The Effect of Smoking on Your Teeth, Gums & Oral Health

How Does Smoking Affect Your Oral Health?

People who smoke are at risk for oral health problems. Cigarettes and tobacco can cause gum disease, oral cancer, and tooth loss.1 They also have a higher risk for complications following mouth surgery and tooth removal.

Smoking affects your teeth and other structures in the mouth. The most common oral health problems affecting people who smoke are:

  • Periodontal (gum) disease
  • Oral cancer
  • Smoker’s keratosis (whitening of the mouth’s soft tissues)
  • Dry socket (poor wound healing after tooth extraction)
  • Tooth loss
  • Tooth decay
  • Tooth discoloration
  • Leukoplakia (white patches inside the mouth)
  • Decreased sense of taste
  • Buildup of tartar and plaque on the teeth
  • Bad breath
  • Increased risk of bone loss in the jaw
  • Complications following dental implant procedures and gum and mouth surgery 

Quitting smoking improves overall oral health, reduces the risk of oral cancer and gum disease, decreases the risk of complications after an oral procedure, and improves response to oral treatment.

Link Between Smoking and Tooth Decay 

Smoking can cause serious damage to the mouth. It supports tartar, plaque, and bacteria buildup, which leads to the development of cavities. Large cavities present along the gum line can weaken the teeth and cause tooth decay. 

One of the most familiar effects of smoking is tooth decay. Untreated tooth decay is common. More than 40% of adults (20 to 60 years old) who currently smoke cigarettes have been diagnosed with untreated tooth decay.2

Eventually, untreated tooth decay will lead to other infections and pain, which may require a root canal or tooth extraction.

Signs of Tooth Decay

Poor oral health can cause bacteria buildup in the mouth. These bacteria produce acids that attack the tooth’s enamel, or surface. As a result, tooth decay develops.

Untreated tooth decay can lead to cavities. Depending on their extent and location, the signs and symptoms may vary. However, if a cavity is in its early stages, a person may not feel any symptoms. 

As tooth decay progresses, the signs and symptoms may include:

  • Visible pits or holes in the tooth
  • White, black, or brown stained teeth
  • Tooth sensitivity (pain that may range from mild to sharp when drinking or eating something hot, cold, or sweet)
  • Toothache
  • Pain when biting down

Approximately 2.3 billion people have cavities of permanent teeth worldwide. Over 530 million children have caries in their primary (baby) teeth.3

Link Between Smoking and Gum Disease

People who smoke tend to produce bacterial plaque, which can lead to gum infections. Smoking is known to constrict blood vessels, thereby lessening oxygen supply in the bloodstream. Because oxygen cannot reach the infected tissues, the gums won’t heal properly. 

Gum disease, also called periodontal disease or periodontitis, is caused by a bacterial infection made worse by the lack of oxygen supply brought about by smoking. If the infection remains untreated for a long time, this can severely impact the gums and lead to tooth loss.

Approximately 43% of smoking adults aged 65 and above have lost all of their teeth.1

Signs of Gum Disease

It’s important for people who smoke cigarettes or tobacco to visit their dentist regularly. Some signs and symptoms of gum disease to look out for include:

  • Bleeding gums
  • Gums that are red, swollen, and tender
  • Loose gums, pulling away from the teeth
  • A bad taste in the mouth
  • Bad breath or halitosis
  • Loose teeth
  • Spaces in between the teeth
  • Painful chewing
  • Pus between gums and teeth

Smoking, Teeth Stains, and Bad Breath (‘Smokers Teeth’)

Smokers teeth is an oral condition characterized by teeth stains (discoloration) and bad breath. 

Regular smoking can turn normally white teeth into brown or yellow ones. The more a person smokes, the faster tooth discoloration happens. This is brought about by the nicotine and tar in tobacco. 

Additionally, smoking has been known to cause halitosis or bad breath. It dries the mouth, too, making halitosis even worse.

How to Remove Teeth Stains from Smoking

Brushing your teeth several times a day can help improve their appearance. Doing so also helps prevent staining and periodontitis (advanced gum disease).

There is toothpaste made specifically for those who smoke. These toothpaste contain special ingredients that help fight tooth discoloration. 

When looking for a toothpaste, the following ingredients should be present:

Over-the-counter teeth whitening products can also help. This includes teeth whitening strips, gels, and pens. For severe teeth stains, professional teeth whitening services are highly recommended.

It is also possible to whiten teeth at home using homemade toothpaste. Simply add a few drops of hydrogen peroxide to baking soda and mix together until it forms a paste. Be careful not to use too much hydrogen peroxide because it can damage your teeth.

How to Combat Bad Breath from Smoking

Smoking decreases saliva production, which dries out the mouth. This results in “smoker’s breath.”

