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Smokers Mouth | Learn the Negative Effects and How to Improve Your Oral Health

If you are a smoker, there are many unique things going on in your mouth that aren’t present in the mouths of non-smokers. It’s important that you understand this contrast so that you can work to improve your oral health.

With this guide, you’ll gain a clearer understanding of smoker’s mouth and the effects that it has on your health. If you’ve been smoking for a long time, these effects are likely to be more pronounced. However, don’t let that stop you from taking steps to better yourself.

a cigarette between teeth model

How Smoking Affects Oral Health

It is well known that smoking plays a role in the development of lung cancer and cardiovascular disease. It also acts on various diseases and injuries of the oral cavity; the most common of which is gum disease (see also 'Is Vaping Bad For Your Teeth?'). 

What’s more, dental implant failure is more common in smokers than non-smokers, and gum disease around these implants is also more common in smokers. But that’s not all.

There are many other oral health concerns associated with smoking, including:

  • The failure of dental implants
  • Decrease in taste and smell 
  • Oral pre-cancer and cancer
  • Stained dental fillings
  • Smoker’s melanosis
  • Smoker’s palate
  • Coated tongue
  • Stained teeth 
  • Gum disease
  • Tooth decay
  • Oral thrush
  • Bad breath

That’s quite a lot to take into account. Let’s shift our focus to looking at some concerns in greater detail.

a smoker's smile vs non-smoker's smile

Gum Disease

For the past 10 to 15 years, smoking and its association with gum disease have been well documented. Based on the amount of bone around a given tooth caused by smoking, smokers are around three times more likely to suffer from severe gum disease. 

Smokers also tend to lose more teeth than non-smokers. The effect of smoking on gum disease also depends on the number of cigarettes or cigars smoked per day. 

Severe gum disease in smokers is caused by poor oral hygiene and worsened by smoking. It is now well known that smoking and poor oral hygiene can still cause more gum disease than in non-smokers.

Bacteria, blood vessels in the gums, and the effects of bacteria on the body should all be taken into consideration. For instance, there are three common bacteria associated with gum disease:

  • Aggregatibacter actinomycetemcomitans
  • Porphyromonas gingivalis
  • Prevotella intermedia

All three are shown to be present in higher amounts than in people who don’t smoke. While it is unknown as to whether there are more bacteria in general, there are a lot of studies showing that the types of bacteria in smokers are more likely to cause gum disease. This is due to the increase in the number of unhealthy bacteria present in smokers.

As far as the blood vessels in gums go, due to the narrowing of facial blood vessels, smokers have less inflammation and bleeding than non-smokers. When people stop smoking, this restriction will not only disappear, but it will continue for a while after smoking. 

Reducing inflammation around the gums can also lead to the false belief that the gums are healthy, because dentists measure gum health by the amount of inflammation around the gums.

a patient on the oral medical exam

And lastly, the body’s response to bacteria must be considered. Smoking changes the body’s response to the bacteria in the plaque and reduces the body’s ability to respond well to bacteria. This can lead to gum disease. 

Smoke contains many compounds (such as nicotine) that can weaken the immune system. Our body mainly responds to bacteria through inflammation, and neutrophils are the most important cells to prevent gum disease. 

Smokers have more neutrophils, yet fewer neutrophils reach their gums, which is mainly due to nicotine exposure. Because neutrophils cannot control bacteria as usual (because they are less likely to reach the gums), the chance of developing gum disease is much higher. 

Due to the presence of elastase, interleukin 1, matrix metalloproteinases (MMP), and prostaglandin 2, the smoker’s gums will also form faster. They are involved in the body’s immune response to inflammation, collagen loss, and bone loss. 

It is obvious that the nicotine and various compounds in tobacco can have harmful effects on the blood system, inflammatory process, and immune system, which can all lead to the progression of gum disease and poor response to treatment.

Let’s look at a few ways to identify gum disease so you’ll know what to look for. 

According to the Centers for Disease Control and Prevention (CDC), smokers are twice as likely to suffer from gum disease (periodontitis) as non-smokers. Gum disease can damage the tissue that holds the teeth and may cause the teeth to loosen or even fall out. 

Anyone who does not maintain good oral hygiene can develop gum disease, but according to the National Institute of Dentistry and Craniofacial Research, smoking is the most common disease. An important risk factor.

Gum disease symptoms:

  • Tender, red, or swollen gums
  • Persistent bad breath
  • Pain when you chew
  • Receding gums
  • Sensitive teeth
  • Bleeding gums
  • Loose teeth

a woman with sensitive gums in pain

If your dentist diagnoses gum disease early, planing and root smoothing can reverse this effect. Your dentist will use hand-held instruments and ultrasonic instruments to remove plaque from your teeth and under your gums. The teeth make the gums grow together after the operation. Tartar removal and root leveling may require one or more visits.

But remember, it helps if you can catch gum disease early. In doing so, you’re less likely to have progressed damage. Your dentist can then provide more effective dental care to your mouth and teeth. Gum disease isn’t always 100% reversible, but you’ll have much better chances of recovery.

Dental Implants

Smokers (11% of failures) had a significantly higher inplanting failure rate than non-smokers (5% of failures). It’s not known why smokers are less successful than non-smokers, but it has recently been suggested that the reason for the increase in the failure rate of implants in smokers is not the poor healing of the implant surgery.

Rather, it is believed that it’s due to the exposure of the gums around the implant to tobacco smoke. If not treated in time, chronic peri-implant inflammation can cause implant failure.

