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Smoking: A Danger To Healthy Gums


You’ve probably seen 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 have found that tobacco use may be one of the biggest risk factors in the development of periodontal disease,” says David A. Albert, D.D.S., M.P.H. Dr. Albert is an associate professor at the Columbia University College of Dental Medicine.

Periodontal (gum) disease is a bacterial infection. It destroys soft tissue and bone that anchor your teeth to your jawbones. Bacteria grow in the dental plaque that forms in the pockets around your teeth. Your body’s reaction to the plaque leads to the breakdown of soft tissue and bone.

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. They 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. They may even fall out.

Studies have shown that smokers have more calculus (tartar) than nonsmokers. This may be the result of a decreased flow of saliva. Calculus is the hardened form of plaque.

Smoking tobacco products can make gum disease get worse faster. Smokers have more severe bone loss and more deep pockets between their teeth and gums than nonsmokers. In studies, smokers were three to six times more likely to have gum destruction than nonsmokers. Severe bone loss was five times greater among current or former heavy smokers than among people who never smoked.

“Smokers have much less gum bleeding and redness than other people even though their mouths are not healthy,” Dr. Albert says. “This 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 gum health.”

Not only does smoking increase the chance that you will develop gum disease, it makes treatment much more difficult. And the treatment is less likely to succeed. That’s because smoking hinders healing in your mouth.

One study found that smokers were twice as likely as nonsmokers to lose teeth in the five years after completing periodontal treatment. In most studies of nonsurgical gum treatment (deep scaling), smokers improved less than nonsmokers. Smokers also don’t respond as well to oral surgery treatments. Dental implants are much more likely to fail in people who smoke, because of poor bone healing.

Crowns and bridges look great when first placed in the mouth. In smokers they often lose this beautiful appearance, especially as the gums recede and bone is lost. Popular cosmetic procedures, such as porcelain laminates, will not look good for a long time in a person who smokes.

Researchers still are studying just what smoke does to mouth tissue. 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,” Dr. Albert says. “This leads to a slowdown in the healing process. It makes the treatment results less predictable and often unfavorable.”

It is not just cigarette smoke that contributes to periodontal disease, Dr. Albert says. All tobacco products can affect gum health. This includes pipe tobacco, smokeless tobacco and cigars. Labels on smokeless products such as chewing tobacco or snus include warnings that the products can cause oral cancer, gum disease or tooth loss.

A study conducted at Temple University showed this risk. Researchers reported that 18% of former cigar or pipe smokers had moderate to severe gum disease. “This is three times the amount found in non-smokers,” Dr. Albert says. The study was published in the Journal of Periodontology in 2000.

Experts say pipe smokers have rates of tooth loss similar to those of cigarette smokers. Smokeless tobacco can cause the gums to recede. This increases the chance of losing the bone and fibers that hold teeth in place.

The only good news about smoking and oral health is that the Surgeon General’s warning holds true. Quitting now does greatly reduce serious risks to your health. A recent study reported that people who had quit smoking 11 years before had about the same rate of periodontal disease as 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. 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,” Dr. Albert says. “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 medicines can help you quit, such as nicotine patches or gum.”

Oral Cancer

Tobacco’s greatest threat to your health may be its link to oral cancer. The American Cancer Society reports that:

About 90% of people with mouth cancer and some types of throat cancer have used tobacco. The risk of developing these cancers increases as people smoke or chew more often or for a longer time.

Smokers are six times more likely than nonsmokers to develop these cancers.

About 37% of patients who continue to smoke after cancer treatment will develop second cancers of the mouth, throat or larynx. This compares with only 6% of those who stop smoking.

Tobacco smoke from cigarettes, cigars or pipes can cause cancers anywhere in the mouth or the part of the throat just behind the mouth. It also can cause cancers of the larynx, lungs, esophagus, kidneys, bladder and several other organs. Pipe smoking also can cause cancer in the area of the lips that contacts the pipe stem.

Smokeless tobacco has been linked to cancers of the cheek, gums and inner surface of the lips. Smokeless tobacco increases the risk of these cancers by nearly 50 times.

Implant Failure

Dental implants can replace lost teeth in people who smoke. However, smokers should know they have an increased risk that the procedure will fail.

“Studies have consistently found that patients who smoke have more implant failures,” Dr. Albert says. Smokers who are considering getting a dental implant need to realize this risk, he says.

“Before getting implants, it is very important to quit smoking. I advise that you consider seeking counseling and support to help you quit,” he says.

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