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.

Nearly 2,000 Volunteers Set to Help Make a Difference at the 2023 Florida Mission of Mercy

Tomorrow begins the 2023 Florida Mission of Mercy (FLA-MOM) — a free, two-day dental clinic hosted by the FDA Foundation. Happening at the Expo Center at the South Florida Fairgrounds in West Palm Beach, patients will be seen on a first-come, first served basis between 7 a.m. and 7 p.m. The goal is to treat 2,000 patients in those two days (Feb. 24-25). Currently, there are nearly 2,000 volunteers registered for the clinic, including nearly 325 dentists. You can find more information and details on the services that will be provided, as well as those who are eligible to receive treatment by checking out the flyer below.

Beginning today, the Florida Mission of Mercy Veterans First Initiative will provide FREE dental care to military veterans at the Expo Center at the South Florida Fairgrounds. Additional details are provided in the flyer below.

Five Tips to Keep Mouths Healthy This Halloween

Halloween is coming up soon, which for many children (and adults) means celebrating the holiday with candy and other sweet treats. While it’s fun to enjoy the holiday, parents should be mindful that sugary foods can increase the risk of tooth decay, which is the most common chronic disease for children and adolescents. 

When you eat or drink foods containing sugars, the bacteria in plaque produce acids that attack tooth enamel, and over time this can cause tooth decay, the breakdown of tooth enamel and lead to cavities.

The good news is that you can let your children enjoy the holiday and teach them good oral health habits that they can benefit from during any holiday season.

So, before you take your kids to Halloween parties or trick-or-treating, download these five tricks to help their teeth healthy

And of course, continue to practice ongoing oral health care, including flossing daily, brushing teeth twice a day and visiting your Florida Dental Association member dentist regularly. To find your FDA member dentist, visit learn.floridadental.org/find-your-dentist

Why is Dentistry Expensive?

By FDA President David F. Boden, DDS, MS

Really, the question should be: Why is my dentistry expensive? To answer that, I will tell you a story about what happens in your mouth, and mine.

With few exceptions, we are born with the code for great oral health. Our teeth grow and form and eventually say, “Hello,” to the world, hugged nice and tight by healthy gums, ready to do their job for our bodies in helping condition food for digestion. Soon after, they make their premiere, they will be exposed to the enemy of any mammal: bacteria. Bacteria have one purpose: to feed on us and break us down. But they also get a free meal every time we eat. They form colonies of bacteria on our teeth we call plaque, just like they do on high school biology class petri dishes.

Some bacteria convert parts of that food into acids, which allow them to etch into a tooth’s nice, hard, pretty enamel. If they are there long enough, those acids will eat right through into the nerve in the center of that tooth. Our body senses that and registers it in the brain as pain, saying something is very wrong and needs attention. There are other bacteria that make their homes in gums. They feed on tissues, triggering our bodies to fight back with what doctors call an inflammatory reaction. This causes bleeding gums, but unfortunately, the signals sent to our brains are very weak and do not register until a lot of damage has already occurred.

Both cavities and gum disease can cause tooth loss. Unless, of course, you see a dentist. That dentist will attempt to repair tooth damage in numerous ways, depending on the extent of the damage. That can involve fillings, crowns or even root canal treatment. Gum problems — because they are so sneaky and quiet — often are overlooked. Repair can be pretty invasive, including surgery. In health terminology, we refer to reparative procedures as tertiary care. More on that in a moment.

All these repairs are costly because they involve work by a general dentist or dental specialist who has gone through time-consuming, intensive, and very expensive education to perform specialized types of hard-tissue (your teeth) or soft-tissue (your gums) microsurgical techniques using the very best instruments and materials in an extremely clean environment. And, of course, you would not have it any other way.

But it does not have to cost that much. No, I do not mean by getting dental insurance discounts on treatment. High quality dental treatment means a high overhead of costs for the ethical doctor. Deep discounts require cutting corners somewhere in your treatment, and I will let you guess what that means. Actually, it generally means more expense later.

Recall what was mentioned above. Tertiary care is reparative, and repairs are very costly. Why not do something that would avoid those repairs? We know bacteria are the cause of almost all dental problems. If we could only prevent those bacteria from collecting and setting up shop where they do damage, we could prevent the need for repairs!

Prevention is called primary care, and prevention is dirt cheap. Unfortunately, it also requires your dedication. The low-tech toothbrush is the single best invention for doing most of that by disrupting that bacterial plaque from causing trouble. But a brush only cleans half of each tooth. Floss must clean the other half. You must do both, because anywhere you miss cleaning, bacteria will set up shop, grow bigger, and eat and etch to their way to those costly repair procedures. Just insist you have great coaches to train you how to do it well and effectively — your dentist and dental hygienist.

So, why is your dentistry expensive? Because you did not clean off those bacteria. So, get cracking and break out that brush and doggone floss. Every. Single. Day. Because those bugs are sure hoping you’ll leave them alone to feed on you. And to borrow from Smokey the Bear: Remember, only YOU can prevent tooth decay.

Dr. Boden is the FDA president and can be reached dboden@bot.floridadental.org.