Smoking, Teeth, & Gums: 8 Hazards + Best Quitting Strategies

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by Sarah Chouman, DDS Candidate

Sarah Chouman is a born-and-raised New Yorker and a dental student at NYU School of Dentistry. During her adolescence, she noticed the popular culture of smoking (anything) and its impact on dental health, which led her to pursue dentistry. She assists at a dental clinic while pursuing her Doctor of Dental Surgery degree at NYU. You can follow her dental school adventures on Instagram.

Medically reviewed by Mark Burhenne, DDS

You have heard it from your family, friends, and spouses — you need to quit smoking.

From the people closest to you to the doctor you see once a year, they’ve all told you about the detrimental effects smoking has on your body. What is discussed less often is the effect that smoking has on your oral health.

It is true that a healthy smile is maintained by brushing, flossing, and seeing your dentist regularly.

These efforts, however important and necessary, cannot counter the harmful effects of smoking without purposeful intent and steps toward quitting.

I chose to get into dentistry, in large part, after watching the terrible impact of smoking on my friends and family as a teenager and young adult.

I’ll say the same thing I tell them: Your health is worth it. Your mind is worth it. Most of all, you are worth the effort to quit smoking.

What happens when you quit smoking? Benefits + Withdrawal

Quitting smoking after weeks, months, or years is no easy feat. You may feel hesitant to quit smoking because of the withdrawal effects of nicotine. You might even validate continuing smoking because you believe the “damage is already done.”

The human body is resilient and strong if you just give it a chance. In less than a half-hour, your body begins its repair process.

Withdrawal Symptoms

Quitting an addictive substance such as nicotine has short-term withdrawal symptoms. These symptoms can last weeks to months and the first week is always the most difficult. However, these will fade over time and the long-term benefits discussed above are well worth it.

Some symptoms include the following:

Nicotine Cravings

Cravings can be completely sporadic, or they can be stimulated by seeing other people smoking, smelling smoke, or doing an activity that used to accompany smoking (i.e. reading, drinking coffee).

These are called “triggers.”

On the bright side, nicotine cravings from these triggers usually last 15-20 minutes long. It can be very helpful if you can find something to occupy your mind during this time.

Weight Gain

The nicotine in cigarettes triggers the release of glucose (sugar) in the blood. Once you stop smoking, your body will experience a drop in blood glucose, which can have you craving foods that are high in sugars, carbohydrates, and fats.

When people are trying to quit, they most often replace cigarettes with food. If this is the case, try choosing a healthy snack that you can take on the go, such as carrots, nuts, or apples.

Depression, Anxiety, Irritability

Smokers are more likely to experience depression than non-smokers. Nicotine binds to certain receptors in your brain that release dopamine, the“feel-good” hormones.

When you stop smoking, less dopamine is released than your body was previously accustomed to, making you feel sad, anxious, and irritable.

When you begin to feel this way, call a friend or family member and talk to them about it. Plan something fun to do with your friends or an event to look forward to. Keeping busy with physical activity may even boost your energy and mood.

8 Effects of Smoking on Oral & Overall Health

Smoking negatively affects every functioning part of your body, including your mouth. It is the leading cause of preventable death worldwide and kills millions of people each year. Below, I discuss 8 effects that smoking causes, some you may know and others that are lesser-known.

1. Increased Risk of Oral Cancer

Over 70,000 chemicals make up tobacco smoke. 7,000 of these chemicals are known carcinogens.

75 to 90% of people who have been diagnosed with oral cancer have been tobacco users.

In a study done by the American Cancer Society, male cigarette smokers had 28 times the risk of developing oral cancer than males who have never smoked. Women smokers had 6 times the chance of developing oral cancer than women who do not smoke.

It has been established that there is a direct causal relationship between cigarette smoking and oral cancer.

