consider a Closed Claims Project so that cases are analyzed, lessons are learned and deaths could be avoided. Closed claims analysis could lead to the adoption of Pediatric Dental Anesthesia Standards which are most likely to improve outcomes.                                  

I have been a pediatric anesthesiologist for over 40 years and I love to tell the story of my chosen profession’s journey of continuous improvement. Pediatric Dental Anesthesia Associates (PDAA) is a national leader; we have adapted our anesthesia medications, techniques and equipment to deliver advanced pediatric specialty care in the pediatric dental office. We gather outcomes on every one of over 30,000 cases performed each year and we review and compare outcomes to modify our practice protocols which are uniform across the 26 states and over 600 Pediatric Dental Practices served. The investment in quality improvement and safety has been the single most important factor in the success of our practice.

Today, pediatric dentists are able to provide excellent care to children using lasers, innovative materials and techniques. Yet, expert dental care is difficult to deliver because of high rates of dental decay, and changes in parenting and social norms. Modern restorative pediatric dental care means more young children than ever need sedation. 

Pediatric dentistry requires safe, humane and predictable anesthesia for short and longer dental procedures. Our patients deserve the highest standard of care when it matters most.

 Dennis Stone MD 8/23/2022

How To Overcome Financial Setbacks and Start a Dental Practice

By Karen Weeks

Starting a dental practice from the ground up is a dream for many dentists (and aspiring dentists). But financial setbacks can make this dream seem out of reach. If you’ve experienced challenges in the past, know that there are practical strategies for overcoming your obstacles and launching a dental practice that stands the test of time. Florida Dental Association shares some tips for doing just that!

Use your mistakes for growth.

As with any area of life, learning from your mistakes is one of the best ways to overcome your financial setbacks. If you’ve made bad investments, failed to manage cash flow or made any other financial mistakes, take it as an opportunity to learn and inform your decision-making going forward. That way, you can avoid making the same mistakes and position yourself to succeed financially.

Establish an LLC.

Forming an LLC is another step to consider taking when launching your dental practice. This type of business entity can help protect your personal assets if your business fails in addition to providing tax benefits and making it easier to raise capital from investors. Remember to research your state’s rules and regulations and work with a formation service to ensure your LLC is compliant. Plus, it will save you a lot of time!

Find cost-saving tools.

It’s essential to find ways to save money where you can when starting any type of business. Fortunately, there are many cost-saving tools available to entrepreneurs, such as online accounting software, discount office supply sites, web builders, video conferencing apps and more.

You’ll also manage your fair share of digital documents when launching and running your digital business. You can fill out digital forms quickly and accurately with a PDF editor tool, adding text, images and signatures with a few clicks. PDF editors are easy to use, extremely versatile and offer the utmost security for your important documents. You can learn more by clicking this!

Research the wealth of affordable technologies that can help you run a thriving practice. The right tools will help you stretch your budget further while helping you get off to a solid start and sustain success over time.

Image via Pexels

Develop a supportive network.

Every entrepreneur and business needs a supportive network of professionals surrounding them. Talk to other entrepreneurs who have started businesses despite facing financial challenges; learning from their experiences can give you valuable insight into how to triumph over hindrances and achieve the success you dream of. Plus, a supportive network can provide moral support when times are tough.

Learn to market your dental business.

Learning how to craft a stellar marketing strategy is one of the most important steps you can take when starting a business. Marketing is especially crucial for attracting new patients and growing your practice!

There are many different marketing channels to utilize — both digital and traditional. You’ll be in a much better position to launch and manage your dental practice by becoming well-versed in marketing fundamentals and creating a solid plan.

Consider these simple tips while developing your marketing strategy:

  • Establish a strong online presence through social media, content marketing and search engine optimization (SEO).
  • Utilize email campaigns to stay in touch with existing patients and inform them of new services or promotions.
  • Develop relationships with other local businesses to get referrals.
  • Create professional materials like brochures, flyers, posters and business cards that you can distribute within the local community.
  • Run targeted advertising campaigns on radio and television stations to reach more potential patients.
  • Make sure your website is user-friendly and up-to-date with accurate information about your services and contact details.

Wrapping Up

Moving forward after suffering one or more setbacks can be an overwhelming prospect. But you can use your mistakes for growth and lay a firm foundation for a brighter future. Remember to establish the appropriate business structure, take advantage of cost-saving technologies, surround yourself with supportive people and learn how to market your dental practice. Get ready to overcome your obstacles and build a business that flourishes long-term!

Would you like to read more helpful content or learn about our dental association? Visit FloridaDental.org today!

New “Chew on This” Focuses on Social Media for Dentists

Do you want to know more about social media marketing for yourself or your practice? Have you wondered what to post or how to cater to the audience you’re trying to foster on your social media pages? Did you know that new patients are more likely to respond positively to personable posts that draw emotion rather than clinical posts about dentistry? All these questions and more are answered in this episode of “Chew on This” with FDA Executive Director Drew Eason and special guest, FDA member dentist, Dr. Joshua Golden. Dr. Golden is a social media influencer who shares his knowledge about successful social media from a dental perspective. This is an episode you won’t want to miss! Watch it now