The Effects of Smoking on Oral Health

Cigarette smoking has been linked to increased risk of heart disease, stroke, poorly controlled diabetes, respiratory disease and premature babies. In addition to all these, smoking is a major cause of tooth loss and periodontal disease.

In the first ever study estimating the proportion of periodontal disease cases which can be attributed to cigarette smoking, published in the Journal of Periodontology, researchers analyzed government health data on 13,650 people aged 18 and older who had their teeth. They found that smokers are about four times more likely than people who have never smoked, to have advanced periodontal disease.

The study also revealed a dose-response relationship between cigarettes smoked per day and the odds of periodontitis. “Smokers who smoked less than half a pack per day were almost three times more likely than nonsmokers to have periodontitis. Those who smoked more than a pack and a half per day had almost six times the risk,” explains the study’s lead researcher, Scott Tomar, D.M.D., Dr.P.H. of the Division of Oral Health at the Centers for Disease Control and Prevention (CDC).

“Cigarette smoking may well be the major preventable risk factor for periodontal disease,” elaborated Tomar. “The good news is that quitting seems to gradually erase the harmful effects of tobacco use on periodontal health.”

Cigar and pipe smoking may have nearly the same adverse effects on periodontal health and tooth loss as cigarette smoking. A study in which researchers analyzed 705 people whose ages ranged from 21 to 92, found that 17.6 percent of current or former cigar or pipe smokers had moderate to severe periodontitis, nearly three times that of non-smokers. In addition, they averaged four missing teeth.

“Cigarette, cigar and pipe smokers all had a much higher prevalence of moderate to severe periodontitis, compared to former smokers and non-smokers,” explained Jasim Albandar, D.D.S. Ph.D., lead researcher of the study and professor of periodontology at Temple University School of Dentistry.

Cigar smokers are also at a higher risk of alveolar bone loss than non-smokers. “This increase in risk is similar in magnitude to that of cigarette smokers,” said Albandar. His teams’ study can also be found in the Journal of Periodontology.

The negative effect tobacco has on oral health doesn’t stop there. Smoking interferes with healing, making smokers more likely to lose teeth and not respond to treatment. “Tobacco reduces the delivery of oxygen and nutrients to gingival tissue,” explains Robert Genco, D.D.S. Ph.D., and editor of the Journal of Periodontology. “Smoking impairs the body’s defense mechanisms, making smokers more susceptible to an infection like periodontal disease.”

Also, according to a study by Swedish researchers, smoking impairs the outcome of surgical and non-surgical periodontal therapy. “In this study we investigated the relationship between tobacco smoking and the inflammatory response in smokers who consumed 10 to 20 cigarettes per day. What we found in tobacco smokers is that the body’s defense mechanism was weakened, whereas the defense mechanism in non-smokers promoted a more favorable healing response,” said Michael P. Rethman, D.D.S., M.S., and president of the American Academy of Periodontology (AAP).

Rethman also urges patients who want to quit smoking, to increase brushing and flossing and says, “It’s suggested that the fresh clean feeling a person feels in the mouth after brushing and flossing may curb the urge to smoke. Ironically, these simple tips also help to prevent periodontal diseases.”

Yet another very scary risk associated with smoking is oral cancer. According to the American Cancer Society, this is news that upwards of 31,000 people in the United States alone face each year. Approximately 90 percent of those diagnosed with oral cancer, including cancer of the mouth, tongue, lips, and throat, are tobacco users.

All forms of tobacco increase the risk of oral cancer. Smokers are six times more likely than non-smokers to get an oral cancer. Pipe and cigar smokers are also at risk for oral cancers, even if they don’t inhale. This risk is compounded when combined with alcohol use. And, due to the fact that men are more likely to smoke and drink heavily for longer periods of time than females, men contract oral cancer at twice the rate of women.

Some sobering statistics from the American Cancer society state that:

• About 90 percent of people with cancer of the mouth, lips, tongue, and throat, use tobacco, and the risk of developing these cancers increases with the amount smoked or chewed and the duration of the habit. Smokers are six times more likely than non-smokers to develop these cancers.
• About 37 percent 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 six percent of those who stop smoking.

Oral cancer screening is performed as a part of dental checkups, and is one of the best ways to catch oral cancer early. The earlier oral cancer is detected, the better a person’s chances for survival.

Besides all of the above oral health downsides, smoking also causes bad breath and stained teeth.

Regardless of time spent using tobacco products, quitting now can greatly reduce serious risks to your health. Nicotine gum and patches may help you calm nicotine cravings. Some of these products can be purchased over-the-counter; others (such as Zyban) require a prescription. Smoking cessation classes and support groups are often used in conjunction with drug therapy.

Hypnosis, acupuncture, and herbal remedies are also treatments that may help you kick the habit.