Tobacco or a Whole Smile?

Certifieded orthodontist Alīna Krutika

Smoking is one of the major preventable causes of disease and premature death worldwide. Most people are aware that smoking is harmful to their health, yet many are less aware of the damage smoking can cause to the mouth, teeth and gums.

According to the World Health Organization (WHO), tobacco kills more than 7 million people each year, including more than 1.6 million non – smokers who are exposed to second – hand smoke. All forms of tobacco use are harmful, and there is no safe level of exposure to tobacco.

While much has been said about the negative effects of tobacco, such as lung cancer, heart disease and respiratory conditions, tobacco use can also have a significant impact on oral health. Tobacco use is an important modifiable risk factor for oral diseases, including periodontal disease, and is one of the leading causes of oral cancer.

How does smoking affect your teeth and oral health?

Smoking can affect almost every part of the oral cavity, from the color of the teeth and tongue to the health of the gums and supporting bone. It can also impair healing and increase the risk of several oral health problems.

Tobacco use may lead to:

• Tooth discoloration – exposure to tobacco smoke can cause teeth to become darker over time. People who smoke occasionally or for a relatively short period may notice yellowish discoloration, while the teeth of heavy, long-term smokers can become significantly darker or even brownish.
• Increased plaque and tartar formation – people who smoke tend to develop more plaque and tartar. Plaque contains bacteria that can contribute to gum inflammation and tooth decay. When plaque hardens into tartar, it cannot be removed by normal brushing or flossing and needs to be removed professionally by a dentist or dental hygienist.
• Tongue discoloration – smoking may cause a yellowish-brown coating on the tongue. Nicotine, heat and changes in the oral environment can also affect taste perception.
• Changes in periodontal tissues (gums and supporting bone) – smokers are more prone to periodontal disease than non-smokers. Long – term smoking can contribute to gum disease, loss of the bone supporting the teeth and the formation of periodontal pockets between the teeth and gums. The World Health Organization identifies tobacco use as an important risk factor for periodontal disease, which can eventually lead to tooth loss.
• Dental erosion – some smokers regularly use mouthwashes, chewing gum or mint sweets to freshen their breath. Frequently consuming sweets or drinks containing sugar and acids, including citric acid, may contribute to dental erosion and tooth decay.
• Slower wound healing following various surgical procedures, including dental implant placement.
• Bad breath.
• Reduced sense of smell and taste.
• Other oral health problems, including tooth wear, chronic inflammation and an increased risk of oral cancer.

How does smoking affect dental implants?

Smoking can negatively affect the success of dental implant treatment because it affects blood circulation and healing and increases the risk of complications around dental implants.

One of today’s well – established methods for replacing missing teeth is treatment with dental implants. Dental implants can provide a successful long-term solution for missing teeth, but smoking is an important risk factor that must be considered when planning treatment.

One of the key conditions for successful dental implant treatment is osseointegration – the process by which the implant integrates with the surrounding bone. Smoking may interfere with healing and is associated with a higher risk of implant complications and failure.

Smoking is also associated with poorer periodontal and peri – implant health and may increase the risk of inflammation affecting the tissues surrounding a dental implant.

One of the reasons smoking can make implant treatment and other surgical procedures more difficult is its effect on blood circulation. Nicotine causes blood vessels to narrow, which may interfere with normal tissue healing – an important factor in successful dental implant treatment.

Can smokers get dental implants?

Yes. Dental implants can be placed in patients who smoke, but smoking increases the risk of complications and implant failure.

The suitability of implant treatment depends on several factors, including how much and how frequently the patient smokes, their oral hygiene, general oral health and their motivation to follow the dentist’s recommendations.

A 2024 systematic review and meta – analysis involving 32 clinical studies, 59 246 dental implants and 14 115 patients found a significant association between smoking and early dental implant failure. At the implant level, smokers had approximately 2.6 times the odds of early implant failure compared with non-smokers.

For this reason, both the dentist and the patient should be aware of the additional risks associated with smoking before implant treatment is undertaken. Smoking cessation is strongly advisable to reduce these risks and support successful healing.

Is snus a safer alternative to smoking?

Snus should not be considered a harmless or healthy tobacco product. Although it does not involve inhaling tobacco smoke, traditional snus contains tobacco and nicotine and exposes the oral tissues directly to the product.

Snus is a form of smokeless tobacco traditionally associated with Sweden. It is usually supplied as moist tobacco that is placed under the upper lip. The sale of oral tobacco such as snus is prohibited in the European Union, with an exception for Sweden.

Because snus does not produce smoke, it is sometimes perceived as a safer or more convenient alternative to cigarettes. However, it still contains nicotine, which is highly addictive, and its use can affect the tissues of the oral cavity.

Snus is placed in direct contact with the mucous membrane of the mouth. Regular use can cause visible changes in the oral mucosa, particularly at the site where the product is placed.

It may also contribute to:

• gum irritation and recession;
• changes in the oral mucosa;
• tooth discoloration;
• bad breath;
• changes in taste.

The health effects of different smokeless tobacco and nicotine products continue to be studied, and the evidence regarding individual products and specific diseases is not always conclusive. From an oral health perspective, however, traditional snus should not be regarded as harmless.

How often should smokers visit a dentist and dental hygienist?

Smokers have a higher risk of several oral health problems and should therefore have regular dental examinations and professional dental hygiene.

Plaque and tartar accumulation, tooth discoloration and periodontal problems are more common among smokers. Regular examinations make it possible to detect changes in the teeth, gums and other oral tissues at an earlier stage.

During a dental examination, the dentist evaluates not only the health of the teeth but also the condition of the gums and other tissues of the oral cavity, including the tongue, cheeks and lips.

A dental hygienist can also recommend an appropriate and effective individual oral hygiene routine.

How can smokers protect their teeth and gums?

The most effective way to reduce the oral and general health risks associated with tobacco is to stop using tobacco products. However, if a person continues to smoke or use tobacco, careful oral hygiene and regular professional dental care are particularly important.

The following measures can help reduce some of the effects of tobacco on oral health:

1. Visit a dentist and dental hygienist regularly, usually at least twice a year or as recommended individually.
2. Brush your teeth twice a day with fluoride toothpaste containing at least 1,400 ppm fluoride. Whitening toothpaste ortoothpaste designed for smokers may help remove some surface staining, although it does not eliminate the underlying health effects of smoking.
3. Clean between your teeth at least once a day using dental floss or an interdental brush.
4. Clean your tongue regularly to help remove coating and bacteria.
5. Rinse your mouth with still, unsweetened water after using tobacco.
6. Limit frequent exposure to acidic foods and beverages, such as cola and lemon water, as acids can contribute to dental erosion.

Ultimately, good oral hygiene and regular dental care can help reduce some of the consequences of tobacco use, but they cannot eliminate the health risks associated with smoking.

References

World Health Organization. Tobacco and nicotine. Updated 26 June 2026.
https://www.who.int/news-room/fact-sheets/detail/tobacco

World Health Organization. Oral health. Updated 17 March 2025.
https://www.who.int/news-room/fact-sheets/detail/oral-health

World Health Organization Regional Office for Europe. Effects of tobacco on health. Updated 19 May 2025.
https://www.who.int/europe/news-room/fact-sheets/item/effects-of-tobacco-on-health

Fan YY, Li S, Cai YJ, Wei T, Ye P. Smoking in relation to early dental implant failure: A systematic review and meta-analysis. Journal of Dentistry. 2024;151:105396. doi:10.1016/j.jdent.2024.105396.

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. 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.