Dr. Fares Akl
Doctor in Dental Surgery
Periodontology and implantology
We live in a region where a high percentage of the population are heavy smokers, who consume more than 20 cigarettes or several shisha smoking sessions daily.
This kind of behavior has a negative impact on the general and oral health, from cardiovascular diseases to cancers of the lungs, bladder, mouth and throat.
Besides causes that are obvious to the patient, such as teeth staining, discoloration, gum pigmentation (darkening of the gum), and tartar build-up, smokers are prone to developing periodontal problems earlier and in more severe or advanced ways than non-smokers, even if they are carrying out the same oral hygiene routine. This means that smokers are susceptible to more bone loss, gingival recession and pocket formation around their teeth, which could eventually lead to teeth loss.
It has also been established that smoking has a negative influence on periodontal treatments, for 90% of all refractory periodontitis patients were smokers.
There is clinical evidence that the negative effect of smoking on the periodontal tissue might be reverted after smoking cessation.
Nicotine is the most common substance used in tobacco. While it is known and proven to be addictive, increase the heart rate and blood pressure, and decrease the appetite, it is not the most toxic substance that one should worry about. Cigarettes contain around 6,000 chemicals, of which at least 100 are toxic and carcinogenic. Cadmium, for instance, is used in batteries, stearic acid in candle wax, methanol is rocket fuel, in addition to arsenic, mercury, butane, tar, and many more.
The main issue is not tobacco itself, it is the release of these chemical substances during the process of tobacco burning, which occurs at around 800 to 900 degrees Celsius. The heat itself causes damage to the oral cavity tissues that might lead to different forms of cancers.
Some consider that smoking shisha is less harmful because the smoke gets filtered by passing through the water. Studies have shown that only 3% of the heavy metals and toxins stay in the water, while the rest is inhaled by the smoker. A single shisha smoking session provides the consumer with 125 times more smoke than a pack of cigarettes, and 7 times more carbon monoxide, which mainly comes from the incomplete burning process of the charcoal and the heating of the aluminum foil covering the tobacco. Quantifying shisha smoking is very difficult because of sharing habits, the time spent smoking the shisha and the quantity of tobacco that is being consumed during each session-
The highest complication rates and failures after oral surgery occur among smokers. For example, when comparing dental implant failure rates between a non-smoker and a smoker who consumes 20 cigarettes per day, the percentage rises from nearly 3% to 21%.
The real mechanism of how smoking and nicotine affect wound healing is not very well defined, nevertheless, it has been proven that smoking causes peripheral vasoconstriction, leading to the decrease of the blood flow in the small vessels of the mouth. Immunity among smokers is altered, nicotine delays the formation of blood clots, while the sucking motion and the exhaling of the smoke can dislodge them.
The best way to reduce or revert these side effects is to quit smoking. Twelve hours spent without smoking reduces a person’s carbon monoxide blood levels to normal. Two weeks after smoking cessation, blood circulation and the functioning of the lungs improve. Coughing and shortness of breath become less noticeable after 9 weeks. Five years after smoke cessation, the risk of developing mouth, throat and bladder cancers is reduced to half of the risk faced by a smoker, while 15 years after quitting, the risk of heart disease becomes the same as the non-smoker’s.
For some, quitting is very hard or even impossible, so shifting to an alternative such as e-cigarettes (with nicotine-based solutions) or heated tobacco is always a good and less harmful option.
As previously mentioned, burning the tobacco in regular cigarettes raises its temperature up to 800 to 900 degrees Celsius and releases around 100 toxic and carcinogenic substances. On the other hand, recent studies have shown that heating tobacco instead of burning it reduces the exposure to these chemicals by an average of 95% compared to burning it.
In conclusion, smoking cessation is the best solution. However, if it is hard or impossible to achieve, then shifting to a smoke free alternative is always a better option. It can reduce and sometimes revert the damage caused by regular cigarettes on your general and oral health.