Smoking on oral health/ Smoking advice

How does smoking affect the immune response in periodontal disease?

↓ Immune response, especially neutrophil function → impaired defence

What vascular change masks bleeding in smokers?

Vasoconstriction

Effect of smoking on periodontal treatment healing?

↓ Healing after periodontal treatment → ↑ tooth mobility & bone loss

What percentage of oral cancers are squamous cell carcinomas?

90%

What increases oral cancer risk alongside smoking?

Alcohol consumption

Common sites of oral cancer?

Lateral tongue, floor of mouth, soft palate

What cellular change leads to malignancy?

DNA mutations in oral epithelial cells → malignant transformation

Key symptom of oral cancer?

Non-healing ulcers

Referral rule for suspected oral cancer?

2-week rule

How does nicotine affect bone healing around implants?

Impairs osteoblast function → poor bone healing

How does microvascular constriction affect implants?

Reduces blood supply to surgical site → ↑ implant failure

Why does smoking delay wound healing?

Carbon monoxide & nicotine ↓ oxygen delivery to tissue

Effect of smoking on fibroblasts & collagen?

↓ Fibroblast activity → delayed epithelialisation & collagen production

Common post-extraction complication in smokers?

Dry socket

Cause of yellow-brown extrinsic staining?

Tar & nicotine (mainly lingual surfaces)

Cause of smoker’s bad breath (halitosis)?

Volatile sulphur compounds + ↓ salivary flow + gingival disease

How does smoking alter oral microbiota?

Shift towards more pathogenic bacteria (e.g. P. gingivalis)

Nicotine effect on plaque?

Promotes biofilm adherence & calcification

Salivary flow in smokers?

Reduced

Why is gingival bleeding reduced in smokers?

Vasoconstriction of capillaries

What is leukoplakia?

White patch that cannot be rubbed off

Which leukoplakia type has higher malignant potential?

Speckled/erythroleukoplakia

Typical appearance of nicotine stomatitis?

Painless grey/white palate with red inflamed duct openings

Is nicotine stomatitis reversible?

Yes, benign & reversible

Common tobacco forms to ask about?

Waterpipes/shisha/hookah, zarda, gutkha, scented chewing tobacco, naswar/nas, chillam, paan, snuff/snus, khaini

What should you ask every patient?

About tobacco use (smoke, paan, snuff, shisha, past use)

What to examine at each visit?

Staining, halitosis, mucosal changes, oral cancer signs, BPE

How to advise at-risk patients?

Offer brief info, avoid confrontation, give quitting resources

Steps if patient is interested in quitting?

Recommend e-cigs/nicotine replacement, refer to local stop-smoking services, record in notes

Steps if patient is not interested in quitting?

Give patient control, keep door open, record in notes, reassess at future visits