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Smoking and Oral Health

A proven relationship exists between smoking and oral diseases, ranging from dental cavities and gum disease through to numerous forms of oral cancer and other dangerous pathologies.1,2 The high burden of these diseases on the health care system has led to a change in the perspective of management towards prevention and early intervention, with education through numerous different age and occupational groups and high investment in advertisement attempting to inform people on the importance of oral and general health.3

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  • Smoking masks the signs of gum disease
  • The chance of developing oral cancer is halved within three to five years of a smoker quitting
  • The oral cavity is a common area of smoking-related disease
  • Globally, there are almost 6 million tobacco related deaths annually
  • Smoking is the principal cause of preventable death and disease within Australia
  • 600 000 non-smokers die each year from exposure to second hand smoke

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Smoking is the principal cause of preventable death and disease within Australia and worldwide, with non-smokers in close proximity of users also affected.4 Globally, there are almost 6 million tobacco related deaths annually, 600 000 of which are non-smokers who die from exposure to second hand smoke.5 Among this 6 million are the 15,000 Australians that die from smoking related illnesses, with an estimated economic impact of $31.5 billion.6 It has been estimated by The World Health Organization [WHO], that unless the appropriate action is taken, by 2030 this ‘tobacco epidemic’ will be taking the lives over 8 million people annually.7

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The chemicals within cigarettes cause damage to almost every organ within the body.8 A large portion of this destruction occurs within the mouth, with serious long term disastrous effects on overall health.9 The oral cavity is a common area of smoking-related disease, the early signs of which can be detected and managed conservatively with a high rate of success. Smoking-related diseases have been well established to have a higher rate of morbidity and mortality when left undetected. Moreover, smoking may mask signs of gum disease due to the diminished blood supply to the gums. This acts against the inflammatory process which is our body’s natural defence system. This lack of bleeding and/or inflammation may lead individuals to incorrectly assume that they possess healthy gums.10,11

The progression of gum disease
Figure 1. Progression of gum disease. Image courtesy of OraMedia. Source

Recent surveys have shown that within Australians 20.4% of males and 16.3% females are tobacco smokers.12 While these statistics rank Australia lower than many of its western counterparts, it is significant considering the commitment and economic investments the Australian government has used in dissuading tobacco use.13 This has been achieved through a number of promotion and prevention strategies, the most recent being a global first in the introduction of plain packaging on all tobacco products. The Australian Government has worked collaboratively with states and territories and non-government agencies to develop a 2012 -2018 National Tobacco Strategy (NTS). This policy framework is threefold; to reduce the economic and social costs whilst improving health. 14

Biannual dental check-ups are recommended to not only maintain optimum oral health but also search regularly for the first signs and symptoms of potentially life threatening conditions. A general examination by your dentist should not only involve assessment of the teeth, but also the gums, palate, cheeks, tongue and throat for any of the countless signs of oral diseases. Often the first signs of other significant pathologies will also be picked up in the mouth prior to anywhere else.

Oral Hairy Leukoplakia
Figure 2. Oral Hairy Leukoplakia – may be one of the first signs of HIV/AIDS. Image courtesy of Crowe, Hoy & Mills (1996). Source
Erythroplakia on the soft palate
Figure 4. Erythroplakia on the soft palate can be an indication of oral cancer. Image courtesy of Australian Dental Association. Source

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[gdlr_heading tag=”h3″ size=”24px” color=”#ffffff” font_weight=”bold”]Common oral health problems that affect smokers: [/gdlr_heading]

  • Tooth discolouration
  • Halitosis (bad breath)
  • Dry mouth (lack of saliva increases the risk of cavities)
  • Oral thrush
  • Reduced taste and smell
  • Tartar/calculus build up and nicotinic stomatitis (smoker’s palate).
  • Whitening of the oral mucosa (mucus membrane) – also known as smoker’s keratosis,
  • Trouble healing after gum or mouth surgery
  • Dry sockets
  • Precancerous lesions and oral cancer (smokers develop around five times more oral cancers that non-smokers),
  • Periodontal disease including varying severities of gingivitis, periodontitis and their acute necrotising variants. Apart from gingivitis, the damage of these diseases are permanent and will lead to the premature loss of teeth.

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Not only does smoking increase the risk of oral diseases, but is a gateway to a number of other life threatening diseases. A study conducted through Harvard’s School of Public Health by Dr. Michaud found men who had suffered from periodontal disease greatly increased their risk of pancreatic cancer compared to men with no history of gum disease.15 Other diseases associated with poor oral health are Cardio-vascular disease, Ischaemic stroke and Alzheimer’s to name a few.16,17,18 Furthermore, diabetics who smoke have a higher risk of dying from heart disease as well as suffering from gum disease, circulation problems, kidney disease, nerve damage and eye damage to name a few.19

Maintaining good oral health and treating dental problems is extremely difficult while an individual continues to smoke. While the underlying cause of a disease is present, the problem can never be fully eradicated. The chance of developing oral cancer is halved within three to five years of a smoker quitting and continues to decrease over time.20 Management of other smoking related diseases (e.g. gingivitis and periodontitis) will respond significantly more favourably even by reducing the amount of tobacco consumed. For this reason, your dentist may discuss the possibility of quitting smoking and appropriate mediums of achieving this.