Oral Cancer

As per Johns Hopkins Medicine, smokers are 10 times more likely to develop oral cancer than non-smokers. As such, quitting smoking is the best way to avoid oral cancer. 

After 5 to 10 years of quitting smoking, your risk of oral cancer and throat cancer is halved. However, if you quit smoking, you cannot completely rule out the risk of oral cancer. Check for cancer regularly, especially if you have sores or lumps that may indicate malignancy. 

If diagnosed early, oral cancer can be treated. If you notice any of the following, contact your doctor right away:

If you have any of the following symptoms, you should see a doctor:

  • Sores on your lips or mouth that won’t heal
  • White or reddish discoloration
  • Any loosening of your teeth
  • Pain in your mouth or ears
  • Abnormal lumps or bumps
  • Difficulty swallowing

There is treatment for oral cancer, which include one or more of the following:

Surgery

  • Targeted Drug Therapy targets genes and proteins that help cancer cells grow
  • Immunotherapy can amplify or suppress your immune response as needed
  • Chemotherapy uses chemical drug treatments to kill cancer cells
  • Radiation therapy sends energy beams to kill cancer cells
  • Surgery can cut out cancer from infected areas

a surgeon during the surgery

Furthermore, a large number of studies on different populations show that smokers have a significantly higher risk of oral cancer than non-smokers. If you smoke more tobacco, the risk will increase. When people quit smoking, reducing the risk of cancer also has obvious benefits. 

Exactly how smoking causes cancer remains unknown. But the toxic elements in smoking can cause cell damage and can easily lead to cancer. Furthermore, the combination of smoking and excessive drinking can increase the risk of oral cancer. 

It is estimated that somewhere between 75% and 90% of all oral cancers are caused by the combined effects of smoking and drinking. This may be due to the following facts: For starters, alcohol dissolves certain carcinogenic toxic compounds in tobacco smoke. And secondly, alcohol increases the permeability of the oral epithelium. 

Oral pre-cancer is another concern that must be addressed. Oral leukoplakia is precancerous lesions that are more common in smokers than non-smokers. Moreover, oral leukoplakia is basically any white lesions of unknown cause, and it’s understood that these lesions may develop into cancer. 

Tooth Decay/Saliva

Smoking has many different effects on saliva. For one, smoking causes the immediate stimulation of saliva secretion. It does not affect long-term salivation. In the long run, however, it will slightly lower the pH (making the mouth more acidic) and buffer capacity, which means the possibility of tooth decay and erosion are slightly higher compared to non-smokers.

This is due to the reduced level of cystatin in saliva. It is believed that this contributes to good dental health. Studies have shown that smokers have more bacteria associated with tooth decay than non-smokers, namely Lactobacillus and Streptococcus mutans. 

Interestingly, smoking during pregnancy is also associated with an increased chance of tooth decay in preschool children.

A dentist looking at the x-ray

Other Considerations

Smoking can cause more serious discoloration of teeth than coffee and tea (see also if vaping stains your teeth), dental fillings, and dentures, which can affect the appearance of the mouth. What’s more, it’s a common cause of bad breath and affects the smoker’s sense of taste and smell. 

Melanosis is related to smoking and appears as brown spots in the mouth. Smoker melanosis occurs in 5% to 21.5% of smokers. Another issue is oral pigmentation, which is the result of tobacco smoke. Smoking stimulates the production of melanin (brown pigment in the skin and mouth).

Increased pigmentation in heavy smokers and nicotine stomatitis (upper jaw of smokers). Nicotine stomatitis occurs in the mouth as a series of red bumps that occur in the upper part of the mouth, which is usually white. 

This appearance is related to the irritation of the salivary glands by the inflamed ducts entering the mouth. Nicotine stomatitis is a response to heat (the tobacco contains no chemicals); therefore, this trauma has no direct possibility of causing cancer. 

When a person quits smoking, nicotine stomatitis usually disappears. This is certainly something to celebrate, and all the more reason to quit.

Another concern is a condition called “hairy tongue.” It is characterized by the overgrowth of tiny “hairs” called papillae on the tongue. Depending on the source, the papillae can be white, yellow, brown, green, or black.

When tobacco is used, the color is usually brown or black. This situation is worrying because it doesn’t look good, and it can also cause bad breath.

a man worried about his health

Good Oral Care and Smoking

Yes, you can still practice good oral health care as a smoker. Cigarette smoke promotes the growth of bacteria in the mouth. At the same time, the smell of smoke remains in the mouth, which makes daily oral care particularly important. 

Brush your teeth at least once a day (see 'Best Toothpaste For Smokers'), floss, and use an antibacterial mouthwash and tongue scraper. Visit the dentist regularly to clean your teeth and check the health of your teeth and gums. If your gums are not healthy and you can’t wait for your next exam, make an appointment with your dentist immediately.

a toothpaste, toothbrush, dental floss and mouthwash

In Closing

Quitting smoking can be difficult, but you should think about how the alternative is not only bad oral hygiene but also life-threatening. As such, the effort is well worth it. With good oral hygiene and the help of a professional dentist, you can reverse some of the harmful effects of tobacco products.

It’s likely not going to be easy, which is why you should consider getting in contact with a support group to assist you in your smoking cessation. There are numerous programs available that you can use to help you stop smoking for good.

So be sure to explore the options in your area. You may be surprised to find just how many different programs are available nearby.