Oral and periodontal implications of tobacco and nicotine products

Abstract

Tobacco use contributes to more mortality and morbidity globally than any other behavioral risk factor. Adverse effects do not spare the oral cavity, with many oral diseases more common, and treatments less successful, in the tobacco‐using patient. Many of the oral health effects of cigarette smoking are well established, but other forms of tobacco, including cigars and smokeless tobacco, merit dental professionals' attention. Recently, an expanding variety of new or emerging tobacco and/or nicotine products has been brought to market, most prominently electronic cigarettes, but also including heated tobacco and other noncombustible nicotine products. The use of cannabis (marijuana) is increasing and also has risks for oral health and dental treatment. For the practicing periodontist, and all dental professionals, providing sound patient recommendations requires knowledge of the general and oral health implications associated with this wide range of tobacco and nicotine products and cannabis. This review provides an overview of selected tobacco and nicotine products with an emphasis on their implications for periodontal disease risk and clinical management. Also presented are strategies for tobacco use counselling and cessation support that dental professionals can implement in practice.

Evaluation of periodontal indices among non-smokers, tobacco, and e-cigarette smokers: a systematic review and network meta-analysis

“…Some of them also involves the oral cavity, such as increased risk of developing periodontal disease [ 3 , 4 ] and more frequent implant failure [ 5 , 6 ]. Recent investigations confirmed a strong association with worse periodontal status [ 7 , 8 ] with a greater quantity of plaque and calculus among smokers [ 2 ]. This is particularly important considering that more and more clinical studies underscore the paramount importance of oral health to systemic health [ 9 ].…”

“…Quitting smoking is usually challenging because nicotine is addictive and can cause withdrawal symptoms such as anxiety and panic disorders [ 15 ]. To overcome these problems, over the last decades, a new alternative to tobacco smoking has been introduced: the electronic cigarette, a portable battery-operated device which contains liquid in the tank (usually composed of three main components: a carrier solution (propylene glycol or vegetable glycerin), nicotine (unless a nicotine-free version), and flavoring; which are heated by a resistor releasing an aerosol and inhaled by the user during consumption [ 2 ]. In this device, combustion that reaches temperatures of about 800° does not take place; instead, the vaporization of the liquid takes place, at much lower temperatures (about 300 °C), creating less oxidative stress than in traditional cigarettes [ 2 ].…”

“…To overcome these problems, over the last decades, a new alternative to tobacco smoking has been introduced: the electronic cigarette, a portable battery-operated device which contains liquid in the tank (usually composed of three main components: a carrier solution (propylene glycol or vegetable glycerin), nicotine (unless a nicotine-free version), and flavoring; which are heated by a resistor releasing an aerosol and inhaled by the user during consumption [ 2 ]. In this device, combustion that reaches temperatures of about 800° does not take place; instead, the vaporization of the liquid takes place, at much lower temperatures (about 300 °C), creating less oxidative stress than in traditional cigarettes [ 2 ]. It could be assumed that, if existing smokers switched completely from conventional cigarettes (without other changes in usage patterns) to e-cigarettes, there would be a lower burden of disease caused by nicotine addiction [ 16 ].…”

Cannabis use and the risk of periodontitis: A two‐sample Mendelian randomization study

“…Cannabis is the most widely smoked substance after tobacco, and its prevalence is increasing as more legal markets emerge (Manthey et al, 2021). There is strong evidence from prospective observational studies, Mendelian randomization (MR) studies, and laboratory‐based studies that tobacco smoking increases the risk of periodontitis (Baumeister et al, 2021; Chaffee et al, 2021). Cannabis smoke shares many of the chemical constituents of tobacco, except for cannabinoids and nicotine (Tashkin & Roth, 2019).…”

Influence of E-Cigarette and Cannabis Vaping on Orthodontically Induced Tooth Movement and Periodontal Health in Patients Undergoing Orthodontic Therapy

“…From an orodental aspect, tobacco smoking induces changes in the oral microflora, promoting the colonization of key periodontal pathogens such as Porphyromonas gingivalis and Candida species [ 3 , 4 ]. Nicotine consumption has also been associated with an increased risk of oral cancer and oral inflammatory and periodontal diseases such as periodontitis [ 5 ].…”