Smoking and Oral Health
Smoking and oral health in Scotland
- Across the general population in Scotland in 2022, one in 10 people had a toothache or mouth pain in the last month, and 6% had problems with their mouth, teeth or dentures and often experienced bleeding gums. People who smoke are substantially more likely to have oral health problems.
- Smoking weakens the body's immune response, reduces its ability to fight gum infections and makes it harder for gums to heal.
- Smoking cessation reduces the risk of all oral health problems caused by smoking and increases the effectiveness of treatments and interventions.
Smoking and oral, head and neck cancer
- People who smoke are 6 to 10 times more likely to develop mouth cancers compared to non-smokers. The more cigarettes smoked per day the higher the risk.
- A study in 2015 found that of 1190 cases of head and neck cancers in Scotland, 425 (36%) were attributable to smoking.
- Continued smoking after diagnosis can reduce the effectiveness of treatment and increase the risk of recurrence and side effects associated with treatments.
The damaging effects of smoking on oral health
People who smoke have twice the risk of developing periodontal (i.e. gum disease) and the risk increases with the number of years and the number of cigarettes per day smoked.
Smoking increases the formation of dental cavities but some risk may be attributable to shared factors, as people who smoke are more likely to live in deprived areas where increased alcohol intake, poorer diet and lower dental hygiene are more common.
Smoking is one of the most common causes of tooth discolouration and due to smoking itself and changes in the oral microbiota (bacteria), smoking is a common cause of bad breath.
People who smoke have twice the risk of tooth loss compared to never-smokers.
Smoking has a negative impact on the oral microbiota (all bacteria found in the oral cavity), increasing the risk of tooth decay and periodontal diseases. A 2018 systematic review found that smoking increases the risk of periodontitis by 85%. Long-term or unresolved periodontal diseases increase the risk of serious infections and complications, including tooth loss.
Nicotine may promote the production of biofilm, a protective layer some bacteria produce to protect themselves, which increases the risk of cavities forming and periodontal disease developing.
Smoking can also reduce healing and increase infection risk following dental surgery due to its immune suppressive effect and vasoconstriction (constriction of blood vessels) caused by nicotine. There is also strong evidence that smoking is associated with a higher risk of dental implant failure.
The benefits of smoking cessation on oral health
- People who quit smoking cut their risk of cancer of the mouth or oesophagus by half within five years. Continued smoking after a cancer diagnosis leads to an increased risk of cancer recurrence, new cancers and higher risk of long-term side effects from cancer treatment.
- A meta-analysis of 65 studies found that people who smoke have twice the risk of tooth loss compared to never-smokers. Stopping smoking reverts the risk of tooth loss back to that of never-smokers.
- After stopping smoking, 40% of people who have given up cigarettes reported having developed mouth sores or ulcers which lasted for up to two weeks.
You can download a PDF file of the 'Smoking and Oral Health' factsheet which includes references.