2. High Probability of Gum Disease & Bone Loss

Tobacco is the biggest risk factor for gum (periodontal) disease. Gum disease is an inflammation of your gums and the surrounding bone structure that anchors your teeth to your mouth. In severe cases, gum disease can eat away at your bone, leaving little support for your teeth.

Pocket depths (space between your gum and tooth) become large enough for bacteria to accumulate and cause extensive decay. This results in increased mobility, which you may notice when your teeth move around in their socket more than they should, and may even cause your teeth to fall out.

The toxic chemicals in smoking weaken your body’s ability to fight infection, leading to gum disease, bone destruction, and eventually tooth loss.

3. Tooth Decay/Cavities

Cavities are caused by a variety of factors, including a lack of proper oral hygiene and eating a diet high in carbohydrates and sugars.

The presence of cavities has also been linked to the usage of nicotine.

Streptococcus mutans is a bacteria found in the oral cavity that is a well-known contributor to dental caries, or cavities. The severity of cavities is increased with an increased ingestion of nicotine.

Studies have shown that nicotine enhances the growth of this specific bacteria, therefore contributing to tooth decay.

4. Tooth Discoloration and Yellowing

There are two types of staining that can happen to the teeth: intrinsic and extrinsic.

Intrinsic stains occur when the inner part of the tooth (dentin) yellows. This can be due to trauma to your teeth as a kid, ingesting an excess of fluoride, certain antibiotics, or if the doctor prescribed your mother tetracycline while she was pregnant with you.

Extrinsic staining results when the outer structure of the tooth gets discolored. This can be caused by coffee, red wine, or other richly pigmented food.

When you smoke, your tooth enamel is dried out and worn away more quickly than it should be. This premature “aging” of the tooth structure leads to intrinsic yellowing. Smoking is also one major cause of extrinsic staining due to the nicotine, tar, and other chemicals present.

5. Bad Breath

Bad breath can make anyone feel self-conscious. Smoker’s breath, in particular, is extremely obvious.

Smoking dries out your mouth, which can contribute to bad breath. Saliva is needed to wash away all the debris, dead cells, and plaque that regularly accumulate.

Moreover, as we mentioned above, smoking also leads to gum disease. Having deeper gum pockets is a home for food and bacteria that are harder to clean, resulting in bad breath.

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6. Leukoplakia (White Patches Inside Mouth)

Coincidentally, another phrase for leukoplakia is “smoker’s keratosis.”

Leukoplakia is a collection of thick, white patches that form on the inside of your mouth. Leukoplakia can occur the borders of your tongue, gum, and inside your cheeks.

Tobacco, especially chewing tobacco, is the most common cause of leukoplakia and can indicate early signs of oral cancer. Even after leukoplakia patches are surgically removed by your dentist, your risk of oral cancer remains if you continue smoking.

7. Poor Healing & Unsuccessful Dental Procedures

As mentioned, smoking can cause gum disease, yellowing of teeth, and tooth decay. If you care about the health and beauty of your smile, you may want to consider certain dental treatments.

Even if you have professional teeth whitening done, there will be recurrent yellowing of your teeth if you continue smoking. If your dentist suggests an implant for a missing tooth, for example, the implant must integrate into your jaw and become supported by your bone.

The failure rate of implants is significantly higher for those who smoke than those who do not. Failure happens in as many 6.5% to 20% of cases.

For this reason, some dentists will not even place an implant unless you commit to quitting smoking.

8. Other Health Effects of Smoking

We know that smoking can cause lung cancer, heart cancer, and oral cancer. We also know that it negatively affects our respiratory system as well as our circulatory system, making it harder for us to breathe and exert physical energy. Here are a few other results of smoking that are less discussed:

Cataracts

Cataracts are the leading cause of blindness in the world.

Smokers have a higher risk of developing vision problems than non-smokers, such as clouding of the lenses and an increase in intraocular pressure. Studies have shown that tobacco is significantly associated with cataracts, showing a stronger association with smokeless tobacco.

