Guest Columns

Smoking and oral health

In spite of the growing awareness about the potential ill effects of smoking, it continues to be a major public health challenge world over. Of particular concern to a country like ours is the fact that a greater proportion of tobacco related deaths occur in developing countries rather than developed ones. A huge proportion of these deaths have been related to diseases such as stroke; heart attack; chronic bronchitis; chronic cough; asthma; cold; and cancer of the lungs, throat, mouth, stomach, kidney and bladder.

In the midst of all this documentation, the effect of smoking on the oral cavity is sometimes overlooked. As the oral cavity is exposed almost instantaneously, it should come as no surprise that smoking causes many deleterious effects, even if these are sometimes not fully appreciated.

At the very least, smoking leads to staining of teeth and halitosis (bad breath), both of which can lead to socially unacceptable consequences. Smoking can lead to coating of the tongue and increased melanin deposition inside the oral cavity. Although these ill effects may not directly lead to dangerous health consequences, they are unpleasant to live with.

The effect of smoking on the periodontium has been well documented. The American association of periodontology lists smoking as an important risk factor for the development of gum disease. Some of the ways in which it leads to gum disease is by changing the microflora associated with the gum tissue, decreasing the vascularity to the gum, suppressing the normal immune responses and delaying wound healing.

Smoking leads to development of smoker’s palate, a condition in which a number of small spots with red centre project from the surface. The reduction in salivary flow and the change in pH that results from chronic smoking may lead to an increase in the predilection to develop tooth decay.

Smoking has been strongly associated with implant failures, both early as well as late failures. Considering that implants are much in vogue today as a replacement option for missing teeth, this effect of smoking must be clearly understood.

Perhaps the most significant effect of smoking on the oral cavity is the risk for development of oral cancer. Oral cancer is the fifth most prevalent cancer in India and poses a major health hazard because despite improvements in the management of the disease the five year survival rates are not too encouraging.

Tobacco use has been strongly associated to the development of precancerous and oral cancer lesions. It has been linked to the development of leukoplakia, a white patch that extends from both sides of the angle of the mouth into the cheek mucosa. Other precancerous lesions like erythroplakia are also associated with smoking. The transition of precancerous lesions to oral cancer is also associated with tobacco use in all its forms, including smoking.

Other unpleasant truths about smoking include the fact that it seems to affect women to a greater degree. Most of all, unlike some other risk factors, smoking affects not only one’s own health but also that of people around the smoker. The effects of passive smoking are slightly more difficult to establish, but it is also clearly documented as a health hazard. So the next time you smoke, consider that you may not only end up spoiling your health but also that of your loved ones.

The writer is Dr. KV Arun, Periodontist, Apollo White Dental.

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