Smoking and stimulants

Of all the risk factors for the periodontium, smoking is the strongest that can be influenced. Smokers develop periodontitis more often, they develop it more severely, they lose more teeth, and they respond less well to treatment.

Why tobacco does such harm to the gums

• The blood supply falls. Nicotine narrows the fine vessels. The tissue is less well supplied and heals more slowly.
• The defences are dampened. The cells that remove bacteria work less well.
• The composition of the bacteria shifts in favour of the species associated with periodontitis.
• The warning sign fails. Because the gums have a poorer blood supply, they bleed less. Smokers therefore often consider their gums healthy while bone is being lost underneath. That is the most treacherous part.

In addition there are discolouration, a reduced sense of taste, a higher rate of implant losses and impaired wound healing after every procedure. And, first in the examination: tobacco is the most important risk factor for cancers of the oral cavity, especially in combination with alcohol.

E-cigarettes and vaporisers

They are not harmless, but the evidence differs from that for tobacco smoke. What is emerging: nicotine acts on the vessels regardless of how it enters the body — the reduced blood supply remains. Propylene glycol and glycerine dry out the mucosa. Studies find more plaque formation and an altered composition of the bacteria.

Combustion products and tar are absent, and that is a real difference. For people who smoke anyway, switching can therefore be an improvement. It is not a product that is good for the teeth.

Nicotine pouches and snus

Nicotine pouches lie for hours in the same place between lip and gum. The consequences show up in exactly that place: local recession of the gum, whitish changes to the mucosa, exposed tooth necks. The recession is not reversible.

Among adolescents these products are now widespread, and the changes are easy to recognise at a dental check-up — it is worth asking about them and having the site examined. Anyone who uses them should at least change the place where they are put regularly.

Alcohol

Alcohol dries out the mucosa and reduces the flow of saliva; the body's most important protection is thereby removed. Many alcoholic drinks are also acidic, sweet or both — wine, cocktails, liqueurs. In combination with tobacco, the risk of cancers of the oral cavity rises considerably more than the individual risks would suggest.

Cannabis

Smoked, it affects the gums in much the same way as tobacco. Added to that is a markedly dry mouth and often a changed diet with many sweet snacks. Studies find more caries and more periodontal pockets with regular use.

What improves after stopping

More than most people expect. The blood supply to the gums recovers within weeks — often they only then begin to bleed, which is confusing but a good sign: the tissue is reacting again. Healing after procedures improves, the response to periodontal treatment approaches that of non-smokers over the years, and the risk of cancers of the oral cavity falls markedly.

What does not come back is lost bone. Stopping is worthwhile at every stage — but the earlier, the more is preserved.