Dental Problems Caused Due To Smoking

Most of us recognize the negative impact of smoking on the respiratory system, in particular the lungs. But the impact of smoking on dental health needs to be discussed.

Key takeaways:
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    Smoking has a detrimental effect on overall oral health.
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    It can cause diseases such as oral cancer, dental cavities, periodontal diseases that may lead to tooth loss.
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    Consulting a dentist and joining smoking cessation programs may improve the overall oral health.

Smoking has numerous detrimental effects on the mouth. For instance, smoking increases the risk of dental diseases, taste and smell disorders, impaired wound healing, periodontal disease, oral mucosal lesions such as smoker's melanosis, smoker's palate, potentially malignant lesions and oral cancer.

Here we discuss scientific evidence for smoking and some oral diseases.

Smoking increases the risk of oral cancer

Oral cancer usually starts inside the mouth and affects areas such as the anterior two-thirds of the tongue, gingivae, the mucosal lining of the lips and cheeks, sublingual floor of the mouth, hard palate, and minor retromolar region.

A recent meta-analysis evaluating the risk of oral cancer in various countries including the United States reported that pooled cancer risk estimate in smokers was 3.43 times higher than in nonsmokers.

Symptoms can include:

  • A lump or non-healing sore/ulcer in the mouth for more than 14 days.
  • Soft red, white, or speckled patches in the mouth.
  • Difficulty swallowing, chewing, speaking, and with jaw or tongue movements.
  • Malocclusion or ill-fitting dentures.
  • Sudden weight loss.

How does oral cancer progress?

Oral cancer development is a complicated and multidimensional process. The underlying mechanisms involved in malignancy development include alterations in the tumor microenvironment, which is made up of cells, chemical released by the cells, blood vessels, and extracellular matrix, as well as the complicated "cross-talk" between these structures. Genetic mutations may also play a role in causing oral cancer.


Surgery is the cornerstone of treatment for individuals with advanced stages of oral cancer. External beam radiation therapy and brachytherapy have successfully been used as the primary modality for treating patients with early-stage mouth cancer, and they are the standard of care for use as adjuvant therapy (to keep the cancer from returning) in patients with late-stage oral cancer after surgery.

Periodontal diseases

Smoking can increase the risk of periodontal disease. Periodontal disease develops when plaque bacteria produce toxins that irritate the gums and bones, causing them to retreat from the tooth. Periodontal disease can harm the periodontal ligament, which connects the tooth to the alveolar bone, leading to tooth loss.

Symptoms can include:

  • Gingival bleeding when brushing or may occur spontaneously.
  • Tooth mobility.
  • Presence of gingival enlargement.
  • Tooth migration.

How do periodontal diseases advance?

Periodontal disease development is mediated by the inflammatory response to microorganisms in tooth biofilm. Bacteria such as Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola were associated with periodontal disease.

Environmental influences influence the regulation of immune-inflammatory systems, which govern patient susceptibility.

Treatment of periodontal diseases

Periodontal disease is treated in stages, beginning with the most conservative methods.

Professional dental cleaning, including scaling and root planing to remove dental plaque and calculus found both above and below the gum line, is the first phase of treatment for all forms of periodontitis. Patients are also advised at-home oral hygiene regimen to improve their oral health.

A regular follow up to determine the disease progression may be necessary. If the symptoms persist, the patient should return to the dentist for frequent cleaning, as periodontitis is a chronic disease that can reactivate under poor oral hygiene conditions.

Dental caries

Epidemiological studies have revealed a link between smoking and tooth caries (cavities). Dental caries are caused by cariogenic bacteria, poor dental hygiene, a high carbohydrate consumption frequency, malnutrition, and a low socioeconomic level. The content of saliva plays a crucial role in determining the occurrence of dental caries.

Symptoms can include:

  • White or brown spots on teeth.
  • Cavities on the surface of the teeth. If the deeper layers of the teeth are affected, tooth decay can also harm the nerves and the roots.
  • The teeth become sensitive and hurt.
  • Dental caries can damage the teeth so much that they need to be replaced, for example with a bridge.

How are dental caries caused?

Saliva composition is a key element in predicting caries prevalence. Many studies have found that salivary secretory IgA (sIgA), pH, and flow rates all play a role in oral mucosal immunity. sIgA concentrations might fluctuate based on salivary flow rate, hormonal factors, emotional states, physical activity, and environmental influences.

The decreased buffering effect and probable lower pH of smokers' saliva, as well as the higher amount of lactobacilli and Streptococcus mutans in smokers' saliva, may favor increased susceptibility to caries.

The link between smoking and tooth cavities is widely established among the elderly. In conclusion, lower levels of sIgA favor an increase in the prevalence of dental caries.


In the early stages of dental caries, brushing your teeth with fluoride toothpaste and having a fluoride treatment at the dentist’s office may be sufficient. If tooth damage is significant, restorations such as a partial or full crown may be required. Root canal treatment is frequently recommended if nerves are also damaged. Sometimes a tooth must be extracted.

Oral candidiasis

Smokers are more likely to develop oral infections than nonsmokers. Cigarette smoke has been demonstrated to influence the activities of Candida albicans that cause oral candidiasis. The prevalence of oral Candida in healthy people has been observed to range between 17% and 75%.

Cigarette smoke condensate boosted the growth of C. albicans adhesion and biofilm development. Cigarette smoke condensate-induced C. albicans adhesion, proliferation, and biofilm formation could explain the pathogen's higher persistence in smokers.

Symptoms can include:

  • Oral candidiasis appears as a white coating covering mouth and throat.
  • Irritated red spots that frequently bleed slightly upon scraping.
  • A persistent cottony feeling in their mouth despite good dental hygiene.
  • Altered taste.
  • Pain or a burning feeling on their tongue.
  • Difficulty in eating and drinking difficult.
  • Severe oral thrush might impair your ability to swallow and speak.


Antifungal drugs such as nystatin, clotrimazole, amphotericin B, and miconazole are used to treat Candida infections. Antifungal creams are also available and can be used for seven-day treatments. Econazole or fluconazole 150 mg orally once a day are also options.

Tooth loss

Tooth loss is one of the most common oral disorders, following dental caries and periodontal disease. Several published observational studies have found a link between smoking status and tooth loss. Cigarette smoking was linked to a higher prevalence of tooth loss at the start of the study as well as a higher incidence of tooth loss over the follow-up period.

Given the bad impact of smoking on oral health, dentists recommend quitting smoking, as you may experience oral cancer, tooth loss or periodontal disease. Quitting may be difficult but smoking cessation programs may offer good support during the process.


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