When people think of what smoking does to teeth, yellowing comes to mind first. Yet the real damage happens out of sight, in the tissues that hold the teeth.
Staining of the teeth
Tar and nicotine settle into the pores of the enamel and stain the teeth from yellow to brown. These stains do not brush off; professional cleaning removes most of them, but as long as smoking continues they soon return.
Gum disease: damage that advances silently
Gum disease is far more common in smokers than in non-smokers and takes a more severe course. There are several reasons for this:
- Nicotine narrows the blood vessels in the gum; less blood and oxygen reach the tissue.
- The immune cells are less able to fight bacteria.
- The bone that holds the tooth is lost faster.
Smoking suppresses bleeding from the gums. Because bleeding, the earliest warning sign of inflammation, does not appear, the disease progresses unnoticed. If you smoke, the fact that your gums do not bleed does not show that they are healthy.
Slow healing
Wounds close more slowly after extractions, gum treatment and surgery. Dry socket (alveolitis), which follows an extraction and causes severe pain, is markedly more common in smokers. The response to gum treatment is also weaker.
Implant success
The fusion of an implant with the bone depends on healthy blood circulation. Smokers have a higher risk of implant loss and of inflammation around the implant. This does not mean implants cannot be placed; but the risk needs to be understood and smoking paused at least during the healing period.
Bad breath and the sense of taste
On top of the smell of smoke itself, dry mouth and gum disease lead to lasting bad breath. The senses of taste and smell are dulled.
Oral cancer
Tobacco use is the main risk factor for cancers of the mouth, tongue, lip and throat; the risk rises further when it is combined with alcohol. If any of the following lasts more than two weeks, be sure to have an examination:
- A mouth sore that does not heal
- White or red patches on the tongue, cheek or floor of the mouth
- A lump or swelling you can feel in the mouth or neck
- Difficulty swallowing, hoarseness
- Numbness or bleeding with no clear cause
E-cigarettes and waterpipes
E-cigarettes also contain nicotine; they narrow the blood vessels and dry the mouth. Their long-term effects are still being studied, but they cannot be said to be harmless to the tissues of the mouth. A waterpipe (shisha) means breathing in smoke for a long time in a single session; its effect on the teeth and gums is no milder than that of cigarettes.
What changes in the mouth after you stop?
- Within a few days the senses of taste and smell begin to recover.
- Within a few weeks blood circulation in the gums improves. The gums may start to bleed during this period; this shows the tissue is responding again and is a sign that it is time for a cleaning.
- In time the risk of gum disease and the response to treatment approach those of people who have never smoked.
- The risk of oral cancer falls markedly over the years.
If you smoke
- See a dentist every six months, more often if possible.
- Have regular scaling.
- Brush twice a day and do not skip cleaning between your teeth or your tongue.
- Stop smoking for a period before and after any surgical procedure.
- Ask your doctor for support with stopping; the chance of success rises markedly with support.
Frequently asked questions
Will whitening remove smoking stains?
Surface stains largely come off with professional cleaning; whitening also lightens the tooth's own colour. But as long as smoking continues, the staining soon comes back.
Can smokers have implants?
They can, but the risk of failure is higher. Your dentist discusses the risk with you and asks you to stop smoking at least for the period before and after surgery.
Do a few cigarettes a day do harm too?
Yes. The risk rises with the amount smoked, but even a small amount adversely affects blood circulation in the gums and healing.
This article is for general information and is not a substitute for diagnosis or treatment. If you have a complaint, please see your dentist.