Smoking: the consequences of tobacco use

Written by: Dott. Claudio Caldarelli
Edited by: Top Doctors®

In Italy, despite the number of smokers has decreased dramatically over the past five years, 21% of the population continues to be dependent on tobacco. The Doctor Claudio Caldarelli , expert in Maxillofacial Surgery, explains what are the most common pathologies derived from the use of tobacco



Oral cancer

The Smoking is one of the most important risk factors for the diseases of the oral cavity, starting from carcinoma of the oral mucosa.

Scientific research has shown that, for smokers of cigarettes, the relative risk of contracting this type of cancer is 2 to 5 times higher than non-smokers, and increases in relation to the amount of cigarettes smoked and the number of years of habit smoking. Furthermore, although the risk decreases with the passage of the years of abstinence, can trascorrerne up to 20 before it uniform to that of non-smokers.

Next to smoking, alcohol abuse is another major risk factor for oral cancer. Numerous studies have shown that heavy smokers who use alcohol develops a risk for this pathology of many times greater than the sum of the independent effects of alcohol and smoking.

The high increase of the relative risk of developing an oral cancer to which the tobacco users than in non-smokers are exposed has also been observed between cigar smokers (from 7 to 10 times), those of the pipe (from 2 to 3, 5 times) and among those who use chewing tobacco and to be aspirated.

Finally, cigarette smokers suffering from oral cancer (where the cancerous lesion may appear in the form infiltrating, ulcerated or esofilitica) are often forced to deal with more smoking-related diseases, such as cardiovascular diseases and primitive tumors.



Potentially malignant disorders of the oral mucosa

The oral mucosal injuries are very common in subjects who use chewing tobacco and to aspirate and may develop even after a limited use. Their prevalence also increases based on length of habit. The mucosa of potentially malignant lesions are of two types:

  • Leukoplakia: white plates, opaque, hard and thickened. It is considered a precancerous lesion that may resolve with smoking cessation and has a malignant transformation rate of between 3.6 and 17.5 percent.
  • Erythroplakia: red plaques looking shiny and smooth. Most striking in the age group between 60 and 70 years old and has a high risk of neoplastic transformation (from 14% to 50%).

Even cigarette smoking may be associated with oral leukoplakia and all'eritroplachia, as well as with other lesions of the oral mucosa such as nicotine stomatitis (inflammation of the mouth), oral candidiasis (fungal infection of the mouth), black tongue villous ( benign abnormality), losangica median glossitis (inflammation of the tongue).



periodontal disease

Cigarette smoking is a significant risk factor for the development of periodontal disease. Periodontitis, in fact, is more common in smokers than in non smokers (the risk of gingival retraction, for example, is 2 to 5 times greater) and the number of cigarettes smoked is an important determinant of risk (2 times greater in those who smoke up to 15 cigarettes, up to 6 times higher in those who smoke more than 30).

Many studies have shown a correlation between the speed of disease progression and the ' smoking habits , while in former smokers was observed a significant reduction in the risk of periodontitis. Moreover, the answer to parondontale therapy is scarce and patients who smoke for which the risk of failure to respond to surgery is 7 times greater than non-smokers.

Periodontal disease is linked to a complex interplay between environmental factors (smoking and bacterial flora of the oral cavity) and patient-related factors (genetic, immune system, age, diabetes). However, the 'bacterial infection is the primary cause of periodontitis and, in smokers, there was a greater presence of some species of bacteria more difficult to eradicate: the' Actinobacillus actinomycetemcomitans, Bacteroides forsythus and Porphyromonas gingivalis.

Finally, there exists a strong scientific evidence that smoking results in significant deleterious effects on the inflammatory and immune response to the disease such as, for example, the reduction of blood flow to periodontal level and revascularization of the bone and soft tissues, which make reason for the greater incidence , the increased aggressiveness and unresponsiveness to treatment of periodontal disease in smokers than non-smokers.

Recently, some studies have also suggested that smoking may also negatively affect bone metabolism.



It has been detected a correlation between smoking and the development of caries. In particular, patients who chew tobacco to bring the highest average of caries destruenti or infiltrating at the level of coronal and root compared to non-smoking patients. Obviously, the number of lesions is directly related to the amount of tobacco consumed per week and the total time of the habit. The increased risk mechanism seems to be related to the levels of fermentable sugar present in chewing tobacco, which stimulate the growth of cariogenic bacteria.


aphthous lesions

Canker sores afflict more non-smokers than smokers: quit smoking increases the incidence of ulcers, while restart reduces. This phenomenon is explained by the fact that smokers develop a hyperkeratinization of the mucosa, which protects it from ulcers. The nicotine, also, can induce a reduction in the inflammatory response which, in the smoker patient, induces a reduced suscettibiltà to aphthous stomatitis.



Disorders and saliva glands

It has been shown that passive smoking causes substantial alteration of the structure of the salivary glands in experimental situations, such as altering its functionality, while active smoking involve alterations in both the glandular structure in the composition of saliva.

In smokers, in fact, the concentrations of the most common salivary antioxidants appear to be significantly reduced. This reduction appears to be related to the onset and progression of oral cancer and smoking-induced saliva-mediated.



The tobacco in all its forms, is a risk factor for cancer and for other lesions of the oral mucosa, for periodontal disease, for the gingival recession and for the coronal and root caries. The more you smoke, the more the risk of developing oral disease increases. In addition, smokers who have periodontal disease respond less to surgery than non-smokers, while those who develop cancer have a higher risk of developing other cancers of the upper digestive tract-plane level.

It is clear, therefore, that quitting smoking has obvious benefits, both as regards the risk of cancer of the oral mucosa and periodontal disease, for which to develop some lesions of the oral cavity.

It is the duty of the specialist to communicate to the patient smoker risks due to exposure and suggest a recovery therapy to quit smoking. The intervention of 'dentist can be very effective by virtue of the business relationship established with these patients, who are inclined to follow his advice.

*Translated with Google translator. We apologize for any imperfection

By Dott. Claudio Caldarelli
Oral and Maxillofacial Surgery

Dr. Claudio Caldarelli specializes in Maxillofacial Surgery and Otorhinolaryngology. He deals with Implantology and Guided Tissue Regeneration, Surgery and Aesthetic Medicine, Surgical Treatment of Oral Tumors, Head and Neck, Cranial-Facial Traumatology and Functional Surgery of the Temporomandibular joint, as well as Nasosinus functional surgery . He is currently involved in the study of the surgical treatment of mandibular condyle head fractures and is an expert in All-on-Four and All-on-Six techniques, new generation implant procedures. Since 2009 he has been in charge of the Simple Structure of Maxillofacial Surgery at the San Giovanni Bosco Hospital in Turin. The intense research activity translates into the activity of reviewer for various journals, including the British Medical Journal Case Reports, the Trauma Monthly Journal and the Journal of Neurosciences in Rural Practice, and editor of the journal Archives Otolaryngology and Rhinology. Finally, it can boast the affiliation to important Scientific Societies.

*Translated with Google translator. We apologize for any imperfection

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