Type 2 Diabetes Mellitus

Both smoking and diabetes adversely affect the functions of blood glucose. When combined, these effects are multiplied.

One study reported that smoking reduced insulin-mediated glucose in men by 10-40% more than in men who do not smoke. Since nicotine is associated with insulin resistance, smoking cessation is an important target for diabetic control.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic inflammatory condition affecting the joints of your hands and feet and is caused by genetic and environmental factors.

Studies have shown that heavy cigarette smoking over a prolonged period of time is strongly associated with rheumatoid arthritis development.

Birth Defects

Smoking while pregnant is an established risk factor for a wide range of birth defects. This includes premature births, low birth weight, and orofacial anomalies.

According to the U.S. Department of Health and Human Services (HHS), more than 100,000 babies have died from Sudden Infant Death Syndrome, prematurity, and low birth weight due to maternal smoking.

Despite these risks, many women still smoke while pregnant, perhaps because they think the risks are exaggerated or simply because they just do not believe any of these things will happen to their child.

More educational materials should be available and advocated to stop maternal smoking or prevent it from happening in the first place.

Benefits of Quitting

Let’s look at a timeline of how you start to heal after you put out that last cigarette:

20 minutes…

Your heart rate drops to a relatively normal level. This could range from 60 to 100 beats per minute (bpm).

12-24 hours…

Cigarettes contain a toxin known as carbon monoxide (CO). Carbon monoxide enters the blood and blocks the body’s ability to carry oxygen to its cells. Vital organs, such as the heart and brain, do not receive enough oxygen to function properly.

However, within just one day or quitting, your carbon levels return to normal.

2 weeks-3 months…

Your circulation and the functions of your lungs improve. Your risk of a heart attack begins to drop.

1-9 months…

Your breathing improves. Coughing, wheezing, and shortness of breath has decreased.

1 year…

Your risk of coronary heart disease is reduced by 50%. In other words, you have ½ the chance of getting coronary heart disease than a current smoker.

5-15 years…

Your risk of oral cancer, throat cancer, and esophageal cancer are reduced by 50%. Your risk of having a stroke has reduced to the same risk of that of a non-smoker’s.

10 years…

Your risk of lung cancer is half of that of a smoker’s risk. Bladder cancer, laryngeal cancer, and cervical cancer are also cut in half.

15 years…

Your risk of coronary heart disease is the same as that of a non-smoker (recall that in just one year, it was reduced by half).

Steps to Quitting [Conventional + Natural]

Nicotine is a powerful drug, but the human mind and spirit are stronger.

Quitting is no easy feat, but it is not impossible.

There are many ways to help yourself quit which are discussed below. The most important way to quit and to stay healthy is having a good support system. Friends, family, and partners who love you and care for your well-being will always be there when you feel weak.

Conventional Remedies for Kicking the Habit

Tobacco cravings can overpower your discipline. Some people are not ready to completely give up smoking and do not want to go through the withdrawal symptoms that we mentioned previously.

If quitting cold turkey is not for you, consider asking your doctor or dentist about certain medications that can help you quit.

You’ll notice that vaping is not on this list. Smoking anything will dry out the mouth and wreck your oral health, and vaping is associated with many of the same drawbacks as smoking regular cigarettes. It’s not worth it!

Nicotine Replacement Therapies (NRT’s)

The U.S Food and Drug Administration (FDA) have approved several types of NRT’s that gradually wean you from nicotine dependence. These products supply nicotine in controlled amounts that eventually decrease over time:

  • Skin Patches
  • Chewing Gum
  • Lozenge (tablet)

These are all FDA approved and available for over the counter (OTC) purchase. Be mindful of following the exact instructions and let your doctor know if you are experiencing any adverse symptoms.

Non-nicotine Medications

The FDA has also approved medication that contain no nicotine, but reduce nicotine cravings and urges:

  • Zyban (bupropion)
  • Chantix (varenicline)

Both these medications interfere with nicotinic receptors in the brain, which reduces the pleasure you get from smoking. Both these medications must be prescribed by your healthcare provider.

