When you see the warning on cigarette packages — "Quitting smoking now greatly reduces serious risks to your health." — What smoking-related diseases come to mind? Lung cancer, probably. Emphysema, maybe. But, did you know that half of periodontal (gum) disease in smokers is caused by smoking? Chronic (long-term)gum disease can lead to the loss of your teeth.
Studies conducted to examine the effects of smoking on oral health have found that tobacco use may be one of the biggest risk factors in the development of periodontal disease.
Not only does smoking increase the chance that you will develop gum disease, it makes treatment much more difficult and less likely to be successful. Smoking also lessens your mouth's ability to heal, so much so that many of the treatments you may want and need will not work well if you continue to smoke.
For example, crowns and bridges in a person who has gum disease will not look very good because the gum disease will cause bone loss and receding gums around the crown edges. Implants are much more likely to fail in people who smoke. Popular cosmetic procedures, such as porcelain laminates, also will not be successful in a person who smokes.
Periodontal (gum) disease is a bacterial infection that destroys soft tissue and bone that anchors your teeth to your jawbones. The bacteria found in dental plaque that forms in the pockets around your teeth and your body's reaction to the plaque contribute to the breakdown of soft tissue and bone.
Smoking tobacco products can make gum disease get worse more quickly.
- In early stages of the disease, you may notice that your gums bleed when you brush or floss.
- As the infection worsens, your gums begin to break down and pull away from your teeth, forming pockets.
- Later, the pockets between your teeth and gums deepen as more of the supporting structures are destroyed.
- Ultimately, your teeth may become loose and painful and may even fall out.
Studies have shown that smokers have more calculus (tartar) than nonsmokers. This maybe the result of a decreased flow of saliva. Smokers have more severe bone loss and more deep pockets between their teeth and gums than nonsmokers. Among specific findings, smokers were 2.6 to 6 times more likely to have gum destruction than nonsmokers, and severe bone loss was 4.7 times greater among current or former heavy smokers compared with people who never smoked.
"Smokers have less gum bleeding and redness, which can lead to the false impression that the gums are healthy. It is therefore very important that tobacco smokers have regular dental exams to evaluate their oral and gingival health," Dr.Albert says.
Researchers still are studying just what smoke does to oral tissue, but it appears to interfere with basic functions that fight disease and promote healing. Researchers have found that smoking affects the way gum tissue responds to all types of treatment.
"It is believed that the chemicals contained in tobacco interfere with the flow of blood to the gums, leading to a slow down in the healing process and making the treatment results less predictable and often unfavorable," Dr. Albert says.
One reason smokers are more likely than nonsmokers to lose their teeth if they get gum disease is that smoking can slow the healing process after periodontal treatment or any kind of oral surgery. One study found that smokers were twice as likely as nonsmokers to lose teeth in the five years after completing periodontal therapy. Additionally, the American Academy of Periodontology reports that in most studies of nonsurgical periodontal treatment, smokers showed less improvement than nonsmokers. Smokers also responded less favorably than nonsmokers to surgical treatment.
"It is not just cigarette smoke that contributes to periodontal disease," Dr.Albert says. All tobacco products, including pipe tobacco, smokeless tobacco and cigars, can affect the health of your gums.
In a study conducted at Temple University and published in the Journal of Periodontology in 2000, researchers reported that 17.6% of former cigar or pipe smokers had moderate to severe gum disease.
In addition, experts say pipe smokers experience similar rates of tooth loss as cigarette smokers, and smokeless tobacco can cause the gums to recede,increasing the chance of losing the bone and fibers that hold teeth in place.
The only good news about smoking and the health of your teeth and gums is that the Surgeon General's warning holds true — quitting now does greatly reduce serious risks to your health. A recent study reported that the likelihood of having periodontal disease was not significantly different among former smokers who had quit 11 years before and people who never smoked.
Even reducing the amount you smoke seems to help. One study found that people who smoked more than a pack and a half per day were six times more likely to have periodontal disease than nonsmokers, whereas those who smoked less than a half pack per day had only three times the risk.
"The dental office is a good place to visit for help with quitting. Your dentist can show you the effect of smoking on your mouth and teeth. She or he can help you set a quit date and provide you with advice on which medications can help you quit, such as nicotine patches or gum,"
Tobacco use may pose the greatest threat to your health as a risk factor for oral cancer. The American Cancer Society reports that:
Implants can be used to replace lost teeth in people who smoke, but smokers should know they are at increased risk for the procedure to fail.
Studies that have examined dental implants in smokers and nonsmokers have consistently found that patients who smoke have more implant failures.
"As a result, it is important that patients who smoke and who are considering having a dental implant placed be made aware of the fact that their tobacco use increases the chance that the implant will fail.
They should be encouraged to quit smoking before undergoing the procedure and should be provided with tobacco-cessation counseling and support," he says.