The Effect of Smoking on Oral Health

by Diane, M.P.H, M.S.

Smoking increases the risk of many dental problems:

  • Bad breath
  • Tooth discoloration, especially yellowing
  • Inflammation of salivary gland openings on the roof of your mouth
  • Build-up of plaque and tartar on your teeth
  • Bone loss within the jaw
  • White patches inside the mouth (leukoplakia)
  • Periodontal (gum) disease, a leading cause of tooth loss
  • Delayed healing process following tooth extraction, periodontal treatment, or oral surgery
  • Lower success rate of dental implant procedures
  • Oral cancer: Smokers are up to 5 times more likely to develop mouth cancer than nonsmokers..

How does smoking or the use of tobacco products promote gum disease?

  • Tobacco products interfere with the normal function of gum tissue cells and attachment of bone and soft tissue to your teeth.
  • Users of tobacco products and smokers are more susceptible to infections, such as periodontal disease.
  • Blood flow to the gums becomes impaired, resulting in slower wound healing.

Does pipe and cigar smoking increase the risk of oral health problems?

Yes. Just like cigarettes, pipes and cigars can cause oral health problems. A 23-year long study published in the Journal of the American Dental Association found that cigar smokers experience tooth loss and alveolar bone loss (bone loss within the jawbone that anchors teeth) at rates equivalent to those of cigarette smokers. Pipe smokers have a similar risk of tooth loss as cigarette smokers. Pipe and cigar smokers are also at risk for oral and pharyngeal (throat) cancers even if they don’t inhale, as well as, bad breath, stained teeth, and increased risk of periodontal disease.

Are smokeless tobacco products safer?

  • No. Like cigars and cigarettes, smokeless tobacco products like snuff and chewing tobacco contain at least 28 chemicals that have been shown to increase the risk of oral, throat, and esophageal cancer. Furthermore, chewing tobacco contains higher levels of nicotine than cigarettes, making it harder to quit than cigarettes. One can of snuff delivers more nicotine than over 60 cigarettes!
  • Smokeless “Spit” tobacco contains over 2,000 chemicals, many of which have been directly related to causing cancer.
  • Smokeless tobacco can irritate your gum tissue, causing it to recede or pull away from your teeth. Once gum tissue recedes, teeth roots become exposed, creating an increased risk of tooth decay. Exposed roots are also more sensitive to hot and cold or other irritants, making eating and drinking uncomfortable.

Health effects of smokeless tobacco include:

  • Tooth abrasion: Grit and sand in smokeless tobacco products scratches teeth and wears away the hard surface or enamel. Premature loss of tooth enamel may increase sensitivity and require corrective treatment.
  • Gum recession: Constant irritation to the area in the mouth where a small wad of chewing tobacco is placed can result in permanent damage to periodontal tissue, as well as, the supporting bone structure. Injured gums pull away from teeth, exposing root surfaces and leaving teeth sensitive to heat and cold. Erosion of critical bone support leads to loosened teeth that can be permanently lost.
  • Increased tooth decay: Sugars are often added to smokeless tobacco during the curing and processing to improve its flavor. The sugars react with bacteria found naturally in the mouth, causing an acid reaction, which leads to decay. A study published in the Journal of the American Dental Association notes that chewing tobacco users were 4 times more likely than nonusers to develop tooth decay.
  • Tooth discoloration and bad breath: Very common in long-term smokeless tobacco users. The habit of continually spitting can also be both unsightly and offensive.
  • Nicotine dependence: Nicotine blood levels achieved by smokeless tobacco use are similar to those from cigarette smoking. Nicotine addiction can lead to an artificially increased heart rate and blood pressure. In addition, it can constrict the blood vessels that are necessary to carry oxygen-rich blood throughout the body. Athletic performance and endurance levels are decreased by this reaction.
  • Unhealthy eating habits: Chewing tobacco lessens a person’s sense of taste and ability to smell. As a result, users tend to eat more salty and sweet foods, both of which are harmful if consumed in excess.
  • Oral cancer: With the practice of “chewing” and “dipping,” tobacco and its irritating juices are left in contact with gums, cheeks and/or lips for prolonged periods of time. This can result in a condition called leukoplakia. Leukoplakia appears either as a smooth, white patch or as leathery-looking wrinkled skin. It results in cancer in 3-5 % of all cases.
  • Other cancers: All forms of smokeless tobacco contain high concentrations of cancer-causing agents. These substances subject users to increased cancer risk not only of the oral cavity, but also the pharynx, larynx and esophagus.