Once again, if you are experiencing any adverse symptoms, be sure to discuss them with your doctor to modify your smoking cessation plan.

Natural Quitting Strategies

There are a few ways you may be able to naturally support your transition away from smoking and other forms of tobacco.

Yoga

An analysis of 10 studies, published in 2014, found that yoga-based “cessation strategies” had a positive effect in helping smokers kick the habit.

If you’re not sure you’re ready to do yoga on your own, look for a class in your area or search for a yoga instructor who offers private sessions.

Acupuncture

A massive study conducted in Hong Kong followed nearly 3,000 smokers through an 8-week course of acupuncture.

The results were promising, showing that 34% of smokers were able to quit for a full week after the 8 sessions, while 18.4% successfully stopped smoking for an entire year. For those who continued to smoke, the number of cigarettes smoked each day and the carbon monoxide each person inhaled dropped dramatically.

Hypnotherapy

A clinical trial conducted at Massachusetts General Hospital in Boston tested the effectiveness of nicotine replacement therapy against hypnotherapy for smoking cessation.

What they found was astounding. The patients in this study had already been “hospitalized for a smoking-related illness,” and the researchers found that patients treated with hypnotherapy were twice as likely to have successfully quit smoking after 26 weeks out of the hospital than NRT patients!

Mindfulness & Meditation

The practice of “mindfulness” is a psychological habit involving a purposeful focus on what is currently happening in the present without judgment.

Don’t let the explanation distract you from the evidence-based nature of this treatment. Cognitive-behavioral therapy has picked up on this kind of meditation as an extremely effective method of treatment for anxiety and other mental health concerns.

As it turns out, this seems to extend to smoking cessation, too. When this practice was introduced to 47 meditation “newbies” who wanted to quit smoking, MRIs of their brains showed that mindfulness practice reduced the neural signs of cravings (as well as their self-reported cravings).

T’ai chi, a Chinese martial art used as a form of meditation, may be an effective way to quit as well. A Florida-based survey found that people who practiced t’ai chi as a quitting tool were subjectively more aware of their addiction cycles and experienced fewer cravings.

My S.T.O.P Method for Facing Common Challenges

One of the hardest parts of quitting is that there are so many barriers, particularly for anyone who has had the habit for many years or even decades. With those challenges in mind, quit smoking with my S.T.O.P method!

  • Stay busy
  • Tell people
  • Organize
  • Perspective

Stay busy: If you need to do something with your hands, perhaps you can find a hobby, such as painting, that keeps your hands busy. If you need to have something in your mouth, pack up on sugar-free gum and healthy snacks.

Disassociate behaviors from your regular routine that accompany lighting up. For example, if you usually have a cigarette with your morning coffee, perhaps you can instead read a book or the news while you have your coffee. It can be whatever you like!

Tell people: Set a quit date and tell your friends and family about it. If you make this decision public, everyone who cares for your well-being will be there to support every step you take toward quitting.

Moreover, telling people you are quitting, and specifically asking them not to smoke around you, can prevent you from having nicotinic urges and relapsing.

Organize: Organize your home to make it a smoke-free environment with no triggers. Throw out all your cigarette boxes, ashtrays, and other tobacco products. Have a plan for when you do feel a nicotinic urge.

For example, “when I feel the need to smoke, I will …” It can be as simple as a phone call to a friend or walking in the park.

Perspective: Put things into perspective. Remind yourself that the pleasure you feel from smoking will never outweigh the happiness of a healthy life. To run with your dog, play catch with your child for a long time and going for jogs on a crisp fall day, are all things you can enjoy all the more when you are smoke-free.

what-happens-when-you-quit-smoking-quitting-method

How to Correct Dental Damage from Smoking

The first step is to this is realizing that your dental damage is indeed from smoking. There is a plethora of information available online you can educate yourself on how smoking negatively attributes to oral health.

