Smoking and Dental Implants

Smoking is widely recognized as a significant health hazard, affecting various systems in the body. It is well known that its many detrimental effects have a profound impact on our overall health. But some people don’t realize just what a negative affect smoking has on the oral health of an individual.

A primary relationship has long been known between smoking (this includes smokeless tobacco/vaping) and things like: coronary heart disease, stroke, subclinical atherosclerosis, chronic obstructive pulmonary disease, pneumonia, low birth weight, increased risk of stillbirths and various cancers. .[1] These have all been well established without doubt. But think about it. Since smoking is done IN the mouth, it only makes sense that that part of the body would be directly affected. The harmful chemicals in tobacco not only cause cosmetic issues like tooth discoloration and bad breath, it also leads to severe conditions such as gum disease, tooth loss, root caries, peri-implantitis and oral pre-cancerous and cancerous lesions.

Overview of Smoking and Its Effects on Oral Health

Effects of Smoking on Oral Health

Tobacco negatively affects the outcome of almost all therapeutic procedures performed in the oral cavity.

The failure rate of implant osseointegration is considerably higher among smokers, and maintenance of oral hygiene around the implants and the risk of peri-implantitis are adversely affected by smoking.

The harmful chemicals in tobacco products create an environment conducive to bacterial growth and reduce saliva flow, leading to a dry mouth. Smokers are at a significantly higher risk of gum disease, tooth loss, and oral cancers, as the toxic substances in tobacco weaken the immune system, making it harder for the body to fight off infections and repair tissue damage.

Effects of Smoking on Gums and Teeth

Nicotine negatively affects both the bone density and gum health. It interferes with the normal bone remodeling process, making it difficult for the implant to fuse properly with the jawbone (a process called osseointegration). Nicotine also causes vasoconstriction (narrowing of blood vessels), reducing blood flow to the gums and impairing their ability to heal and maintain health. This can result in inflamed and receding gums. This condition, known as periodontitis, is a severe form of gum disease that weakens the supporting structures of the teeth, including the gums, periodontal ligament, and supporting alveolar bone. As a result, over time, as bone loss progresses, teeth become loose and are prone to falling out.

Tobacco negatively affects the outcome of almost all dental procedures, from simple nonsurgical periodontal therapy to complex surgeries.

It is important to understand that smokers respond less favorably than non-smokers to all manners of dental therapy.[2] Fibrinolytic activity (the process that prevents blood clots from growing and causing problems) caused by smoking reduces alveolar (bone) blood supply after dental extractions and dry socket is common among smokers.[3]

Nicotine negatively affects bone density and gum health, contributing to the instability of dental implants. It interferes with the normal bone remodeling process, making it difficult for the implant to fuse properly with the jawbone. Nicotine also causes vasoconstriction (narrowing of blood vessels), reducing blood flow to the gums and impairing their ability to heal and maintain health. Additionally, the toxic chemicals in tobacco interfere with the normal function of cells involved in the healing process, such as fibroblasts and osteoblasts.

Other Oral Diseases Caused by Smoking

Besides gum disease, smoking is a significant risk factor for oral cancer. The toxins in tobacco can cause mutations in the cells of the mouth, which can lead to malignant growths. Oral cancer can affect the lips, tongue, hard and soft palate, cheeks, floor of the mouth, throat and sinuses. Smoking is also associated with other oral conditions such as smoker’s melanosis (dark pigmentation of the gums) and nicotine stomatitis (inflammation of the roof of the mouth).

Specific Impact of Smoking on Dental Implants

Effects of Smoking on Success Rates of Dental Implants

Clinical trials of dental implants consistently rate smoking as a primary patient-centered risk factor for implant failure. Various studies report failure rates in smokers compared to non-smokers, ranging from 6.5% to 20%, when overall implant failure across ALL implant patients, smokers and non-smokers together) is right around 4%.