How to maintain optimal oral health:

  • Quit smoking
  • Education on oral hygiene maintenance is extremely important – being well informed about the importance of oral hygiene increases the likelihood that individuals will focus more positively on their oral health.
  • Brushing teeth at least twice daily for two minutes using the technique recommended by your dentist will help remove bacteria and plaque.
  • Flossing teeth after brushing will help remove additional plaque and food particles from the teeth that a toothbrush cannot reach.
  • Use antibacterial mouth wash for added protection against plaque build-up.
  • Maintain a healthy diet and healthy eating patterns
  • Schedule regular dental check-ups
  • Opt to have dental x-rays done every 18 months

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Sources:

      1. Deborah M. Winn, “Tobacco use and oral disease,” Journal of Dental Education, Vol 65, No.4. (2001): p.306.
      2. Quit, How does smoking damage my mouth, eyes and nose? http://www.quit.org.au/about/frequently-asked-questions/how-does-smoking-affect-my-body/mouth-eyes-nose.html (accessed May 28, 2015).
      3. Department of health and aging. (2012). Tobacco: Tobacco control. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/content/tobacco
      4. Australian Bureau of Statistics. (2012). Gender indicators (No. 4125.0). Retrieved from http://www.abs.gov.au
      5. World Health Organization [WHO], World no tobacco day 2015: stop illicit trade of tobacco products, http://www.who.int/campaigns/no-tobacco-day/2015/event/en/ (accessed May 28, 2015).
      6. Nicola Roxon, (2011a, June 1). Big donations from big tobacco continues as Tony Abbott ignores hi MP’s[Press release]. Retrieved from http://www.alp.org.au/blogs/alp-blog/june-2011/big-donations-from-big-tobacco-continues-as-tony-a/
      7. WHO, World no tobacco day 2015.
      8. Ann Pietrangelo, “The effects of smoking on the body,” Healthline, August 25, 2014, http://www.healthline.com/health/smoking/effects-on-body, (accessed May 28, 2015).
      9. Dr Gary Leff, “Cigarettes and the mouth,” Your dental health resource, May 4, 2015, http://yourdentalhealthresource.com/cigarettes-and-the-mouth/ (accessed May 28, 2015).
      10. The Telegraph, “How smoking can hide gum disease,” April 8, 2014, http://www.telegraph.co.uk/sponsored/health/teeth-gum-health/10750615/smoking-gum-disease.html, (accessed May 29, 2015).
      11. Australian Dental Association Inc., “Smoking, ” Dental Health Week, http://www.dentalhealthweek.com.au/Adults/Lifestyle-Risks/smoking.html, (accessed May 29, 2015).
      12. Australian Bureau of Statistics. (2013). Gender indicators (No. 4125.0). Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4125.0main+features3320Jan%202013
      13. Department of health and aging. (2012). Tobacco: plain packaging of tobacco products. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/content/tobacco-plain
      14. Department of health and aging. (2012). Tobacco: Tobacco control. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/content/tobacco
      15. Dominique S. Michaud, et al., “A prospective study of periodontal disease and pancreatic cancer in US male health professionals,” Journal of the National Cancer Institute 99, No. 2. (2007): 171-175.
      16. Grau, A. J. et al., “Periodontal disease as a risk factor for ischemic stroke,” Stroke 35, (2004):496-501.
      17. Dumitrescu, A. L., and Inagaki, K. “Interrelationships between periodontal disease and mortality, cardiovascular disease, metabolic syndrome, diabetes mellitus,” in Etiology and pathogenesis of periodontal disease, ed Alexandrina L. Dumitrescu (Berlin: Springer, 2010).
      18. Lehman, Shereen. “Treating gum disease linked to improvements in other conditions,” June 27, 2014, http://www.reuters.com/article/2014/06/27/us-gum-disease-health-costs-idUSKBN0F21IC20140627, (accessed May 29, 2015).
      19. Quit, “Is smoking harmful for diabetics?” http://www.quit.org.au/about/frequently-asked-questions/how-does-smoking-affect-my-body/smoking-and-diabetes.html, (accessed May 29, 2015).
      20. Australian Government, “Smoking causes mouth and throat cancer,” Quitline, May 30, 2012, http://www.quitnow.gov.au/internet/quitnow/publishing.nsf/content/warnings-mouth, (accessed May 29, 2015).

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The content on the LifeCare Dental website is provided for education and information purposes only. Information about therapy, service, product or treatment does not imply endorsement and is not intended to replace advice received from your dentist, doctor or other registered health professionals. LifeCare Dental makes no claim as to the accuracy or authenticity of this content.

Additionally, LifeCare Dental does not accept liability to any person for the information or advice provided on this website or incorporated into it by reference. Content has been prepared for Western Australian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.

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