Health January 2015

Smoking and the oral cavity

Visible and hidden effects on teeth and gums

  • Stained teeth, bad breath are smokers’ main dental concerns
  • Gums are adversely affected by smoking
  • Sense of taste and smell improve after quitting, patients say

It is a well-known fact that smoking is detrimental to one’s health. Ads on the label of cigarette packs show gruesome pictures of individuals affected by this age-old habit, and magazines advertise smoking cessation patches and chewing gums.

The negative effects of smoking on the body have become ingrained in the minds of the general population, but what are its effects on the oral cavity specifically? Does it affect teeth or the structure which stabilises the teeth in our mouths? Can it cause problems in a marriage? Can it make your sushi taste bland?

I would like to briefly elaborate on some points that may clarify these questions.

On a daily basis, I see the profound effects that smoking has on the oral cavity. The most notable is the impact it has on the gums. Yet, contrary to expectations, smokers clinically have less gum inflammation than non-smokers.

This does not mean that smoking reduces the inflammation but, rather, that smokers have a decreased expression of clinical inflammation due to the effects of tobacco on the microvasculature—the smallest systems of blood vessels in the body. T

his clinical representation is one of the reasons gum disease is termed the silent disease. It can melt the supporting structures—the bone of the jaw and skull—that hold the teeth in the mouth, despite the gums looking relatively healthy.

When smokers come to me for a general check-up, they primarily have two major concerns: stained teeth and bad breath. For most of them, the impetus to make an appointment is generally subtle comments made by their partners.

The nicotine in tobacco products stains teeth. This can be addressed by a simple dental cleaning. One quick appointment with the hygienist, and almost all patients walk out of the surgery, delighted with their newly white and shiny smiles. Halitosis (bad breath), however, is a separate issue.

If it is not of medical origin, in most cases it is a culmination of periodontal bacteria that have built up over the years. These bacteria can dwell in the gums and cause havoc to the surrounding structures of the teeth. One cleaning session does not take care of this chief complaint.

Tobacco contains many substances known to be destructive to your body’s cells and tissues. Smokers have more calculus (tartar) and plaque than have non-smokers.

Moreover, the nicotine in tobacco causes vasoconstriction, or narrowing of the blood vessels. In fact, blood circulation has been shown to decrease by as much as 70% during the smoking of a cigarette.

When dried plaque is removed from a smoker’s mouth, the sulfurous vapours emitted can be noticed even through a dentist’s mask, and the distinct tinge of the nicotine can be seen.

In some cases, the smell can be the result of an infection or abscess that has created a bag of pus within the confines of the patient’s gums.

Smoking can also cause drying of the mouth, which inadvertently leads to a temporary decrease in salivary flow. Saliva is a natural buffering agent. It aids the washing away of food debris, and increases the pH level in the mouth which, in turn, helps to prevent the incidence of tooth decay.

Drying of the mouth also affects the taste buds that are embedded on the surfaces of the tongue.

After they have stopped smoking, people often tell me that, in addition to having healthier gums, they enjoy their meals more than they did when they were smoking. This is because their sense of smell and taste are heightened.

As well as bad breath, stained teeth and bone loss, smoking causes gums to shrink, mouth sores, a decreased sense of taste and smell, and impedes the healing of mouth sores.

It can also result in cases of hairy tongue (a coating on the tongue’s top surface), leukoplakia (a growth of keratin on mucous membranes of the oral cavity) and oral cancer.

I have noticed that a patient’s awareness of the impact of smoking on their health is the result of its effects on their oral cavity. It is my hope that awareness of these conditions will help prevent people from becoming addicted to tobacco.