There is overwhelming evidence that tobacco usage produces harmful effects in the mouth. Thus if you are currently smoking, it is best to know whether these conditions are affecting you now. If so, perhaps it is best to do something about it now.
How smoking affect your oral health
- Aesthetics (how you look)
Figure 1 : Stained teeth
Smoking can change the way you look. A dark brown to black discolouration on the cervical margins of teeth caused by tar /nicotine stains and other by-products of combustion is commonly associated with smoking. It causes discolouration of your teeth. Discolorations on your teeth and dental fillings are unsightly (Figure 1). If you are a denture wearer, smoking may also stains your dentures when not cleaned properly1, 10. The discolouration developed through smoking is even more severe when compared to stains that developed when you consume coffee and tea11.Thus if you smoke, you must be prepared to clean your teeth properly to avoid these unsightly stains.
- Dental decay
Figure 2 : Dental decay
Smoking lowers the pH of your saliva during smoking. If you are a chronic smokers, the presence of saliva with low pH level may be consistent enough to cause dissolution of your tooth surfaces .This promotes dental decay (Figure 2). Left untreated, it can cause loss of teeth.
- Diminished smell and taste of food
Figure 3 : Smoker’s tongue
Diminished taste and smell acuity are common side effect of smoking4, 13. When your sense of smell and taste diminishes, you may not be able to enjoy your food as much as before.
- Halitosis (Bad breath)
Smoking causes halitosis / bad breath. The strength of the smell corresponds directly to the amount you smoke4, 13. Obviously, the more you smoke the worst the condition. Halitosis is embarrassing and may cause social problem such as break down in relationships. Treatment outcome from tooth cleaning alone is not good when you continue to smoke.
- Impaired wound healing after surgical procedures
Figure 4: Dry socket after tooth extraction
Several studies have shown that smoking influences wound healing in the mouth after surgical procedures14, 7, 9. A common condition is dry socket after tooth extraction (Figure 4). This is due to poor blood supply following peripheral vasoconstrictions associated with increased plasma levels of adrenaline and nor adrenaline when you smoke.
Even with advance technologies, dental implant failure rates are significantly higher in smokers than in non-smokers. Thus if you smoke, you may not be a good candidate for surgeries even if we have the best technologies to treat.
- Gum problems (Periodontitis and gingivitis)
Figure 5: Gum diseases
Smokers tend to have more gingival inflammation (gingivitis), dental plaque and calculus as compared to non-smokers. Smokers are at a higher risk for developing periodontitis (Figure 5).The prevalence and severity is directly proportionate to the amount of cigarette smoke. The diseases results in marginal bone loss, formation of deeper periodontal pockets and attachment loss.
- Oral precancerous lesions
Figure 6: Leukoplakia
The toxic chemical released from smoking irritates the oral mucous membranes .This may result in formation of oral precancerous lesions. Of the potentially malignant lesions of the oral mucous membranes, the so-called leukoplakia (white lesion) is the most common16.Leukoplakia occurs six times more frequently in smokers than in non-smokers3. There is found to be a dose-response relationship between tobacco usage and the prevalence of oral leukoplakia (Figure 6). Reducing or cessation of tobacco use may result in the regression or disappearance of oral leukoplakia16, 5.
- Oral cancer
Figure 7: Squamous cell carcinoma
Tobacco smoke has a direct carcinogenic effect on the epithelial cells of the oral mucous membranes. It has been well demonstrated that there is a dose-response relationship for tobacco use and the risk of the development of oral cancer (Figure 7). Thus if you want to avoid oral cancer, it is best to quit now. Smoking cessation significantly decreases the increased risk of oral cancer within 5–10 years.
- Smoker’s palate
Figure 8: Smoker’s palate
Heavy smokers, especially pipe-smokers, frequently develop white changes in the hard palate, often combined with multiple red dots sometimes located centrally in small elevated nodules (Figure 8) smoker’s palate is asymptomatic and it disappears shortly after cessation of the smoking habit. It is not premalignant. The palatal keratosis associated with reverse smoking, as it can be seen in some parts of the world, is a premalignant lesion3.
Acute Necrotizing Ulcerative Gingivitis
Figure 9: Acute Necrotizing Ulcerative Gingivitis
Acute necrotizing ulcerative gingivitis (ANUG) is a painful and rapidly progressive disease of the free gingiva, attached gingiva and alveolar mucosa characterized by necrosis of the gingival papilla accompanied by halitosis (Figure 9). ANUG primarily affects young adults who smoke heavily and have poor oral hygiene 18. Although the exact interaction between ANUG and smoking is not clear, local and systemic effects have been suggested 5. The progression of ANUG may be enhanced by plaque accumulation in sites with tar deposits and tissue ischemia secondary to nicotinic vasoconstriction18 .Without treatments, ANUG may progress to involve the marginal alveolar bone. This causes tooth to be mobile and then eventually loose support.
If you have any of the conditions above, consider quit before it’s too late!
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- Axéll T. Occurrence of leukoplakia and some other oral white lesions among 20 333 adult Swedish people. Community Dent Oral Epidemiol 1987; 15: 46–51.
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- Gupta P C, Murti P R, Bhonsle R B et al. Effect of cessation of tobacco use on the incidence of oral mucosal lesions in a 10-yr follow-up study of 12,212 users. Oral Dis 1995; 1: 54–58. | PubMed | ChemPort
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- Mehta F S, Jainawalla P N, Daftary D K et al. Reverse smoking in Andra Pradesh, India: variability of clinical and histologic appearance of palatal changes. Int J Oral Surg 1977; 6: 75–83.
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- Pasquali B. Menstrual phase, history of smoking, and taste discrimination in young women. Percept Motor Skills 1997; 84: 1243–1246.
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- Renvert S, Dahlen G, Wikström M. The clinical and microbiological effects of non-surgical periodontal therapy in smokers and non-smokers.J ClinPeriodontol 1998; 25: 153–157.
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- Salvi Ge, Lawrence H P, Offenbacher S, Beck J D. Influence of risk factors on the pathogenesis of periodontitis. Periodontol 2000 1997; 14: 173–201.
- Wade DN, Kerns DG. Acute necrotizing ulcerative gingivitis- periodontitis: a literature review. Mil Med 1998; 163:337-42.