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The Smoking Effects on the Teeth and Mouth


The Smoking Effects on the Teeth and Mouth

What are the dangers that cigarette smoke represents for oral health?
The chronic use of tobacco is considered a risk factor for a number of oral disorders. Every form of tobacco use is demonstrably harmful to human health and especially the mouth. Consumption of cigarettes, cigars or chewing tobacco products can be detrimental to oral health. Most studies found in the literature are related to tobacco use in the form of cigarettes.

Among the main damage to the mouth caused by smoking are oral cancer, periodontal disease and halitosis. Smoking also cause stains on teeth, tongue and mucous membranes, leaving the mouth with dark spots called smoker melanosis. Body’s defenses are lowered, both local as systemic, affecting wound healing and dental implants´ osseointegration.

Tobacco causes bad breath?
Yes tobacco combustion products are a major cause of bad breath, also called halitosis. The smoke inhaled odors are expelled during talking and breathing. The use of cigarettes, cigars, pipes, chewing tobacco or marijuana (smoke roll), associated with a bad hygiene of the mouth, tongue and the presence of periodontal disease, can become extremely unpleasant breath. Another problem is the decreased salivary flow (dry mouth) caused by these substances, reducing the body's own physiological "cleanliness”, increasing the patient halitosis.

Can you lose your teeth due to smoking?
Yes, several studies show the association between smoking and periodontal disease. Periodontal disease is a chronic inflammation of the gingiva and / or the supporting tissues of the teeth, which can lead to alveolar bone reabsorption, increasing the tooth mobility, roots´ exposure and tooth loss.
The main cause of periodontal disease is the plaque buildup on tooth surfaces. This plaque is composed mainly of bacteria that produce toxins that destroy the supporting tissues of the teeth (gums, cementum, bone and periodontal ligament), causing gingivitis (inflamed gums) and periodontitis (tissues around the tooth inflammation). Periodontitis, when severe, affects the bone, causing increased mobility and even tooth loss.
The exact role of tobacco on periodontal tissues has been widely investigated. Research claim that smokers have higher plaque buildup than non-smokers and that the bacteria present on this plate are more aggressive and can cause more severe forms of periodontal disease. Other studies claim that toxins in cigarette may induce or exacerbate existing periodontal disease, and impair the treatment by altering the local immune response and reducing the action of the fibroblasts in the repair of damaged tissues. The severity of periodontal disease is related to the duration and number of cigarettes smoked per day.

Why the smoker oral health is more fragile than that the non-smoker?
According to INCA, tobacco use causes approximately 50 different diseases and a smoker become ill on average 2-3 times more than a non-smoker. In cigarette composition there are more than 4,720 substances, among them more than 60 are capable of causing damage to our body. In the mouth, the cigarettes assaults the mucosal cells and also decreases its healing ability and defense, making it more subject to the action of aggressive agents such as bacteria, viruses and fungi, and contain carcinogenic substances that increase the likelihood of developing oral cancer.

Why teeth and gums become dark?
Among the cigarette´s components is nicotine, which accumulates on the tooth surfaces, causing a dark pigmentation.
The pigmentation of the mucous membranes is called smoker melanosis. Nicotine Cigarette stimulates the melanin production, causing brown patches, especially in the gums of cigarette smokers and at the corners and cheeks of pipe smokers. Women are more affected, and it has been suggested that this fact is due to female hormones. The pigmentation occur more in heavy smokers. With the smoking cessation stains disappear gradually from the mucosa, but it may take up to three years.

Can the cigarette cause salivation problems?
Yes. The saliva plays an important role in protecting the mouth, gastrointestinal epithelium, and oropharynx. In its composition are substances that participate in the mouth cleaning and oral microflora balance. The saliva´s decrease increases the risk of cavities and the propensity for oral candidiasis.
Cigarette smoking causes a decrease in salivary secretion, leaving a dry mouth, called xerostomia. This symptom causes difficulty in chewing, swallowing and speech, as well as making the oral mucosa most sensitive, which may arises mouth sores and cracks in the language.
A study by the Technion -Israel Institute of Technology in Haifa, recreated the cigarette smoking on cancer cells in the mouth effects. Half of the samples were only exposed to smoke and the other a mixture of smoke and saliva. The researchers found that the combined cigarette with saliva produces more cell damage that smoking separately.

