Effects of Smoking on Oral Health

Smoking can cause a number of health related problems. Little is known about the amount of adverse effects smoking can have on your oral health. It can cause irreversible damage to your oral health and even may lead to some fatal diseases if not diagnosed and treated at an appropriate time

Effects of Smoking on Oral Health

Smoking can cause a number of health related problems. Little is known about the amount of adverse effects smoking can have on your oral health. It can cause irreversible damage to your oral health and even may lead to some fatal diseases if not diagnosed and treated at an appropriate time

‘Smoking is Injurious to Health’. These words have been repeated time and time again and extensive public awareness campaigns have been arranged to spread the awareness. But sadly, the menace of using tobacco products is still widely spread in almost every culture and every part of the world. According to Centers for disease control’s health report ‘Cigarette smoking is the leading preventable cause of death in the United States’.[1]  Rates of smoking have peaked and even declined in the developed world.[2] But in the developing world, tobacco consumption is still rising by 3.4% per year.[3] The WHO in 2004 projected 58.8 million deaths to occur globally, from which 5.4 million are tobacco-attributed, and 4.9 million as of 2007.[4]

Cigarette smoking harms nearly every organ of the body, causes many diseases, and reduces the health of smokers in general. As the awareness regarding the harmful effects of smoking increases the prevalence of smoking has declined in the past couple of decades from 20.9% (nearly 21 of every 100 adults) in 2005 to 14.0% (14 of every 100 adults) in 2017.[5] There is a growing realization about the harmful effects smoking can have on your body and general health, but still many are unaware of the deleterious effects that smoking can have on your oral health.

Some prominent problems on oral health from smoking:

PERIODONTAL PROBLEMS

Periodontal area or Periodontium is the area around your tooth surface that supports and stabilizes your tooth in its place. To stay healthy and functional your periodontium needs two things; to stay clean from plaque and calculus and a continuous supply of oxygen in your blood stream to help it heal in case of any gum disease. Smoking causes gum disease to progress faster than in non-smokers. Gum disease is seen as the most common cause of tooth loss in adults.

There is a vast amount of research evidence that the type of bacteria seen in smokers has a greater tendency of causing gum disease. This can be attributed to the higher quantity of “bad” bacteria that is present in smokers.[6]

The contents of cigarette like nicotine can alter a smoker’s immune system (body’s defense mechanism). Smokers exhibit a decrease in several pro-inflammatory cytokines and chemokines and certain regulators of T-cells and NK-cells. Tobacco smoking reduces leukocyte activity and is responsible for a low chemotactic migration rate, low mobility and low phagocytic activity.[7] This reflects the immunosuppressant effects of smoking which may contribute to an enhanced susceptibility to periodontitis.[8]

Smokers also have reduced inflammation and bleeding from gums than in non-smokers. This is due to the constriction in blood vessels around the tooth. Due to this reason the universal sign of unhealthy gums i-e the ‘bleeding gums’ is masked and the smoker has a false sense of safety about the health of his gums..

Therefore, Smoking works in a triad to cause a periodontal disease. a) It changes the kind of bacteria present in your mouth and invites the more harmful micro flora b) It alters the human immune response to the disease and hinders the healing process c) It masks the signs of your gum disease so it can take years before the patient seeks help, which is at times a little too late.

AESTHETIC PROBLEMS

Another harmful effect of smoking on oral health is staining of the teeth. Twenty eight percent of smokers reported having moderate and severe levels of tooth discoloration.[9]  This is mainly attributed to the presence of tar and nicotine in the cigarette. When a person starts smoking teeth first start getting discolored and become yellowish within a short period of time. If the smoker continues to smoke the teeth will eventually become brown after a few years of smoking.

Smoker’s melanosis is also associated with cigarette and pipe smoking. A study conducted by Axéll T and Hedin CA in Swedish population concluded that 21.5% of tobacco smokers exhibited smoker's melanosis, whereas only 3% of nonsmokers had the lesion.[10] It is seen as brown spots inside the mouth mostly over the gums and interdental papilla. The amount of melanin pigmentation is increased in heavy smokers leading to darker spots.

