Tobacco 101: A Guide to Working with Nicotine Addicted Patients
Impact of Tobacco Use in the Oral Cavity

Cleft Lips and Palates

Studies have shown that maternal smoking, be it passive or active during pregnancy, may be associated with an increased risk for cleft lips and palates in offspring.^32,33

Dental Caries

There is a higher incidence of dental caries seen in those using tobacco products as there is an increased acidity seen in the oral cavity and a decreased buffering capacity of the saliva.⁸

Periodontal Disease

To quote the 2014 Surgeon General’s report, “The evidence is sufficient to infer a causal relationship between smoking and periodontitis.”² This was highlighted by Tomar and Asma, when they showed that 52.8% (8.1 million people) of periodontitis in the US population was attributable to current and former smokers.³¹ In addition, it was also demonstrated that quitting smoking reduced the risk of periodontitis.^8,34

Dental Implants

Given that the anchoring of a dental implant is achieved by osseointegration, and smoking is a risk factor for the destruction of soft and hard tissue that support the teeth, it is agreed that smoking increases the risk of implant failure.^2,8,35-38

Leukoplakia

Leukoplakia occurs six times more frequently in smokers than non-smokers. It also has been shown that over 40% of smokeless tobacco users exhibit a lesion where the tobacco is held. Given the unpredictability of benign leukoplakia changing to a malignancy, these lesions must be carefully assessed.^2,8

Oral Cancer

The American Cancer Society estimates that 49,670 people will get oral and oropharyngeal cancer in 2017, with 9,700 dying from these cancers, which is most commonly squamous cell carcinoma. The risk of developing oral cancer is much greater in tobacco users than in non-users as approximately 75% of all people getting oral cancer use tobacco. The combination of tobacco and alcohol use increases the odds even further.^2,8

Given the dire consequences of developing oral cancer, it is incumbent upon dental professionals to discuss tobacco’s role in causing this disease and through tobacco cessation prevent oral cancer from occurring.