What kind of cancer the smoking habit can cause in the mouth and throat region?
Smoking is related to cancers of lip and oral cavity (mouth cancer), pharynx, larynx and esophagus. Depending on the type and the amount of tobacco used, smokers have a probability 4-15 times more likely to develop oral cancer than non-smokers. If the person stops smoking the risk decreases, but only after 10 years without smoking will have the same risk of developing the disease than a person who never smoked.
The cause of cancer is not a single factor defined. It depends on a number of systemic factors, such as systemic diseases and nutritional deficiencies, and external factors to which the individual is exposed voluntarily, such as smoking, alcohol and sunlight. Among patients who die from cancer of the oral cavity, 90% are smokers.
Lip cancer is more common in fair-skinned people who are exposed for a long time in the sun without protection. The vast majority (90%) of cases occur on the lower lip and appears as a painless ulcer, hardened, hard and crusted on the lower lip vermilion.
On the palate the most affected areas are the tongue and floor of the mouth. The lesions initially appear as small painless sores that do not heal, volume increases (lumps, bumps) or whitish or reddish spots.
According to INCA estimates for 2008 mouth cancer is in 5th place in incidence in Brazil, followed by esophageal cancer.

Are there changes in taste?
Yes, smokers have alterations in smell and taste of food. Smoking causes atrophy of the taste buds of the tongue back, causing decreased taste, especially salty foods.

Are there caries risk?
There is no scientific evidence of a direct relationship between caries prevalence and smoking yet. There are some hypotheses that suggest that changes in the saliva caused by smoking decrease the potential for remineralization and saliva cleaning, increasing the risk of caries. Some studies have shown that smokers have a higher amount of accumulation of plaque than non-smokers and a poorer oral hygiene, as well as a decrease of body defenses, leading to an increased risk of periodontal disease, exposing the roots of teeth to through oral and action of cariogenic bacteria.
A 2003 US study showed an association between passive smoking and tooth decay in primary teeth (milk). Passive smoking was assessed by the level of a derivative of nicotine, cotinine, present in the saliva of children exposed to cigarette smoke. Socioeconomic status, dietary habits and oral hygiene in both groups were similar. It was found that in children exposed to cigarette pH of saliva was significantly more acid, which can cause further development of caries. The study also found that approximately 32% of children exposed to cigarette had cavities on the surfaces of their baby teeth, compared with 18% of non-exposed children.

What are the treatments to combat some smoking effects?
More important is to deal with prevention, is to guide the patient of the risks to their health and those around you and guide you to quit smoking. The dentist has to be aware of its importance as a health professional collaboration in anti-smoking campaigns and early diagnosis of oral lesions, increasing the chance of cure of patients and decreasing the after-effects of treatments.
Smokers should make visits to the dentist regularly, making a follow-up of the teeth, gums and particularly the buccal mucosa. There are periodontal and restorative treatments to limit the damage caused by smoking and poor oral hygiene. Stains on teeth can be removed by professional cleaning and whitening, since the patient to quit smoking.
The stomatologist is professional skilled dentist can identify precancerous lesions and perform biopsies or collecting injury cells to a correct diagnosis and carrying out the necessary treatments.
The self-examination is another important weapon that the patient has in preventing oral cancer. It is made by the patient himself before a mirror and illuminated, inspecting up all surfaces of the mouth, especially back of the tongue and mouth floor. The patient should look for:

- Wounds or ulcers that do not heal for more than 15 days;
- Whitish spots or signs that are not removed by scraping;
- Red spots or signs;
- Nodular lesions, hardened;
- Swelling in the mouth or neck.

This examination does not replace examination by a specialist. Even if you do not find any changes, be sure to consult a dentist at least once a year.
To prevent oral cancer smokers should:
Reduce cigarette use and even abandon it. We must remember that the damage is proportional to the amount of cigarettes smoked.
Avoid the smoking and alcohol association, as these increases the harmful effects of smoking.
Have a healthy diet, consuming fruits and vegetables.
Hold regular consultations with the dentist and maintain good oral hygiene.

Source: Pizzete, Natalia. Site: IDENT. Published: Nov 24, 2010. Accessed on 14 Aug 2015. Available at: