Smoking, Vaping and Your Mouth: What Tobacco and E-Cigarettes Do to Teeth and Gums

Most people know smoking harms the lungs and heart. Fewer realize how much it affects the mouth, where tobacco smoke and vapor make first contact. This guide summarizes what the ADA, the FDA and the National Institute of Dental and Craniofacial Research (NIDCR) say about cigarettes, other tobacco and e-cigarettes, and what your dentist can do to help. If you use any of these products, the most useful thing you can do for your mouth is tell your dentist, so they know what to look for.

What smoking does inside the mouth

The ADA’s MouthHealthy site lists a range of effects (MouthHealthy: Smoking):

• Stains. Tobacco stains teeth, often turning enamel yellow or brown, and cosmetic procedures such as whitening may not work as well or last as long.
• Taste and smell. Smoking dulls both.
• Bad breath. MouthHealthy says smoking causes chronic bad breath. Our bad breath guide covers other causes.
• Less saliva. Smoking reduces saliva flow, which normally helps rinse away cavity-causing bacteria. See our guide to dry mouth and your teeth.
• Gum irritation and disease. Tobacco chemicals irritate the gums. As gum disease advances, gums can pull away from the teeth and form pockets where infection develops, and the bone and tissue holding teeth in place can break down.
• Cancer. MouthHealthy says smoking can cause cancers of the mouth, throat, tongue or jaw.

Gum disease and tobacco

NIDCR says that of the several risk factors for gum disease, smoking or using tobacco products is the most significant, and that tobacco use can make treatment less successful (NIDCR: Gum disease). Gum disease often starts quietly with gums that are red, swollen or bleed easily, and in later stages can lead to loose teeth. Smoking can also make gum problems harder to spot, so regular exams matter. Our gum disease signs guide explains the warning signs, and our article on scaling and root planing explains a common treatment.

MouthHealthy also notes that smokers are more likely than non-smokers to lose all their teeth, and that untreated gum disease has been linked with other health problems.

Oral cancer

NIDCR says most cancers in the mouth are related to tobacco use, drinking alcohol, or both, and that tobacco of any kind, including cigarettes, pipes, cigars, e-cigarettes, chewing tobacco and snuff, puts you at risk (NIDCR: Oral cancer). Dentists check for signs of oral cancer during routine exams. Our guide to oral cancer screening explains what the check involves and which symptoms, such as a sore that doesn’t heal, to get looked at promptly.

Is any tobacco product safe?

The FDA states plainly that no tobacco product is safe (FDA: Health effects of tobacco use). It describes the health risks as existing on a spectrum: combusted products such as cigarettes are the most harmful, while non-combusted products such as e-cigarettes generally have lower risks than cigarettes. Lower risk is not the same as no risk.

Hookahs

MouthHealthy says many people assume hookah (waterpipe) smoking is safer, but research published in the Journal of the American Dental Association links it with gum disease, dry socket after extractions, and cancers of the head, neck and mouth.

Smokeless tobacco

Chewing tobacco and snuff sit directly against the gums and cheek. NIDCR includes smokeless tobacco among oral cancer risk factors. If you use it, ask your dentist to look closely at the area where you hold it.

What about vaping?

MouthHealthy explains that we still don’t have all the facts about vaping and dental health because e-cigarettes are relatively recent compared with cigarettes (MouthHealthy: Vaping). What is known is concerning enough to take seriously:

• E-cigarette liquid usually contains nicotine or cannabis, along with flavorings and other chemicals. MouthHealthy notes that even cartridges claiming to be nicotine-free have been shown to contain some nicotine.
• Researchers have found carcinogens, heavy metals such as nickel, tin and lead, and fine particles in vape cartridges.
• Some flavorings contain sugar, which contributes to tooth decay.
• Nicotine is highly addictive and is known to affect brain development in children, teens and young adults.

If you vape, mention it at checkups, just as you would smoking, so your dentist can watch for gum changes, dry mouth and decay.

Tobacco and dental treatment

Smoking can affect healing after dental procedures. If you are planning surgery such as an extraction, gum treatment or an implant, tell your dentist or surgeon about any tobacco or vaping and ask whether stopping beforehand would help. Our guides to bone grafts before implants and gum grafts explain those procedures.

Quitting helps your mouth too

MouthHealthy says quitting now reduces your risks for many forms of cancer. Your dentist and physician can point you to support, and the FDA’s site links to resources for quitting. Even if you are not ready to quit, regular dental visits help catch problems early; our guide on how often to see the dentist explains why tobacco users may need more frequent checks.

What your dentist looks for

When you tell your dentist you smoke or vape, they can pay closer attention to the areas tobacco affects most. That often includes measuring the gums for pockets, checking for recession, looking at the tongue, cheeks, floor of the mouth and the area where any smokeless tobacco is held, and watching for new decay where saliva is reduced. NIDCR notes that a dentist or hygienist diagnoses gum disease with tests such as gum measurements and X-rays, along with questions about risk factors like tobacco use.

Your dentist may also suggest more frequent cleanings, extra fluoride, or a closer watch on a particular spot. Our fluoride guide explains when extra fluoride is used.

Signs to report between visits

• Gums that bleed, are swollen, or are pulling away from the teeth
• Teeth that feel loose or are shifting
• A sore, lump, or white or red patch in the mouth that doesn’t heal
• Persistent dry mouth or bad breath

Being honest about how much and how often you use these products helps your dentist give advice that fits you.

Frequently asked questions

Does smoking cause gum disease?

NIDCR calls smoking or tobacco use the most significant risk factor for gum disease, and MouthHealthy says tobacco chemicals irritate the gums.

Is vaping safe for my teeth?

MouthHealthy says the full effects are not yet known, but harmful substances have been found in vape cartridges and sugary flavorings can contribute to decay. The FDA says no tobacco product is safe.

Will whitening remove smoking stains?

MouthHealthy notes that cosmetic procedures such as whitening may not work as well or last as long in smokers. Ask your dentist what to expect; our whitening guide compares options.

Should I tell my dentist I smoke or vape?

Yes. It helps your dentist know what to look for, including early signs of gum disease and oral cancer.

Is chewing tobacco safer than smoking?

Smokeless tobacco is still a risk factor for oral cancer according to NIDCR. The FDA says no tobacco product is safe.

Sources

• MouthHealthy (ADA): Smoking
• MouthHealthy (ADA): Vaping
• FDA: Health effects of tobacco use
• NIDCR: Gum disease
• NIDCR: Oral cancer

By the Dentist Review Editorial Team.

This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.

Featured image: “Cigarette butts in a smoke-free area” by quellatizia, via Wikimedia Commons, licensed CC BY-SA 4.0. Resized and compressed for the web.