How Tobacco Affects Oral Health

Written by Megan Rose, Physician Assistant.When most people think of the negative consequences of tobacco use, they commonly picture the damage it causes to lungs.  Did you know tobacco affects oral health just as severely? Both smoking tobacco and using smokeless tobacco contribute to negative oral health effects. 

Smoking leads to oral health problems, including:

• Halitosis (Bad breath)
• Yellowing or darkening of teeth
• Trauma to the salivary gland openings on the roof of the mouth causing inflammation
• Increased plaque and tartar on the teeth
• Accelerated bone loss of the jaw
• More incidences of leukoplakia, or white patches inside the mouth
• Much higher risk of developing gum disease (a leading cause of tooth loss)
• Delayed healing of any surgery, especially tooth extractions, periodontal treatments, or oral surgery
• Much lower success rates of dental implant osseo-integration (successful implants)
• Over higher risk of developing all types of oral cancer (including mouth, tonsils and pharynx)
• Decreased tolerance to pain, such that one’s threshold for pain is lower than a nonsmokers’

 

 Smoking affects gum health by loosening the attachments from a person’s gum tissue to their teeth. In addition, smoking specifically inhibits the gum tissue cells from functioning normally.  This increase in space between the teeth and the gum tissue becomes a breeding ground for bacteria and is very difficult to keep clean with regular hygiene.The nicotine also decreases immune system function by approximately 50%, so your body needs to work harder to fight that bacteria.  Furthermore, nicotine is a well-known vasoconstrictor (meaning it constricts blood vessels).  You can imagine this by picturing a kinked garden hose which allows a very small amount of water through the hose.  Gum tissue requires adequate blood supply with nutrients to deposit and ability to pick up the waste and carry it away.  Nicotine cuts off that blood supply to areas trying to fight infection and to areas trying to heal after a surgery—therefore it slows both of these processes. 

What about smoking cigars and pipes?

The Journal of the American Dental Association published a 23-year long study stating that smoking cigars and pipes carries the same risks to the mouth that inhaling cigarette smoke does.  Smoke coming into contact with the teeth allows for plaque deposit and discoloration of teeth.  Cigar and pipe smokers have the same risk for tooth loss and also alveolar bone loss (the socket bone that holds the teeth in their place) as cigarette smokers. 

 Beyond these possibilities, pipe and cigar smokers remain at risk for oral and pharyngeal (throat) cancers (even if they do not inhale). They are also at risk for other oral consequences as well such as bad breath, stained teeth, and increased risk of gum disease. 

But what about smokeless tobacco?

Smokeless tobacco contains even higher levels of nicotine than cigarettes do. Therefore, it is much more difficult to quit. Just one can of snuff contains more nicotine than over 60 cigarettes!Some brands can also contain sand and grit which can cause mechanical wear to one’s teeth.  Other flavored brands contain sugars which create sticky plaques and cause decay.  One study published in the Journal of the American Dental Association demonstrated that smokeless tobacco users were four times more likely than nonusers to develop tooth decay.  Chewing tobacco can irritate the gum tissue, causing it to recede and pull away from your teeth. Once that gum tissue pulls away, the teeth roots become exposed, and that causes an increased risk of tooth decay. Eating and drinking hot or cold foods also becomes more uncomfortable as exposed roots are more sensitive to temperature. 

 

But It’s Never Too Late to Quit!

Regardless of how long you have used tobacco products, quitting now can greatly reduce serious risks to your health. Eleven years after quitting, former smokers' likelihood of having periodontal (gum) disease was not significantly different from people who never smoked.Even reducing the amount that one may smoke appears to help overall health. One study revealed that smokers who cut their cigarette use to less than 10 cigarettes per day had only three times the risk of developing gum disease compared with nonsmokers. This was significantly lower than the six times higher risk seen in those people who smoked more than a pack and a half per day (30 cigarettes).Another study which was published in the Journal of the American Dental Association found that the leukoplakia (a white lesion found in the cheeks of people who use smokeless tobacco) completely resolved within 6 weeks of quitting in 97.5% of patients who chewed.Additionally, some statistics from the American Cancer Society offer some other sobering reasons to quit smoking cigarettes. They state that:

1. About 90% of people with cancer of the mouth, lips, tongue, and throat use tobacco.  The risk of developing these cancers also increases with the amount smoked or chewed and the duration of the habit. Smokers are six times more likely than nonsmokers to develop these cancers.
2. About 37% of patients who persist in smoking after apparent cure of their cancer will develop second cancers of the mouth, lips, tongue, and throat, compared with only 6% of those who stop smoking.

So do not only your lungs, but your mouth, teeth, whole body (and your bank account) a favor and talk to your doctor about the many ways you or someone you love can get help to quit using tobacco products.