Smoking, Tobacco and Vaping




General risks

Smoking and chewing tobacco both have a direct association with various medical conditions including:

  • Various types of cancer
  • Pulmonary and cardiovascular diseases
  • Low birth weight
  • Risk factor for initiation and progression of periodontal disease.
  • Malignant and non-malignant oral lesions.


Chewing tobacco facts

  • Smokeless, snuff, or chewing tobacco contains nicotine as well as many known carcinogens (cancer-causing substances).
  • More nicotine is absorbed by chewing tobacco than by smoking a cigarette.
  • Chewing tobacco use is a risk factor for the development of oral cancers and precancers.
  • Other health risks of chewing tobacco include gum disease, tooth decay and tooth loss, and possible links to other cancers and cardiovascular disease.
  • Products that are designed to help smokers quit can also be used to help quit chewing tobacco.
  • Chewing tobacco is known to contain at least 28 cancer-causing chemicals, medically known as carcinogens. The main carcinogens in chewing tobacco are the tobacco-specific nitrosamines (TSNAs). Some of the other cancer-causing agents found in chewing tobacco are formaldehyde, acetaldehyde, arsenic, benzopyrene, nickel, and cadmium.


Smoking facts

Smoking leads to dental problems, including:

  • Bad breath
  • Tooth discolouration
  • Loss of sense of taste
  • Inflammation of the salivary gland openings on the roof of the mouth
  • Increased build-up of plaque and tartar on the teeth
  • Increased loss of bone within the jaw
  • Increased risk of leukoplakia, white patches inside the mouth
  • Increased risk of developing gum disease, a leading cause of tooth loss (in fact, current smokers are bout 4 times more likely to have advanced periodontal disease compared to those who have never smoked.
  • Delayed healing process following tooth extraction, periodontal treatment, or oral surgery
  • Lower success rate of dental implant procedures
  • Increased risk of developing oral cancer
  • Dramatic change to the balance of bacterial species in the mouth, which may affect the risk of oral disease.
  • Lack of oxygen in your bloodstream which can lead to infected gums not being able to heal.


Vaping facts

While there is no tobacco in e-cigarettes, the vapor does contain nicotine, other chemicals, and heavy metals, all of which are bad for the body and teeth.

The nicotine in e-cigarettes can damage gum tissue and reduce saliva production, resulting in bad breath, receding gums, and tooth loss.




Non-malignant dental conditions

Pronounced tobacco stains

Tobacco stains on teeth are often difficult to remove because they have occurred over years of smoking. The stains have settled deep into the enamel and often will penetrate to the outer layer of the dentin. Fortunately, these stains are not at permanent and can be removed with professional teeth whitening.



Tooth abrasion and gum recession

Tooth abrasion is where your teeth start to lose enamel due to outside mechanical action; in other words, your teeth are physically worn down by an external force. Tobacco’s harmful agents also attack the gums over time, making them prone to diseases which can lead to gum recession. Smoking causes a decrease in saliva flow which harms the gums over time as well.



Necrotizing ulcerative gingivitis

Necrotizing ulcerative gingivitis (NUG) is an acute form of periodontal disease. It has distinctive characteristics of rapid onset, gingival pain, bleeding, and halitosis. has an acute clinical presentation with the distinctive characteristics of rapid onset of interdental gingival necrosis, gingival pain, bleeding, and halitosis. Necrosis is the death of body tissue that occurs when too little blood flows to the tissue, due to injury or exposure to chemicals.


Smoker’s melanosis

Smoker’s melanosis is increased tissue pigmentation, or darkening, due to irritation from tobacco smoke. Typically this pigmentation occurs on the gingiva (gums) of the upper and lower front teeth. The amount of pigmentation increases with greater tobacco use, and is more common in females; it occurs in 5.0 – 22% of cigarette and pipe smokers. There is no treatment for smoker’s melanosis; however, tissues typically return to normal color in six to 36 months after quitting smoking.



Leukoplakia is smokeless tobacco-induced lesion. It is a white or gray patch that develops on the tongue or the inside of the cheek and is the mouth’s reaction to chronic irritation of the mucous membranes of the mouth. The affected site or lesion can be a white or yellow-brown colour and it may develop a thickened and wrinkled appearance with increased use of the tobacco product.



Nictoninic stomatitis

In nicotinic stomatitis, the hard palate (roof of the mouth) appears white instead of pink, and numerous, small, raised areas with red centers are found throughout the palate. These red areas are irritated minor salivary glands whose duct openings are inflamed in response to the heat from tobacco products. This lesion is most commonly seen in older male tobacco users who smoke pipes but it also can be found in cigar and cigarette smokers.

There is an increased risk for cancer of the tonsils, posterior mouth, and lungs in individuals who develop nicotinic stomatitis from their tobacco use. However, if the individual stops their tobacco use, the appearance of hard palate typically returns to normal within a few weeks.


Malignant lesions

Oral cancer starts in the cells of the mouth. A cancerous (malignant) tumour is a group of cancer cells that can grow into and destroy nearby tissue. It can also spread (metastasize) to other parts of the body. The most common place oral cancer spreads to is the lymph nodes in the neck. Oral cancer may also be called oral cavity cancer or mouth cancer.

Cells in the mouth sometimes change and no longer grow or behave normally. These changes may lead to non-cancerous (benign) tumours such as warts and fibromas.

Changes to cells of the mouth can also cause precancerous conditions. This means that the abnormal cells are not yet cancer, but there is a chance that they may become cancer if they aren’t treated.

Squamous cell carcinoma

In some cases, changes to the cells of the mouth can cause oral cancer. The mouth is covered by a lining called the oral mucosa (mucous membrane). The oral mucosa is made up of squamous cells called the squamous epithelium. Most often, oral cancer starts in these flat, thin squamous cells. This type of cancer is called squamous cell carcinoma of the mouth.



Verrucous carcinoma

Verrucous carcinoma is an uncommon variant of squamous cell carcinoma. This form of cancer is often seen in those who chew tobacco or use snuff orally, so much so that it is sometimes referred to as “Snuff dipper’s cancer”.