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Smokers have a tendency to have more problems in the mouth such as gum recession but how does tobacco cause gum recession?
This post takes a brief look at what gum recession is and what causes it. We then look tobacco containing products and how tobacco causes gum recession.
Gum Recession
Gum recession (also called gingival recession) is when the gum tissue surrounding the teeth pulls back. The gingival margin (the edge of the gum) shrinks to a lower level on the teeth. As the gums recede the teeth start to look longer and a ridge may be felt on the tooth above the gum line. Gum recession exposes the tooth roots which can cause pain and sensitivity to hot, cold, sweet and sour.
Gum recession happens slowly over time so those affected may not notice it happening until they experience the symptoms of gum recession.
Causes of Gum Recession
There are many causes including aggressive tooth brushing methods, crooked teeth, genetics, thin fragile gum tissue and oral piercings.
Periodontal disease is a major cause of receding gums. Smoking puts you at higher risk of developing severe periodontal disease and thus gum recession.
What Ingredient In Tobacco Causes Gum Recession
Tobacco smoke contains around 7,000 chemicals including nicotine, tar, carbon monoxide, oxidising chemicals, metals and radioactive compounds. Many of these have damaging effects on the body including the tissues in the mouth. Nicotine and its impact on gums and periodontal disease have been studied extensively.
Which Products Containing Tobacco Effect The Gums
Many products contain tobacco including cigarettes, bidis, waterpipes, smokeless tobacco products (eg dipping / chewing tobacco), cigars, and pipe tobacco (1). Some are often perceived as less hazardous than cigarettes but smoking any tobacco product can harm the gums – there is no safe level of exposure.
The Effect of Tobacco On the Gums?
Tobacco harms the oral cavity in many ways. Conditions included gum recession and periodontal disease (also referred to as gum disease).
It also puts you at greater risk of tooth decay, poor healing post-surgery and oral cancer (approximately 90% of people with cancer of the mouth, tongue, lips, and throat use or have used tobacco).
Tobacco Causes Gum Recession
Many studies have found that gum recession is more common in smokers and those with periodontal disease (2). It has also been found that the older someone is and the longer they have smoked, the worse the gum recession (4,5).
Tobacco Causes Gum Disease
Gum disease is a common problem in society around the world. It is an inflammatory condition triggered by plaque bacteria but exacerbated by known risk factors including smoking.
When plaque-bacteria builds up along the gum line it causes inflammation of the gum tissue. This is called gingivitis.
Gingivitis is characterised by red, inflamed gums that may bleed when brushed. When left untreated it progresses to periodontitis, a more serious form of gum disease.
Periodontitis damages the gums and those structures under the gum including the jaw bone (alveolar) and periodontal ligaments (attach the teeth to the bone) that hold the teeth in place.
The bone and ligaments give structure and support to the gums. When they are destroyed, the level of the gum shrinks – gum recession develops.
Cigarette smokers are up to 5 times more likely than nonsmokers to develop severe periodontitis (3) at a faster rate (6).
How Tobacco Causes Gum Recession
Smoking is a significant risk factor for periodontal disease and thus gum recession. Smoking affects the prevalence, extent, and severity of the disease. It also affects the outcome of non-surgical and surgical dental therapies, as well as the long-term success of dental implants (7).
Tobacco is believed to increase an individual’s susceptibility to bacteria which trigger gum disease and tissue destruction.
Tobacco has multiple effects on the progression of periodontal disease and gum recession (8). We discuss these below.
Tobacco Effects the Periodontal Cells
Tobacco effects may cells in the gums and underlying structures.
- Cementum & Bone – Tobacco affects the maintenance, regeneration and repair of the periodontal cells – the cells which turn into cementum (the outer layer of tooth roots) and alveolar bone.
- Collagen – nicotine increases the degradation of collagen and prevents its synthesis
- Prevents anchorage of teeth – nicotine damages the cells which anchor the teeth to the bone
- Immunosuppression – Nicotine may weaken host defences to the bacterial invasion induced by plaque.
Tobacco Affects Plaque-Bacteria
Gum disease and thus gum recession is triggered by plaque-bacteria.