BAD BREATH AND ALTERED TASTE

Smokers tend to have a dry mouth resulting in xerostomic conditions and its associated problems. Reduced saliva allows odoriferous volatile compounds to increase thus giving a characteristic bad breath. As discussed before, smoking can also result in severe gum problems which allow bacteria to find harbor in gums and result in a chronic halitosis.

Smoke aerosols produced by burning tobacco contain a complex mixture of thousands of constituents such as irritants, carbon monoxide (CO) and psychoactive alkaloids, including nicotine. Some of these components may affect taste sensory mechanisms. [11] Study results have shown that chronic exposure to cigarette smoke affects the taste function in humans. Smokers exhibited significantly lower taste sensitivity than non-smokers - the higher the nicotine dependence, the lower the taste sensitivity. [12]

FAILED IMPLANT TREATMENT

Most of us have had some form of dental treatment at least once in our lifetime. Whether it’s filling a carious tooth, doing root canal, or even getting a missing tooth replaced by dental implants.

For an implant to succeed there has to be an amalgamation of numerous factors, right from a good surgery to a good prosthesis and its proper maintenance. Various studies report a failure rate of implants in smokers compared to nonsmokers, ranging from 6.5% to 20%.[13] [14] The insertion of implants in smokers significantly affected the failure rates, the risk of postoperative infections as well as the marginal bone loss. A recent study published in the Journal of Oral Implantology in October 2018 concluded that the rate for implant failure among smokers was significantly higher when compared with results of implants placed in non smokers of comparable group.[15]

Peri-implantitis is the name given to gum disease around an implant, and chronic peri-implantitis results in implant failure when left untreated. Systemic review published in the journal of Clinical Oral Implants Research showed that the implant-based meta-analysis revealed a higher and significant risk of peri-implantitis in smokers compared with nonsmokers. Interestingly, the patient-based meta-analysis did not reveal any significant differences for risk of peri-implantitis in smokers but given the low number of included studies, future studies are needed to confirm these results.[16] Programs designed to stop smoking show considerable promise in improving the success rate of dental implants in smokers

ORAL CANCER

Tobacco is the most global cause of cancer, and it is preventable. Most people are aware that smoking can cause lung and throat cancer, but many people still don't know it is also one of the main culprits resulting in oral cancer. Each year thousands of people across the globe die due to oral cancer as a consequence of smoking. Smoking accounts for 75% of oral cancers in the United States. Tobacco use, alcohol consumption, and poor diet together possibly explain about 90% of head and neck cancers.[17]

The risk of developing these cancers significantly increase with the amount of tobacco smoked. Although we do not know exactly how smoking causes cancer, the toxic elements of smoking do cause harm to cells, which could easily lead to cancer. People that smoke are six times more likely than non-smokers to develop these cancers. Oral cancer in smokers is most likely to occur on the side of the tongue and the floor of the mouth. Being a smoker if you notice an ulcer or any other suspicious lesion in your mouth that is not healing than it is important that you contact an oral and maxillofacial as soon as possible.

Quitting smoking lowers your risk for smoking-related diseases and can add years to your life. [1] [18] when it comes to improvement in oral health after you quit smoking, encouragingly, people who stop smoking are found to have the same risk of developing gum disease and responding to gum treatment as non-smokers. When you stop smoking you will clearly notice that your breath will smell fresher, there won’t be any more smoking related staining on your teeth and your sense of taste and smell will improve greatly as well.

Besides these obvious advantages quitting smoking will avoid the long term and fatal deleterious effects on your health. Remember that you are also putting your fellow colleagues and family members at the hazard of second hand smoke which can be harmful to them. Smoking is also an expensive addiction and it can also put a lot of burden on your finances.

In order to quit smoking you can follow a number of steps at a personal level while also seeking professional help. Use of over-the-counter nicotine patches have shown to be quite effective in reducing the urge to smoke. You can also consider becoming part of a quit smoking program or using prescription medications that can help you get rid of this addiction for good. The first step towards fixing a problem is to accept it and if you have accepted today that smoking is a problem and it is badly affecting your life than you are already on the right track.

Allie Leon, Chief Fun Officer

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