Some studies have revealed that increased tobacco use is associated with increased implant failures, citing higher implant failure in heavy smokers (1-2 packs/day). In addition, it has been reported that there is significantly greater marginal bone loss around implants in heavy smokers (>14 cigarettes per day) than in those with low cigarette consumption (<14 cigarettes per day). [4]

As you can see from the figures above, smoking significantly reduces the success rates of dental implants.

It is interesting that the amount one smokes appears to have a direct correlation with the risks and complications that come with smoking. So, someone who only smokes 4 or 5 cigarettes a day is at a much lower risk that someone who smokes a pack a day or more.

Complications in Patients with Dental Implants

Patients who smoke face several complications with dental implants, including increased risks of infection, poor osseointegration, and higher incidences of peri-implantitis, an inflammatory condition that can lead to bone loss and implant failure. The reduced blood flow and oxygen supply to the gums and bones in smokers impair the healing process, making it more difficult for the implant site to recover from surgery.

Scientific Studies Highlighting the Risks

Research indicates that smokers are much more likely to experience implant failure than non-smokers. Studies have shown that the nicotine and other chemicals in tobacco reduce the success rates of implants by impairing healing and increasing the risk of complications. One study published in the Journal of Clinical Periodontology found that the implant failure rate was 15.8% in smokers compared to 1.4% in non-smokers. .[5]

Post-Implant Care for Smokers

Special Considerations and Care Tips

Smokers with dental implants should maintain strict oral hygiene routines to mitigate the risks associated with smoking.

This includes regular brushing, flossing, and using antiseptic mouthwashes to keep the mouth clean and reduce the risk of infection. Just because they don’t decay doesn’t mean they don’t need to be kept clean!

In addition to standard brushing and flossing practices, smokers should use interdental brushes and oral irrigators to clean any hard-to-reach areas around the implants and prostheses. Interdental brushes are small brushes designed to clean between the teeth and around implants, where, in some cases, regular toothbrushes may not reach effectively. Oral irrigators, or water flossers, use a stream of water to remove food particles and plaque from between the teeth and along the gum line, providing an extra level of cleanliness.

Frequent Dental Visits and Additional Maintenance

Ongoing smoking necessitates more frequent dental visits and additional maintenance to prevent complications with dental implants. Regular professional cleanings and monitoring are crucial to managing the risks associated with smoking and dental implants. During these visits, dental professionals will thoroughly clean the implants and surrounding tissues, removing plaque and tartar buildup that can lead to infections and other complications. They will also assess the health of the gums and bone structure around the implants, checking for signs of peri-implantitis or other issues. Periodically, they will take follow up x-rays to monitor the bone around the implants.

Advice for Smokers Who Want Dental Implants

Steps Before Considering Dental Implants

Smokers should consider quitting smoking before undergoing dental implant surgery. This significantly improves the chances of successful implant integration and overall oral health. Smoking cessation can enhance blood flow, improve the healing process, and reduce the risk of complications.

Recommendations from Dental Professionals

Dental professionals recommend that smokers quit smoking at least a few months before the implant procedure. Seeking support from healthcare providers for smoking cessation can enhance the success rates of dental implants. Using nicotine replacement therapies, prescription medications, and behavioral counseling can help in quitting smoking. Quitting is ideally the best recommendation we can make.

Alternative Treatments or Approaches

For smokers who find it challenging or impossible to quit, reducing how much they smoke is highly suggested. Some studies have shown that for well-healed, fully integrated implants, smoking fewer than 10 cigarettes a day is far less risky than smoking a pack a day or more. Less isn’t ideal, but it IS far better!

Conclusion

In conclusion, in addition to the plethora of health dangers it presents, one of the most common being lung cancer, smoking also poses a serious threat to oral health, contributing to a range of issues from cosmetic concerns to life-threatening conditions like oral cancer. The harmful effects on gums and teeth, combined with the increased risk of complications with dental implants, underscore the importance of smoking cessation for maintaining optimal oral health. For smokers considering dental implants, quitting smoking is crucial for improving the chances of successful treatment and overall oral well-being. Maintaining strict oral hygiene and seeking regular dental care are essential steps in mitigating the risks associated with smoking.