Posted on January 2, 2017

After twenty-eight years as a dentist, I know that is if you really want to irritate a smoker then give them the usual advice about the perils of smoking and why they should quit. Perhaps they enjoy their smoking, the mouth-feel and scratch at the back of the throat, having something the hold or the social rituals involved.cigarettes-78001_1280

In this short article, I would like to try and spin the discussion the other way around. How can you basically keep most the benefits of smoking and keep your mouth and teeth healthy? How is that possible?

In January 2016, the Cochrane Library/University of Oxford published “Electronic cigarettes for smoking cessation (Review)”(Hartmann-Boyce 2016). Over the past twenty years, Cochrane has been instrumental on selecting the best medical evidence so help health-care professionals and patient maker better choices. Where this review differed from others is that it acknowledged that “none adequately addresses the sensory and behavioral aspects of smoking that smokers miss when they stop smoking (e.g. holding a cigarette in their hands, taking a puff, enjoyment of smoking, etc.). Electronic cigarettes (EC’s) may offer a way to overcome this limitation or smoking cessation.”


So how can we improve the health of our teeth? Well, the major cause of damage to the mouth comes from the chemicals in the smoke rather than the nicotine, so it would seem obvious that if we can get the smoke out of smoking, improvements will follow. At present, however there is little evidence to support this since EC’s have only been around for about ten years and well conducted oral health studies need to run for a long time since the damage can take years to appear.

  • If you take the smoke out of smoking it  could halve the amount of stain on the teeth based on a paper published in 2005 by the University College London (Alkhatib et al. 2005) where “Twenty-eight percent of smokers reported having moderate and severe levels of tooth discolouration compared to 15% in non-smokers”
  • How about reducing the risk of shrinking gums and mobile teeth. According to a study from the University of Dunedin, New Zealand (Zeng et al. 2014) by the time the long-term smokers had reached thirty-eight years old they had 23% more damage to their gums than the non-smokers and the men had more gum damage than the women.
  • What about keeping hold of our teeth, especially the upper teeth. To get an idea of losing teeth we have to look at some very large long term studies started in 1994 (Dietrich et al. 2015). This is tricky since it starts to showup after the age of fifty,  and then in the next ten years the risk goes up by 30% for men smoking more than fifteen cigarettes a day.
  • If you have had dental implants remember that smoking around 15 regular cigarettes/day can slightly more than double the risk of implant loss at 5-years for similar reasons to the problems with gum disease (Chrcanovic 2015).
  • And finally mouth cancer. Now before anyone panics, this is very rare so a 1.4 to 26-time increase in risk compared to a nonsmoker is still a small risk (Radoï & Luce 2013). The big variation is complicated by the small number of cases, location, and alcohol consumption. If caught early it’s one of the easiest cancers to treat but if left to develop has a poor survival rate of 50% at five-years.


So, back to the Cochrane review. Yes, we need more studies on how safe and effective EC’s really are in the long run. The review showed that using an “EC containing nicotine increased the chances of stopping smoking in the long term compared to using an EC without nicotine. We could not determine if EC was better than a nicotine patch in helping people stop smoking.” Therefore balancing the risk and the benefits, if you need the nicotine then at least consider an electronic cigarette as a first move and then reduce the nicotine if you are going to quit altogether. Good Luck.


Alkhatib, M.N., Holt, R.D. & Bedi, R., 2005. Smoking and tooth discolouration: findings from a national cross-sectional study. BMC public health, 5, p.27. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1079878&tool=pmcentrez&rendertype=abstract.

Chrcanovic, A., 2015. Smoking and dental implants: A systematic review and meta-analysis. J Dent., 5, pp.487–98.

Dietrich, T. et al., 2015. Smoking, Smoking Cessation, and Risk of Tooth Loss: The EPIC-Potsdam Study. Journal of Dental Research, 94(10), pp.1369–1375. Available at: http://jdr.sagepub.com/cgi/doi/10.1177/0022034515598961.

Hartmann-Boyce, 2016. Electronic cigarettes for smoking cessation (Review). Cochrane database of systematic reviews (Online), 0(9), p.0. Available at: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L608013248%5Cnhttp://findit.library.jhu.edu/resolve?sid=EMBASE&issn=15320650&id=doi:&atitle=Electronic+cigarettes+for+smoking+cessation&stitle=Am.+Fam.+Phys.&title=American+Family+Ph.

Radoï, L. & Luce, D., 2013. A review of risk factors for oral cavity cancer: The importance of a standardized case definition. Community Dentistry and Oral Epidemiology, 41(2), pp.97–109.

Zeng, J. et al., 2014. Reexamining the Association Between Smoking and Periodontitis in the Dunedin Study With an Enhanced Analytical Approach. Journal of Periodontology, 85(10), pp.1390–1397. Available at: http://dx.doi.org/10.1902/jop.2014.130577.


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