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The microbial growth also exposes the oral cavity of SLT users to harmful microbial metabolites such as endotoxins and mycotoxins, leading to dysbiosis of the oral microbiome or even chronic inflammation resulting in pre-cancerous lesions303132

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These provisions: Prohibit the sale of tobacco products to anyone under 21 nationwide

Jackler's research team has been following the vaping industry for almost a decade and believes that "simply put, Juul transformed the market by more than doubling the nicotine concentration in the e-liquid consumer markets." More e-cigarette brands are selling devices with higher nicotine levels than in previous years, according to the study For the study, Jackler and his team conducted an online search for Juul look-a-likes that offered more than 5% nicotine salt e-liquid by volume

While they noted that tobacco use has been on the decline for years, there has been an increase in e-cigarette use, which has become an issue at the high school bathrooms, they said