20 July 2023

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Helping to not “burn” your smile: cigarettes’ negative impact on oral health

Gianna Maria Nardi

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Cigarettes are essentially the enemy of good health. Clinicians and health professionals should advise patients that smoking does not cause damage only at a systemic level, damaging the cardiovascular and respiratory systems, but it also significantly compromises the health of the oral cavity.

The most profound consequences are the increased risk of developing periodontitis, a decrease in healing processes after secondary and tertiary prevention therapies, due to the reduction of vascularization, and causes a higher risk of tissue destruction. Cigarette smoke negatively affects the cells of the immune system, but the motivational lever that should scare anyone is the data relating to oral cancer. Some 80% of all malignant tumors of the oral cavity are attributable to the use of tobacco.

The burning of cigarettes causes smoking melanosis, which affects about 20% of smokers, with an intensity that varies depending on the quantity of cigarettes and smoking habit. Smoking also creates blemishes given by the acquired dyschromias of origin and halitosis, compromising social life.

To safeguard health, it is necessary to quit smoking.

Statistics indicate that in Italy the number of smokers has been stable for about 10 years. Recent technological advances have allowed the development of new alternative products to traditional smoking, such as electronic cigarettes and heated tobacco products. 

These are not zero-risk products, and they are not designed for smoking cessation. But in a recent article by Warner et al. 2023 titled “Nicotine e-cigarettes as tool for smoking cessation,” published in Nature Medicine, the authors state that "smokers who use electronic cigarettes more frequently are more likely to quit smoking, thus managing to contribute to the achievement of public health objectives.”

A cigarette burns at a temperature of 600°C, but temperatures can exceed 800°C while smoking. Burning tobacco causes the release of harmful chemicals in the smoke that is inhaled; it is these chemicals that are the main cause of diseases associated with smoking, not nicotine itself. 

Heated tobacco products release a vapor containing nicotine without generating combustion, ash or smoke. This is the main difference between these products and traditional cigarettes.

In recent years, numerous experts and research centers in the field of anti-smoking around the world have focused on these products and continue to investigate smokers' habits.

The tools that can be used to direct patients who smoke towards giving up cigarettes are public resources, the pharmacological approach and nicotine replacement therapy, possibly combined with cognitive-behavioral counseling. A risk containment strategy is viable for people who do not wish to stop smoking. The aim is to try to reduce the exposure to toxic substances generated by the combustion of tobacco by exploiting innovative technologies.

Existing evidence on the impact of smoke-free products, while not without risk, indicates that the use of such systems can reduce the incidence of negative effects on oral health. The objective to be pursued in the management of patients who smoke remains that of the total cessation of smoking.

Resources for doctors and patients in the U.S. include:

• FDA-approved and FDA-cleared cessation products
  
  
• Clinical cessation tools from CDC
  
  
• National and State Tobacco Control Program created by CDC’s Office on Smoking and Health