Tobacco, a whole smile? Alīna Gončarova

Smoking, along with arterial hypertension and obesity, is considered the leading cause of death in the world. Most people are aware that smoking is harmful to health, yet many people are unaware of the damage smoking can do to the mouth.

According to who in 2014

1. Number of women smoking is rising fast
2. Tobacco users rise among children and adolescents
3. The proportion of the daily smoking population in the age group 15 + is 25%

The press and everyday have been told a lot about the negative effects of using tobacco, such as lung cancer, heart and respiratory conditions, while tobacco use also has effects on the mouth and teeth.

All tobacco uses have a negative effect on oral tissue. Tobacco contains more than 4,000 harmful chemicals and gases in cigarettes, cigars and pipes, and 50 of them are carcinogenic (cancer can be called).

Tobacco use may lead to:

• Tooth recoloration – as a result of hot smoke exposure, microcracks begin to form in the tooth enamel (outer layer of the tooth), where tobacco smoke components accumulate – teeth remain darker. For people who smoke for a short period of time or rarely, their teeth can color yellowish, while for heavy smokers, their teeth can recolor even to dark brown.
• Denture formation – people who smoke develop a denture much more and more often. It’s much easier to attach to the denture to the soft application, which can no longer be removed by brushing or threading teeth. It’s important to remember that plenty of bacteria are present in the plot, which can cause gum inflammation and tooth decay. This circumstance, which forms both above and below the gum line, therefore needs to be removed and can be done by a dentist or dental hygienist. Giving up smoking reduces the odds of a denture forming.

• Tongue recolouration – yellowish-brown application and swelling of tongue due to circulatory disorders, decreased taste perception due to nicotine and high temperature exposure
• Changes in periodontal tissue structure (gum and supporting bone) – smokers are more prone to periodontal conditions than non-smokers. By long-term smoking, gum conditions can contribute to bone loss around teeth, gaps between teeth and gums. The more and longer tobacco is used, the greater the tissue damage around your teeth.

• Dental erosions – Some smokers use mouthwashes, chewing gum, mint candy to freshen their breath. The habits of regularly sucking these or other sweets, which contain sugar and often citric acid, can be called off by chemical erosions, which can also later lead to tooth decay.

• Increased wound healing time at various surgical interventions (e.g. dental implants)
• Unpleasant breath,
• The smell and taste of reduced sensitivity,
• Many other altered oral conditions include dental abrasions (wear-and-tear), chronic facial adjacent cavity inflammation and oral cancer.

Smoking and dental implants:

One of today’s now current treatments is replacing teeth with dental implants. So it’s already become everyday among patients and dentists alike. It is a successful long-term treatment plan for people to replace missing teeth, but this treatment may be inaccessible to people smoking. Everything depends on both the frequency and quantity of smoking, oral hygiene and the patient’s own motivation to restore a healthy smile. One of the key conditions for inserting a dental implant (screw) is successful oseointegration (bone ingrowth). For people who smoke, the failure of oseointegration is seen as much higher than for people who don’t smoke. As well as the risk of loss of the implant, poor oral hygiene and periimplitis (inflammation around the implant) are associated. Insertion of implants is possible for smokers, but all risks for both the physician and patient should be aware.

One of the main reasons why performing implants or other manipulations is difficult or impossible is reduced blood supply. People who smoke have narrowed blood vessels, which can interfere with normal wound healing, one of the most important parameters of inserting a dental implant.

Studies show that patients who smoke have an implant success rate between 6.5% and 20% lower. The question over implant insertion may already be if a patient smokes 14 cigarettes a day.

Snus or chewing tobacco:

Press articles have said it is a successful way to replace smoking tobacco. Is that really the case?

It’s Swedish chewing tobacco, which is in the form of moist powder to be placed under your upper lip. It is banned in the European Union but allowed in Sweden. Nevertheless, in Latvia, many athletes and young people choose precisely this type of tobacco, explaining that the use of this tobacco does not result in unpleasant smoke and is much more convenient to use. Snus also contains all harmful substances like a cigarette, including nicotine. Despite the fact that snus is not the most popular and permitted tobacco use in Latvia, many concerns have already been expressed regarding this product. The use of snus involves contact with the mucous membrane of the oral cavity. As a result, almost 100% of cases develop changes in the mucus of the mouth, but for the most part they are not tumour-like. The mucous membrane remains thicker and white formations – leukoclasia.

As well as developing gum conditions, gum retreat, discolouration of teeth, smell from the mouth, altered sense of taste.

There are currently no studies that prove the link of snus to oral cancer, but some studies show a link to the development of oral cancer in the exact places where snus is placed.

Thus, in response to the question, snus is not a healthy alternative to smoking.

Visiting a dentist

As mentioned above, denture and tooth damage are more common in smokers, which requires these people to visit a dentist and dental hygienist more often than once a year.

On his visits, the dentist will look at not only the health of his teeth, but the condition of his entire mouth – his cheeks, tongue, lips. In turn, a dental hygienist will be able to successfully find a suitable and effective way to care for the oral cavity for every person.

Recommendations

If it is, however, that tobacco use is an integral part of life, then it would be good to follow a couple of recommendations that will reduce the effects of tobacco on the oral cavity even slightly:

1. Visiting a dentist and dental hygienist 2 x a year
2. Toothbrushing 2 x/day with fluoride-containing toothpaste with a fluoride content of at least 1400 ppm. It is also possible to use whitening or special toothpaste for smokers, which will help remove the lining
3. Tooth brushing with dental floss or interdental brush at least 1 x per day
4. Tongue cleansing
5. After using tobacco, it is recommended to rinse your mouth with a glass of still and unsweetened water
6. It is recommended to avoid acidic foods and beverages such as coffee, cola, lemon water, which contribute to the formation of dental erosions.

References.

Kasat V, Ladda R. Smoking and dental implants. J Int Soc Prev Community Dent. 2012;2(2):38–41. doi:10.4103/2231-0762.109358

Lee PN. Epidemiological evidence relating snus to health–an updated review based on recent publications. Harm Reduct J. 2013;10:36. Published 2013 Dec 6. doi:10.1186/1477-7517-10-36

Daly B., Watt R., Batchelor P., Treasure E. Essential Dental Public Health. Oxford University Press 2002, 135-181.