Tobacco Use and Oral Health

It’s fairly well-known that tobacco use has serious health consequences. Though the number of smokers has declined significantly over the last decade, cigarette smoking remains the leading cause of preventable deaths in the United States. Beyond direct links to cancer and lung diseases, regular tobacco users account for nearly 90 percent of all people diagnosed with cancers of the lips, mouth and throat. Tobacco use affects many facets of health including oral and dental.


The most obvious dental issue that tobacco use causes is discoloration, turning pearly white teeth into shades of yellows and browns. The otherwise invisible nicotine becomes yellow when it combines with oxygen, and the tar and tobacco in cigarettes is brown. Teeth have pores much like your skin, and the nicotine and tobacco easily absorb into them and cause staining. Brushing alone cannot remove these stains. In mild cases, over-the-counter whitening strips or trays might work. In moderate cases, a professional whitening might be enough to remove them, but some traces may remain even after treatment if the staining is severe.

Tooth Decay

The tar and nicotine in tobacco products create a buildup of tartar and plaque on your teeth, causing tooth decay. Tooth decay is the process that develops cavities—areas where plaque has eroded the tooth, creating a small depression or hole that will grow over time if untreated. Smokers tend to accumulate a buildup of tartar and plaque around the bases of the teeth, which can lead to cavities that are more difficult to fill. More than 40 percent of adults who smoke cigarettes have untreated tooth decay.

Bad Breath

Tobacco use causes bad breath in a number of ways. The surfaces of your teeth, tongue, gums and mouth tissue will trap some of the smoke or tobacco particles and retain their odor. Smoking also causes dry mouth, which is the leading cause of halitosis. Additionally, tobacco dulls your sense of taste and smell, which means you might not be able to sense the problem as well as those around you.

Gum Disease

Smoking is the second most significant risk factor for gum disease (after poor hygiene habits). Tobacco has a muting effect on the immune system, weakening the body’s ability to heal itself. This means that if you develop the mild form of gum disease known as gingivitis, which typically is easily treatable, your body may not respond properly to the intervention. This increases the chance that you will develop the more serious periodontal disease, which can lead to infections and is the leading cause of tooth loss. Not only do smokers have a higher risk of periodontal disease than nonsmokers, but their disease is often worse. Even with successful treatment, they also are highly susceptible to recurrence of the disease.

Delayed Healing

Tobacco use reduces the oxygen in your bloodstream that is necessary for healing processes in your body. Tobacco users will experience delayed healing with any type of dental work including tooth extractions, dental implants, root canals or surgery. They also have a higher risk of periapical and periodontal infections. A periapical abscess is an infection of the tooth’s pulp that damages the soft tissues of the mouth, sinus cavity and bone. A periodontal abscess is an infection localized to the gum tissue surrounding a tooth. Both are serious infections that can seep into the bloodstream and in some cases become life threatening.

Are Smokeless Tobacco Products Safe?

Smokeless tobacco products consist of tobacco that’s chewed, sucked or sniffed, rather than smoked. The most popular products include chewing tobacco, snuff, snus and dissolvable tobacco products. Nicotine is absorbed through the tissues of the mouth and in some cases swallowed.

Chewing tobacco and other smokeless tobacco products are often promoted as safer alternatives to cigarettes because they aren’t linked to lung cancer. However, they are no safer than cigarette smoking. These products contain at least 28 carcinogenic chemicals, and are known to cause cancers of the mouth, lips, tongue, voice box and esophagus.

Smokeless tobacco products have negative impacts on dental health as well. Chewing tobacco, snuff and unprocessed tobacco leaves contain particles that are abrasive to teeth, so they wear down faster and become more susceptible to decay. Smokeless tobacco also increases tooth sensitivity to temperature and pressure, which can make eating and drinking unpleasant.

Many types of smokeless tobacco also contain sugars for added flavor, and these can further increase your risk for tooth decay. According to the American Dental Association, chewing-tobacco users are four times more likely than nonusers to develop tooth decay.

How About E-Cigarettes or Vaping?

Nicotine, whether smoked or vaped, damages the gums by restricting blood flow. Additionally, the fluid in these products can include propylene glycol, benzene, formaldehyde and other toxic chemicals. Exposure to the chemicals in tobacco-less smoking products has several harmful effects on oral health. People who vape or smoke e-cigarettes typically have more bacteria in their mouths than nonusers, especially in the pits and crevices of the teeth. Bacteria that lodge in these areas cause more rapid rates of tooth decay. E-smokers also are prone to dry mouth, as well as high inflammatory and weakened immune responses.

Effects on Orthodontic Treatment

Because the success of your orthodontic treatment is significantly tied to your dental health, it is no surprise that tobacco use has an adverse effect on patients wearing braces. Tooth decay, gum disease and reduced capacity for healing all will affect how quickly and accurately your teeth are able to move. Tobacco users typically will have longer than average orthodontic treatment lengths, and the gums will be slower to respond and slower to heal. You also are more prone to tooth staining while you are wearing braces.

Quitting Tobacco Use

Quitting, or even reducing, tobacco use can benefit your oral health. If you cannot quit cold turkey, every incremental reduction will help. For example, experts have found that smokers who reduce their habit from one pack to a half pack a day cut their risk of gum disease by 50 percent (from six times that of the general population to three).

You should inform all your healthcare professionals, including your orthodontist, about any tobacco use. They will be able to advise you about helpful smoking cessation products such as nicotine gum and patches, and possibly prescribe medication to help curb cravings. They also may have information about smoking cessation support groups in your area, as well as alternative methods such as hypnotherapy.

While you are on your path to quitting, taking charge of your dental health is of utmost importance. Excellent oral hygiene habits are essential, which include brushing at least twice a day, flossing daily and using antibacterial oral rinses. You also will likely need more frequent dental checkups and cleanings.

Interested in beginning orthodontic treatment? Contact us today to schedule a complimentary consult with one of our board-certified orthodontists.


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