Effects of smoking and vaping on oral health

People who smoke have a higher risk of gum problems, tooth loss, complications after tooth removal and surgery in the mouth, and developing mouth cancer. They are more likely to get infections and do not heal as well as non-smokers. Quitting smoking reduces the risk of developing gum disease and mouth cancer, and improves a person’s response to gum treatment.

It is very important for people who smoke to visit their dentist regularly to keep their teeth and gums healthy and to check for signs of mouth cancer. It is also important for people who vape to visit a dentist regularly to detect and treat any oral health problems. If you vape, make sure to tell your dentist.

Fewer adults smoke now than they used to, but smoking still remains a problem.

How does smoking affect teeth, gums and oral health?#

The most common oral problems affecting people who smoke include:

• whitening of the soft tissue in the mouth (called smoker’s keratosis)
• poor healing after tooth removal (known as dry socket)
• poor healing after mouth and gum surgery
• decreased sense of taste
• a higher risk of gum disease and mouth cancer

Smoking and gum (periodontal) disease#

Gum disease (also called periodontal disease) is caused by an infection that destroys the bone surrounding and supporting your teeth. This bone holds the teeth to the jawbone so you can chew food.

Bacteria and food debris, called dental plaque, can cause gum disease. If plaque is left on the teeth and gums, it hardens to form calculus or tartar. The plaque and calculus irritate the gums around the teeth. This build-up is often seen in people who smoke.

The two stages of gum disease are gingivitis and periodontitis. If periodontitis is not treated, the structures that hold the tooth to the gum can become damaged. Teeth may become loose, fall out by themselves, or a dentist may have to remove them.

Preventing tooth loss is important#

Losing teeth towards the back of your mouth can create problems with chewing food. Losing teeth at the front of the mouth affects your ability to eat, your appearance, and can create problems with speech. Teeth also play an important part in holding the shape of the lower part of the face.

Smoking increases gum disease risk#

The risk of gum disease is higher for a person who smokes than for someone who does not. Even for a person who smokes fewer than 10 cigarettes a day the risk is increased, and for people who smoke heavily it is around 4 to 5 times higher. The risk of severe periodontal disease increases further with alcohol use.

If you smoke, the following may occur:

• Tooth loss (of some or all of your natural teeth), making it difficult to chew certain foods, speak clearly or feel confident to smile if lost teeth are not replaced.
• Gum disease may be harder to detect. Bleeding gums – usually a sign of gum disease – may not be present, because tobacco causes a poor blood supply to the gums.
• Gums may not respond as well to gum treatment (professional dental cleaning) as those of non-smokers.
• A higher risk of developing acute necrotizing ulcerative gingivitis, a very painful condition that causes a foul smell and taste.

Will my gums get better if I stop smoking?#

Yes. The good news is that people who quit smoking eventually have the same risk of developing gum disease, and the same response to gum treatment, as non-smokers. Once you quit smoking, do not be alarmed if your gums bleed more for a while. A dentist or dental hygienist can provide treatment and show you how to care for your teeth at home.

Smoking and symptoms of gum disease#

If you smoke, it is important to see your dentist for regular check-ups. Symptoms of gum disease to watch for include:

• red, swollen, tender or bleeding gums
• discharge (pus) coming from your gums
• gums that are loose and pull away from your teeth
• a bad taste or bad breath
• loose teeth, which can change the feel of your bite when your teeth are placed together or make dentures fit differently
• spaces opening up between your teeth

Smoking and slow healing after dental treatment#

Tobacco use makes it harder for the immune system to do its job, which slows down healing after tooth removal or injuries in the mouth. Smoking may lead to:

• dry socket – a slow-healing tooth socket after a tooth removal, which is very painful
• increased pain after oral and gum surgery
• less success if you have dental implants

Contact your dentist if you have any problems after dental treatment.

Mouth cancer and smoking risk#

Mouth cancer (or oral cancer) is cancer of the mouth, including the tongue, cheek, roof or floor of the mouth, and lips. Smoking is one of the main risk factors for mouth cancer, and many people are diagnosed with it every year.

People who smoke and drink alcohol have an even greater risk of developing mouth cancer than those who do just one or the other. Eventually, people who have quit smoking have the same risk of developing mouth cancer as non-smokers, so it is never too late to quit.

Mouth cancer in people who smoke is most likely to occur on the side of the tongue, the floor of the mouth and the lips, although it can happen in other areas of the mouth too. Early diagnosis is important so that treatment can start as early as possible, before the cancer advances or spreads to other parts of the body. Treatment for mouth cancer may include surgery, radiotherapy and chemotherapy.

Symptoms of mouth cancer#

Please see your dentist or doctor immediately if you notice any:

• persistent ulcer in your mouth or on your lip that does not disappear after 7 to 10 days, particularly if the ulcer is not painful
• white or red patch in your mouth
• swelling in your mouth
• dentures that suddenly do not fit properly

Health risks of vaping#

Smoking e-cigarettes or water pipes (known as vaping) may seem less harmful than smoking regular cigarettes. Yet this may not be the case for the health of your mouth. When you vape, you inhale e-liquids (also called vaping juice) which, even when labeled ’nicotine-free’, can contain harmful substances. These include:

• nicotine
• heavy metals
• volatile organic compounds (VOCs)
• cancer-causing chemicals

The risk of vaping devices causing problems in your mouth is much higher if they contain nicotine. The long-term effects of vaping are not fully known, but there is some evidence that vaping can cause inflammation in the mouth, which can lead to gum disease and other oral health problems. A temporary loss of taste may happen in some people (also called vape tongue).

Vaping is sometimes seen as a way to quit smoking. Yet vaping may make it harder to quit smoking completely, which increases the risk of diseases associated with tobacco use, such as mouth cancer.

Preventing teeth and gum problems in smokers#

If you smoke, there are some things you can do to prevent tooth and gum problems:

• Try to quit smoking. Speak to your doctor or dentist, or contact a quit-smoking service, for guidance and support. If you are finding it difficult to quit, try to reduce the number of cigarettes you smoke to start with.
• Clean your teeth and gums twice a day with fluoride toothpaste. Use dental floss (for small gaps) or interdental brushes (for big gaps) once a day to clean between your teeth.
• Visit your dentist every 6 to 12 months. Regular visits can help keep your teeth and gums healthy, as your dentist can provide advice about proper home care and find problems early.
• Avoid having a dry mouth. Drink plenty of water and chew sugar-free gum to stimulate saliva flow. This is especially important if you take medications that cause dry mouth.
• Limit alcohol and avoid recreational drugs.

Key points#

• It is important for people who smoke, and people who vape, to visit a dentist regularly to detect and treat any oral health problems.
• Fewer adults smoke now than they used to, but smoking still remains a problem.
• Smoking can cause gum disease, which is driven by bacteria and food debris (dental plaque).
• Preventing tooth loss is important for chewing, speech, appearance and the shape of the face.
• It is never too late to quit: former smokers eventually have the same risk of gum disease and mouth cancer as non-smokers.

Where to get help#