Schedule an appointment with your dentist to help you begin the smoking cessation process. Be open and honest with your dentist about your goals and together you can come up with a plan to begin your steps toward quitting. One important part of this process will be frequent oral cancer screenings.

Adhere to your appointments so that your dentist can identify your current issues and create a treatment plan to fix these issues and maintain your oral health long after these issues have been treated.

Your dentist can help you develop a plan for both the cosmetic issues (teeth yellowing, etc.) and the functional issues (periodontal disease, cavities, etc.) that have arisen from your habit.

No matter how much money you put into getting dental work done, or how excellent the dentist is, all will be pointless if you continue smoking thereafter. The dentist does 50% of the work, the rest relies on you!

Be patient with yourself and stay committed to quitting. You can get the results you want.

Maintaining Good Oral Health After Smoking

1. Make an appointment with your dentist

A brighter smile after smoking is not impossible. Make an appointment with your dentist to identify any current issues that have resulted from smoking.

This may include inflammation, gum disease, or tooth decay.

In addition to an assessment of the damage, regular dental visits are important for prevention of future issues, as a teeth cleaning will clear your teeth of hardened plaque/calculus.

2. Teeth Whitening

If the discoloration from smoking makes you feel insecure, ask your dentist about teeth whitening methods.

You can opt for a professional whitening at the dental office, an at-home kit, or DIY options. After you get your teeth whitening done, it is important to maintain good oral hygiene to prevent yellowing.

3. Oral Hygiene Habits

Keeping up with your oral hygiene at home regularly is necessary for improvement. Whether you are a smoker or non-smoker, always be sure to:

  1. Floss at least once a day, making sure to wrap the floss in a C-shape along the gum line
  2. Brush at least twice a day
  3. Scrape your tongue after your morning brushing session
  4. Try tongue scraping to rid your tongue of buildup of bacteria
  5. Practice oil pulling, especially if your gum bleed regularly
  6. Chew oral probiotics to help restore proper balance of your oral microbiome

Is vaping, chewing tobacco, or smoking marijuana healthier than cigarettes?

The short answer is no. To explain why, let’s break each of these down.

Vaping

Many people, particularly teens and young adults, have switched to vaping with the advent of e-cigarettes.

Just because e-cigarettes are flavored and lack the pungent smell of cigarettes, they still have many of the same harmful effects on our organs as cigarettes do. E-cigarettes are considered a tobacco product and are as equally unsafe because of the addictive nicotine that is present in them.

The issue is that e-cigarettes are being marketed as a “healthier alternative” to smoking, which has become a public health problem.

In addition to the negative impact of tobacco and the other chemicals found in vaping liquids, the act of smoking will, itself, dry out the mouth and contribute to oral dysbiosis. This imbalance of bacteria in your mouth is one of the biggest risk factors for cavities, bad breath, gum disease, and possibly even oral thrush.

Chewing Tobacco

Chewing tobacco, or smokeless tobacco, is especially dangerous. It is a pouch that is placed in between your gums and teeth or in the cheek.

Chewing tobacco gives you the same amount of nicotine as smoking, so it is just as harmful. Not only does it destroy your gums, but it has also been linked to oral cancer, esophageal cancer, and pancreatic cancer. There are around 30 identified chemicals in chewing tobacco that are reported carcinogens.

As mentioned previously, chewing tobacco is also associated with high rates of leukoplakia. Advertising something as “smokeless” just as deceiving as it is harmful.

Vaping/Smoking Marijuana

Smoking weed is not good for your teeth. It dries your mouth, which prevents saliva from doing its job of cleaning the debris and plaque present in your mouth.

THC is the main psychotropic agent in marijuana, which increases your appetite for foods that are high in sugar and carbohydrates, AKA “munchies.”

The American Dental Association (ADA) reports that people who smoke marijuana regularly have a much higher number of cavities than people who do not smoke marijuana.

