Tobacco, Smoking, and Gum Disease

by | Aug 30, 2021

The first study that identified a correlation between smoking and periodontal disease was published nearly 75 years ago.[1] Subsequent research confirms that smokers have an increased risk of developing periodontal disease. What are the links between smoking and gum disease? Does smokeless tobacco carry the same risks?

The Mechanisms Behind the Connection Between Smoking and Gum Disease

Plaque – the sticky bacteria-laden film that attaches to your teeth and gums – is the starting point for the development of gum disease. If it’s not properly removed, it finds its way beneath the gum line. Plaque then hardens into tartar and causes an infection.

Smokers are more likely than non-smokers to have a build-up of plaque and tartar.[2]  Once smokers develop gum disease, it’s more difficult to fight the infection. This is because of the destructive effects of nicotine. Nicotine damages periodontal cells. It also interferes with tissue immunity, aggravates inflammation, and contributes to bone loss.

Tobacco Damages Periodontal Cells

The nicotine in tobacco changes the cells that form periodontal tissues, membranes, and ligaments. Nicotine can induce these harmful effects through neurotransmitters that influence cell activity.[3]  The damaging effects of nicotine on periodontal cells include:

  • Alteration of the cells that make up the structural framework for periodontal tissues – affecting the ability of teeth to be anchored in the jawbone [4]
  • Degradation of collagen in periodontal tissues [5]
  • Delayed or halted healing process due to nicotine’s toxic effect on periodontal stem cells[6]

Tobacco Reduces Immunity in Periodontal Tissues

The use of tobacco reduces periodontal immunity in several ways:[3]

  • Tobacco interferes with cytokines, which are instrumental in helping the immune system react to diseases
  • Cigarette smoke affects cell movement in the tissue barrier that typically acts as a barrier against bacteria
  • Nicotine can slow the development of T-cells, which play a large role in immune response
  • Nicotine reduces blood flow in periodontal tissues, interfering with wound healing

Tobacco Increases Inflammation

Many are familiar with the function of white blood cells and the role they play in immune response and in fighting infection. The most common type of white blood cells is called neutrophils, which account for 55-70% of all white blood cells.[7]

But until scientists explored the function of neutrophil extracellular traps (NETs) – extracellular webs that trap pathogens – they were unclear as to why smoking increases inflammation. Their research found that while NETS often provide a beneficial service to the body, they can also release molecules that increase inflammation.[8]

Nicotine and Bone Loss

Long-term studies have confirmed that smoking is related to alveolar bone loss. [9] Aveolar bone is the bone that holds the tooth roots in the jaw. Specifically, nicotine accelerates the loss of bone in this area. It also decreases bone volume and thickness, and causes bone destruction. [10][11]

Is Smokeless Tobacco a Danger? What About Vaping?

While smokeless tobacco (sometimes called chewing tobacco, dipping tobacco, or snuff) has long been associated with oral cancer, fewer studies link it to periodontal disease.

However, a study published in 2016 found that both groups – those who smoked tobacco and those that chewed tobacco or held it in their mouths – were at high risk for developing gum disease.[12] The length of time using tobacco – either smoked or a smokeless version – was directly related to the severity of the disease.

And even though the research on vaping is preliminary, results so far show that 43% of those who used e-cigarettes had gum disease or other types of oral infections. Smokers showed the highest rate of gum disease, at 73%. However, the percentage of those who neither smoked nor vaped was only 28%.[13] Since there’s a prevailing idea that vaping is safer than smoking, more research is needed to clarify the potentially destructive impact of vaping on gum health.

Periodontists Can Restore Gum Health for Former Tobacco Users

Tobacco’s link to gum disease highlights one more reason why smokers and tobacco users should quit their habits. The good news is that you can restore your gum health if you give up tobacco use and start a treatment program with a periodontist. The personal risk between tobacco, smoking, and gum disease isn’t inevitable, and the earlier you stop using tobacco, the better.

The staff at Dental Implants & Periodontal Health of Rochester will carefully assess your current condition using the most advanced techniques and technologies. Then, they’ll recommend the services that will restore your oral health. You can be assured that you’ll receive the personalized attention that will lead to optimal care when you visit the practice. Don’t wait to make the changes that can vastly improve your overall health. Commit to quitting tobacco use and schedule an appointment with us today! 585-685-2005



[1] Tobacco and gingivitis: a statistical examination of the significance of tobacco in the development of ulceromembranous gingivitis and in the formation of calculus,
[4] Effects of nicotine administration in rats on MMP2 and VEGF levels in periodontal membrane,
[5] Nicotine increases the collagen-degrading ability of human gingival fibroblasts,
[6] Nicotine Cytotoxicity on the Mesenchymal Stem Cells Derived from Human Periodontium,
[9] Proximal alveolar bone loss in a longitudinal radiographic investigation,
[10] Negative effects of nicotine on bone-resorbing cytokines and bone histomorphometric parameters in male rats,
[11] Effects of Nicotine on Rat Alveolar Bone,
[12] Assessment of Periodontal Health Status in Smokers and Smokeless Tobacco Users: A Cross-Sectional Study,
[13] Electronic Cigarette Aerosol Modulates the Oral Microbiome and Increases Risk of Infection,

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