British Dental Journal 222, 226 (2017) Published online: 24 February 2017 | doi:10.1038/sj.bdj.2017.150Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS.Priority will be given to letters less than 500 words long.Authors must sign the letter, which may be edited for reasons of space.Readers may now comment on letters via the BDJ website (www.bdj.co.uk).A 'Readers' Comments' section appears at the end of the full text of each letter online.Sir, we would like highlight an interesting case of a severe, necrotic looking oral ulcer attributed to the use of an electronic cigarette (e-cigarette).A 72-year-old Caucasian male was referred by his GP as a two week wait referral to the oral and m axillofacial clinic.He had previously been smoking 20 cigarettes a day for 30 years before starting to use electronic cigarettes to aid his smoking cessation.He gave a history of a painful area appearing after inhaling strongly on his e-cigarette and suffered extreme discomfort immediately afterwards.On examination a 2 cm × 1 cm necrotic ulcer was clearly visible (Fig.

An incisional biopsy confirmed no evidence of malignancy and suggested the diagnosis of non-specific ulceration.The ulcer was managed conservatively and after a prolonged period of regular reviews the area eventually healed completely.Figure 1: Necrotic ulcer clearly visible in the mouth of a 72-year-old manFull size image (74 KB) The e-cigarette device consists of a heating element and a container that holds the vapour solution.e cigarette mlIt vaporises the liquid solution into an aerosol mist that contains varying amounts of nicotine.1 The role of the e-cigarette in smoking cessation is widely accepted and its usage is rapidly increasing worldwide.2Despite the availability of research on the direct physiological effects of the e-cigarette, there is a paucity of data available on the physical effects and safety concerns of the e-cigarette on human health.1 The potential for intra oral burns and injuries may present a challenge to the oral healthcare provider.e cigarette liquid tesco

Burns in particular, as in the above case, should be considered as a differential diagnosis of non-healing oral ulceration.Burns and explosions from e-cigarettes are thought to be under reported, although cases of fires and explosions of e-cigarette do exist in the literature.3, 4, 5With the increasing use of the electronic cigarette worldwide, we aim to make healthcare professionals aware of the potential harm these items can cause.e cigarette scotlandWe also highlight the importance of including burn injuries in the differential diagnosis of soft tissue oral ulceration.e cigarette advertising banPotential hazards and safety concerns associated with the e-cigarette requires further research.TopReferences Tomar S L , Fox C H , Connolly G N .e cigarette tech

| Article | PubMed | Besaratinia A , Tommasi S . . ; : 65–67.| Article | PubMed | Rogér J M , Abayon M , Elad S , Kolokythas A . . ; : 1181–1185.| Article | PubMed | Meernik C , Williams F N , Cairns B A , Grant E J , Goldstein A O . . ; : i5024.| Article | PubMed | Harrison R , Hicklin D Jr . . ; : 891–896.| Article | PubMed | Torbay and South Devon NHS Foundation Trust MORE ARTICLES LIKE THIS These links to content published by Nature Research are automatically generated.e cigarette use ukSee comment in PubMed Commons belowBr Dent J. 2017 Feb 24;222(4):226.doi: 10.1038/sj.bdj.2017.150.Electronic cigarettes: Necrotic ulcer.Cant A1, Collard B1, Cunliffe D1.Author information1Torbay and South Devon NHS Foundation Trust.PMID: 28232716 DOI: 10.1038/sj.bdj.2017.150 Full Text SourcesNature Publishing Group Supplemental ContentElectronic cigarettes can stop wounds from healing, experts have warned.A study found that chemicals in the devices can impair the processes that allow the body to repair itself.The findings may explain why some users can develop persistent painful mouth sores and ulcers.

E-cigarettes are widely promoted as a safer replacement for tobacco.But toxicology experts in the US say they can lead to a range of health issues.A study by the University of Rochester in New York, published in the journal Scientific Reports, exposed damaged lung tissue to e-cig vapours in the laboratory.Chemicals and nicotine found in e-cigarette can prevent cells getting enough energy to heal a wound properly and can increase the risk of contracting gum disease (file photo)They found the nicotine and flavour chemicals prevented certain cells getting enough energy to heal a wound properly.Study leader Dr Irfan Rahman said: ‘While it is perceived that they may be less harmful than conventional smoking, our data shows e-cigarettes can lead to other health issues apart from lung damage.’E-cigarettes contain a liquid form of nicotine that is heated into vapour to be inhaled, avoiding the harm caused by tobacco smoke.Nearly 3 million adults in Britain have used e-cigarettes in the decade they have been on the market.Health experts agree that the devices are much safer than smoking tobacco – and the gadgets are thought to have helped 22,000 people quit smoking each year.But many are worried about unresolved safety concerns, particularly linked to the chemicals used to flavour the vapour.Others are also concerned that e-cigarettes provide a ‘gateway’ for teenagers to go on to smoke tobacco.The scientists, whose work is published in the journal Scientific Reports, exposed human lung tissue to e-cigarettes vapours in the laboratory.When they wounded the tissue by scratching it, some of the cells around the wound - known as fibroblasts - began to change to begin the process of repairing the damage.Normally these cells produce matrix-like structures that new tissue can grow across while those cells around the edge of the wound shrink to help close it.But Dr Rahman and his colleagues found after exposure to flavoured e-cigarette vapour, the wounds did not close up.They also found the ability of the cells around the wound to convert to those needed for wound healing was also inhibited.

E-cigarette vapour could also trigger inflammation in the mouth, increasing the risk of gum disease.But experts say they are still less harmful than smoking cigarettes (file photo)Dr Rahman said it appears the nicotine and flavour chemicals in the e-cigarette vapour were preventing the fibroblast cells from getting the energy they needed to heal a wound properly.He said further work was needed to examine what impact this would have in the lungs and mouth of real people.But he added it may explain why vapers often report suffering persistent ulcers and sores on their gums.It builds on previous work by Dr Rahman and his team that found e-cigarette vapour could also trigger inflammation in the mouth, increasing the risk of gum disease.This gum damage could even lead to teeth falling out in the most serious cases, he warned.He said: ‘How much and how often someone is smoking or vaping flavoured e-cigarettes will determine the extent of damage to the gums and oral cavity.’The research comes after scientists at the University of California, Berkeley, found traces of toxic metals in the e-liquids used by five major brands of e-cigarettes.Others have found apparently harmless liquids can generate harmful compounds like formaldehyde when they are heated by the coil in an e-cigarette.Martin Dockrell, head of tobacco control at Public Health England said that despite the results, e-cigarettes remain much less harmful than smoking.He said: ‘We know that smoking slows wound healing and increases the risk of infection, but when smokers switch to e-cigarettes the overall harm to their health is greatly reduced.’Deborah Arnott, chief executive of health charity Action on Smoking and Health (ASH) added: ‘Studies like this one are misleading because they don’t compare the impact of vaping with smoking.‘It’s the smoke that does most if not all of the damage, not the nicotine.‘Sadly that message isn’t getting through - nearly a quarter of smokers who haven’t tried vaping say they’re unwilling to because of concerns e-cigarettes are not safe enough.‘We would always recommend smokers to quit completely but for those who can’t then vaping is much lower risk than carrying on smoking.’