In 2020, the CDC reported that vaping THC products has led to a high rate of hospitalizations and even deaths, due to the combination of chemicals often involved. As of January 2020, there were 60 confirmed deaths and 2,711 hospitalizations involving THC vaping products.

If THC is legal in your area and you still want or need to use it, try using healthier alternatives to smoking, such as baked goods or sugar-free candies. It’s a good idea to prevent “the munchies” from leading you to decay-causing foods, so keep snacks around that will support a healthy mouth instead.

If marijuana is illegal in your area and/or you’re most concerned about addressing anxiety, consider CBD oil as an alternative.

A Brief History of Smoking

Tobacco has been grown and cultivated for hundreds of years. When the Europeans arrived in the early 16th century, the consumption and trading of tobacco quickly spread.

As time progressed and modernization of farming took place, tobacco became more readily available in mass quantities. At first, tobacco was used mainly for pipes, chewing, and snuff. People then started using cigars, and it was not until after the Civil War did cigarettes become popular.

There is a very educational timeline of tobacco and its uses in different parts of the country by the World Health Organization.

Eliminating Secondhand Smoke

When you make the decision to smoke, it is a choice that you made for yourself. However, it is also a choice that you made for other people through second-hand smoking.

The HHS reported that more than 20 million people have died from smoking-related illnesses, but 2.5 million of these were non-smokers that died from second-hand smoke. Young children are the most affected by second-hand smoking, through the adults around them or parents smoking at home.

If you have not yet made the decision to quit, keep in mind the people around you that are potentially being harmed by your decisions.

FAQs on Smoking and Dental Health

Q:

Will my dentist know if I smoke?

A: Even if you chew gum and shower your body in perfume or cologne, your dentist will be able to tell if you smoke by just looking in your mouth.

There are many signs of smoking, such as inflammation, leukoplakia, and deep gum pockets. Another sign of smoking is xerostomia (dry mouth), recurrent tooth decay (cavities), and significant plaque buildup.

Q:

Does smoking age my face?

A: Smoking does indeed age your face much faster than normal. You will notice premature wrinkling, such as “crow’s feet” which originate at the corner of your eyes, and “cobblestone wrinkles” which run down your neck.

The chemicals in smoking also make your skin lose moisture and degrades collagen, creating a dry and dull appearance. One study shows that long-term smokers (greater than 10 years) have similar skin features, regardless of their age, exposure to sun, or weight.

Q:

How can you make your gums pink again after smoking?

A: The melanin that causes the color of your skin is also present in your gums. The color of your gums depends on the color of your skin and can vary greatly from person to person.

The nicotine present in tobacco promotes melanin secretion, resulting in darker gums than normal. “Gingival melanosis,” or darkening of the gingiva, is significantly higher in smokers who smoked more than 10 cigarettes a day.

Quitting smoking reduces this pigmentation to normal, healthy gums.

Q:

How long should my gums bleed after quitting smoking?

A: Smokers have a wide range of oral health issues, but bleeding gums is not one of them. This is because there is very little blood supply to the gums, which leads them into thinking they may not have gum disease, even though they most likely do.

When you quit smoking and your circulation improves, there will be more blood to your gums, and therefore more bleeding. Bleeding gums should subside after a dental cleaning by your dentist or hygienist. You can also reduce the inflammation by oil pulling regularly.

Key Takeaways: Smoking

You know about all the negative effects that smoking has on your body. I hope this article gives you a deeper understanding of the effects that smoking has on your oral health as well.

Quitting smoking may seem like a long and difficult road, but we have seen that the healing process that takes place in just 20 minutes of putting out your last cigarette.

It is the best thing that you can do for yourself and all the people around you.

Talk to your dentist or doctor about quitting smoking. Together you can create a plan to help you live a healthier life. Your support system is one of the most important factors during this process, so don’t be afraid to ask for help when you need it.

Stay active, keep busy, and do things you enjoy. One day you will thank yourself!

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