To help eliminate smoker’s breath, do the following:

  • Brush and floss your teeth at least twice a day
  • Drink a lot of water to prevent dry mouth
  • Use an antibacterial mouthwash meant for dry mouth
  • Chew on sugarless gum to stimulate saliva production
  • Suck on a peppermint to freshen your breath
  • Visit your dentist regularly for plaque and tartar removal
  • Reduce, or stop, smoking

Other Oral Health Risks of Smoking

There are numerous oral health risks related to smoking. These include, but are not limited to:

Oral Cancer

Studies have shown a definitive link between tobacco use and oral cancer. The University of California San Francisco (UCSF) has conducted a study revealing that, out of 10 oral cancer patients, 8 of them were smokers.

Smoking is known to have a high incidence of numerous types of oral cancer, including cancer of the pharynx, larynx, tongue, and oral cavity. The most common type of cancer is squamous cell carcinoma.

Smokeless tobacco greatly increases a person’s risk of oral cancer.3 It can also cause leukoplakia, a condition where gray or white patches develop inside the mouth.3

Gum Recession

Also called advanced gum disease, periodontitis is a serious gum condition.5 It can lead to bone and tooth loss. It is also the most common cause of gum recession

Smoking has been linked to the development of periodontitis because it also weakens the immune system. This impairs the body’s ability to repair tissues and fight infection.4

Dental Caries

There is a correlation between tobacco use and dental caries (cavities), which are caused by the buildup of tartar, plaque, and bacteria.6 Additionally, smoking weakens tooth enamel, making it prone to breakage. 

Studies have shown that the development of dental caries is higher in those who smoke tobacco compared to those who indulge in smokeless tobacco use.7

Can Dentists Tell if You Smoke?

Smoking has a severe impact on oral health, affecting teeth and gums in various ways. A dentist can quickly identify a smoker’s mouth

Some of the common telltale signs of smoking include the presence of plaque, tartar buildup, discolored teeth, white spots in the mouth, receding gums, and more.

The odor of nicotine in the mouth or on clothing is also an indicator.

Tips for Preventing Smoking-Related Oral Health Issues

The best way to prevent smoking-related oral health issues is to quit smoking. However, for some people, this is easier said than done. 

There are, however, preventive measures that one can take, such as:

  • Avoid food and drinks that may stain the teeth
  • Avoid sweet and starchy foods
  • Brush your teeth properly, at least twice a day, using a good quality toothbrush and toothpaste
  • Clean your tongue
  • Drink plenty of water
  • Eat foods rich in fiber and calcium
  • Use toothpaste specially formulated for smokers
  • Use an antibacterial mouthwash
  • Visit a dentist regularly

Tips for Quitting Smoking 

Here are some helpful tips for quitting smoking:

  • Avoid triggers. Stay away from people, places, and situations that tempt you to smoke.
  • Find a distraction. Staying busy by taking up a hobby or focusing on other things will take your mind off the urge to smoke.
  • Nicotine therapy. Some people have successfully quit smoking by using a nicotine patch. This helps reduce cravings.
  • Know your reason. Find something that will motivate you to stop smoking. 
  • Don't be too hard on yourself. If you find yourself relapsing, get yourself back up. Know that it's a temporary setback and try again.
  • Seek help. If you think you need professional intervention, get the help that you need. This may come in the form of behavioral therapy or other treatment options.

Are Vapes/Smokeless Tobacco Products Better for Dental Health?

Some people mistakenly think that smoking water pipes or e-cigarettes (known as vaping) is less harmful to oral health. The truth is, vaping causes you to inhale vaping juice (or e-liquids). These contain harmful substances even though they are labeled “tobacco-free,” such as:

  • Carcinogenic (cancer-causing) chemicals
  • Heavy metals
  • Nicotine
  • Volatile organic compounds (VOCs)

Additionally, daily use of e-cigarettes has been associated with a 78% higher chance of a person having poor oral health.8

Resources

Winn DM. Tobacco use and oral disease. Journal of Dental Education 2001;65:306-312.

Centers for Disease Control and Prevention. Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999–2004 to 2011–2016. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2019.

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1789–8583

Centers for Disease Control and Prevention. Highlights: Smoking Among Adults in the United States: Other Health Effects [last updated 2015 Jul 15].

Eke PI, Dye BA, Wei L, et al. Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. Journal of Dental Research 2012; 91(10):914–20

Jiang, Xue et al. “Correlation between tobacco smoking and dental caries: A systematic review and meta-analysis.” Tobacco induced diseases vol. 17 34. 19 Apr. 2019, doi:10.18332/tid/106117

Mittal, Neelam et al. “Prevalence of Dental Caries among Smoking and Smokeless Tobacco Users Attending Dental Hospital in Eastern Region of Uttar Pradesh.” Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine vol. 45,2 (2020): 209-214. doi:10.4103/ijcm.IJCM_245_19

Huilgol, Priyanka et al. “Association of e-cigarette use with oral health: a population-based cross-sectional questionnaire study.” Journal of public health (Oxford, England) vol. 41,2 (2019): 354-361. doi:10.1093/pubmed/fdy082

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