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Tobacco 101: A Guide to Working with Nicotine Addicted Patients

Course Number: 534

Impact of Tobacco Use in the Oral Cavity

Impact on Oral Health

Tobacco use is associated with many oral pathologies including cleft lip and palate formation, dental caries, periodontal diseases, implant failure, nicotinic stomatitis, leukoplakia, and life threatening oral and oropharyngeal cancer.

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.38,39

Impact of Tobacco Use in the Oral Cavity - Figure 1

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.2

 Impact of Tobacco Use in the Oral Cavity - Figure 2

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.40,41 In addition, it was also demonstrated that quitting smoking reduced the risk of periodontitis.40,41

Impact of Tobacco Use in the Oral Cavity - Figure 3

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.42-44

Impact of Tobacco Use in the Oral Cavity - Figure 4


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

 Impact of Tobacco Use in the Oral Cavity - Figure 5

Oral Cancer

The American Society of Clinical Oncology estimates that 53,260 people will get oral and oropharyngeal cancer in 2020, with 10,750 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 85% of all people getting head and neck cancer is linked to their use of tobacco. The combination of tobacco and alcohol use increases the odds even further.2

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.

Impact of Tobacco Use in the Oral Cavity - Figure 6