Quitting smoking lowers your risk for smoking-related diseases and can add years to your life.

If you currently use cigarettes, cigars, pipes, or smokeless tobacco, or have in the past, be aware of the early signs of oral cancer:

  • A sore that does not heal
  • A lump or white patch
  • A prolonged sore throat
  • Difficulty in chewing
  • Restricted movement of the tongue or jaws
  • A feeling of something in the throat

Pain is rarely an early symptom. For this reason, all tobacco users need regular dental check-ups.

Hookah water pipe smoking: May pose significant risks for oral health, since the water in the pipes does not filter out all of the harmful toxins.

Quit smoking to improve your appearance and overall health:

  • Regardless of how long you have used tobacco products, quitting now can greatly reduce risks to your circulatory and overall health.
  • Reducing the amount you smoke appears to help: One study found that smokers who reduced their smoking habit to less than half a pack a day had only 3 times the risk of developing gum disease compared with nonsmokers, which was significantly lower than the six times higher risk seen in those who smoked more than a pack and a half per day. Another study published in the Journal of the AmericanDental Association found that the mouth lesion leukoplakia completely resolved within 6 weeks of quitting in 97.5% of patients who used smokeless tobacco products.
  • As blood flow improves, your skin, gums and internal organs receive more oxygen and nutrients. This can provide a healthier complexion and improved immunity. If you stay tobacco-free, stains on your fingers and nails should disappear. 
  • When you quit smoking: Your skin becomes more resistant to premature aging. In just 20 minutes, blood pressure and heart rate return to normal. Within 24 hours, your lungs start to clear out smoking debris as tiny cilia help sweep irritants out of the lungs. After a year, your risk of a heart attack drops to half that of people who still smoke; after 15 years of being an ex-smoker, risk of a heart attack falls to that of someone who’s never smoked. After 10 smoke-free years, your lung cancer risk drops to half that of a smoker.
  • Quitting eliminates the pervasive smell of cigarettes in your breath, clothes, and hair: This smell is unattractive to nonsmokers and carries health hazards, too. The odor means that people around you are exposed to tobacco toxins (third-hand smoke). These toxins can be especially harmful to small children.

American Cancer Society statistics show why you should quit smoking:

  • About 90% of people with cancer of the mouth, lips, tongue, and throat use tobacco. The risk of developing these cancers increases with the amount smoked or chewed and the duration of the habit. Smokers are 6 times more likely than nonsmokers to develop these cancers.
  • About 37% 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 6% of those who stop smoking.

To help you stop using tobacco:

  • Your dentist or doctor may be able to help you calm nicotine cravings with medication, such as nicotine gum and patches. Some of these products can be purchased over the counter; others require a prescription. Other medications such as Zyban require a prescription.
  • Smoking cessation classes and support groups are often used in tandem with drug therapy. These programs are offered through local hospitals in your community and sometimes through your employer or health insurance company. Ask your doctor or dentist for information on similar programs they may be familiar with.
  • Herbal remedies, as well as hypnosis and acupuncture, are other treatments that may help you stop the habit.
  • Engage in new activities, classes, or seek support from family and friends.


  1. American Dental Association. WebMD Medical Reference. Reviewed by Michael Friedman, DDS on May 22, 2014. WebMD, LLC.
  2. Effects of tobacco on oral tissue: Using Smokeless Tobacco is gambling with your health! (Source:
  3. “Health Effects of Cigarette Smoking: Quitting smoking lowers your risk for smoking-related diseases and can add years to your life.” The United States Centers for Disease Control and Prevention: Tables, Charts and Graphs-Smoking and Tobacco Use. (Source: www.…/ta…) 02/06/14.

Comments on this entry are closed.

Previous post:

Next post: