The effect of smoking on oral health –

Smoking and the Risk to Oral Health

Smoking is well known for increasing the risk of lung cancer, and for giving smokers bad breath, but it also has a number of other serious ramifications for oral health. It increases the risk of periodontal disease or gum disease, and the risk for oral cancer.

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Smoking and Periodontal Disease

Figures from the Center for Disease Control and Prevention show 41.3% of smokers aged over 65 have lost all their teeth compared to just 20% of non-smokers. This is a shocking statistic, and it might partially be due to the fact that smokers can take less care of their dental hygiene than non-smokers as they may be less concerned about their health in general. Another problem that smokers face is that they are more likely to have significant deposits of calculus or hardened plaque bacteria.


Calculus is something that can only be removed during a professional cleaning, and its presence can significantly increase the risk of gum disease as it irritates the gum tissue, creating inflammation. There is no real evidence that smoking increases the rate of production of plaque, but it’s been found that the number of calculus deposits can depend on whether or not a person smokes cigarettes or a pipe. A study found that smokers who prefer to use a pipe tend to have more calculus than cigarette smokers, and it’s thought this could be because pipe smoke has a higher pH than cigarette smoke. In addition pipe smokers sometimes hold the smoke in their mouths for longer and when combined with the calcium1 in saliva this could exacerbate the likelihood of calculus.

The Effect of Smoking on Gingival Tissues

Smoking also seems to have an adverse effect on gingival or gum tissue. One of the earliest signs of gingival inflammation or gum disease is noticing the gums to bleed more easily as the inflammation normally causes the capillaries to dilate, increasing the flow of blood. However in smokers it’s slightly different as nicotine can cause the capillaries to constrict so the gums are less likely to bleed even though they are infected. This can make the early signs of gum disease more difficult to detect in smokers, increasing the risk that the disease will develop into periodontitis before it is detected.

A Spanish study2 found that while non-smokers with advanced periodontal disease were more likely to have bleeding gums than smokers with this condition, smokers were more likely to have a loss of periodontal attachment. These are the ligaments that help to hold the teeth in place. It’s thought this may be due to the way cigarette smoke affects oral bacteria as it’s likely to make conditions more appealing for anaerobic plaque bacteria, leading to an increase in the depths of periodontal pockets and bone loss found in advanced periodontitis. Periodontal pockets are the pockets that form at the base of the teeth as the gums begin to recede in advanced cases of periodontitis, and these pockets can be filled with infection.

It gets worse, as smoking inhibits the body’s ability to heal so easily. This means smokers receiving treatment for periodontitis won’t respond so well to the therapy. Smoking constricts the capillaries supplying nutrients and oxygen to the gum tissues, and prevents waste products from being removed so easily. Smokers who have been diagnosed with periodontal disease should really try to quit before beginning treatment for this condition.

Smokeless tobacco isn’t any better, as it can also cause the gums to recede, increasing the loss of periodontal attachment and bone. In addition smokeless tobacco products often have added sugars to help enhance the flavor, and this increases the risk of tooth decay. Smokeless tobacco can contain other ingredients such as grit and sand which may wear down the tooth enamel.

Smoking and Oral Cancer

Oral cancer is still thankfully quite rare, but smoking is one of the known risk factors. People who smoke cigarettes, pipes or cigars are up to six times more likely to develop oral cancers compared to non-smokers. It’s even worse for people using smokeless tobacco, as those who like chewing tobacco or snuff are up to 50 times more likely to develop cancer in their lips, cheeks or gums. The odds are even grimmer for smokers who also enjoy a drink.

Additional Reasons for Giving up Smoking

Being at an increased risk of developing periodontal disease or oral cancer is a pretty compelling reason for giving up smoking. Additional reasons for quitting can include the fact that smoking discolors teeth, as it’s always very easy to spot someone who is a heavy smoker. It also delays healing after other dental treatments for the reasons outlined above. Anyone needing a tooth extracted or some other type of oral surgery is likely to experience a longer healing time and an increased risk of complications. Many dentists are also very reluctant to carry out dental implant surgery on a smoker, as the chances of the implant failing are considerably higher than in a patient who doesn’t smoke.

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