Research has found that smokers have more calculus (also called tartar – it’s plaque which has been hardened by calcium in saliva) deposits than non-smokers. This calculus is stiffer and more tightly attached to teeth than that of non-smokers .
It is thought that nicotine
- May alter the mouth environment making it more hospitable for bacteria involved in periodontal disease to survive
- Increases plaque formation
- Alters cell metabolism of plaque bacteria, which may increase the prevalence and quantity of bacterial strains that lead to periodontal disease
Smoking also increases the growth of Candida albicans which may promote the adherence of plaque to the tooth surface and the accumulation of calculus and thus periodontal disease and gum recession.
Tobacco Reduces Periodontal Tissue Immune Defence
Multiple barriers help to defend our gums from attack by plaque bacteria. Defence barriers include saliva, immune cells and special cells in the gums called epithelial cells.
Tobacco affects these immune defences in several ways.
- It has been shown that cigarette smoke increases the invasion of epithelial cells by bacterial species involved with the development of periodontal disease
- Nicotine decreases the blood flow in and around the gums, which has several effects
- Delayed wound healing
- Gingivitis becomes less obvious – the gums don’t bleed and the don’t become red or inflamed. This means that gum disease is easily missed
- Reduced level of immune cells arriving at the gums to help fight the early stages of the bacterial infection and gum disease
Tobacco Exacerbates Periodontal Tissue Inflammatory Response
The cells of the immune system arrive at the gums to fight the bacterial infection. However, when the bacterial infection is not defeated the inflammatory response becomes chronic.
Smoking may increase the number of immune cells involved in the immune response aggravating periodontitis. How smoking does this has not yet been fully elucidated.
Tobacco Effects on The Alveolar Bone
Smoking alters alveolar bone metabolism and accelerates bone loss. This is thought to be because
- Inflammatory cell responses are exaggerated
- Blood flow to the gums (gingival circulation) is decreased
- Oxygen concentration in healthy gum tissue is reduced
Tobacco Causes a Dry Mouth
Those that smoke have reduced flow of saliva. Saliva helps to protect the gums and teeth by helping to wash bacteria away.
If I Stop Smoking Will My Gums Repair
Yes. If you quit smoking you have the same risk of developing gum disease and responding to professional gum health treatments as non-smokers.
Sadly any gum recession you’ve experienced will not repair on its own (surgical gum grafts are available to some candidates) but you can prevent it from getting any worse by developing first-class oral hygiene and seeking help from a dentist.
When tobacco use is eliminated, blood flow will return to the gums and they may bleed. Don’t be alarmed but seek advice on how to treat your gum disease.
How Long for Gums to Heal After Quitting Smoking
Quitting smoking is one of the best things you can do for your oral and your general health. Within weeks of smoking cessation, you may see improvements in your oral health however how long your gums take to fully heal may depend on how long you smoked, the quantity consumed and your body’s immune response to the tobacco.
Quit Today and Minimize Dental Complications
Smoking any product containing tobacco has a negative effect on the oral cavity. It puts you at increased risk of developing periodontal disease and gum recession.
Tobacco has many damaging effects on every cell in the oral cavity. It increases your susceptibility and risk of infection by inducing immune dysfunction.
You can reduce your risk of gum recession developing further by quitting smoking and developing first-class oral hygiene.
Sources In How Does Tobacco Cause Gum Recession
- Non-cigarette tobacco products: What have we learned and where are we headed? – PMC. Available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716250/
- Effect of Smoking on Gingival Recession. Dental Research Journal (Vol. 5, No. 1, Spring-Summer 2008). Available here: http://drj.mui.ac.ir/index.php/drj/article/view/58/33
- Page RC, Beck JD. Risk assessment for periodontal diseases. Int Dent J. 1997 Apr;47(2):61-87. doi: 10.1111/j.1875-595x.1997.tb00680.x. PMID: 9448791.Available here: https://pubmed.ncbi.nlm.nih.gov/9448791/
- Müller HP, Stadermann S, Heinecke A. Gingival recession in smokers and non-smokers with minimal periodontal disease. J Clin Periodontol. 2002 Feb;29(2):129-36. doi: 10.1034/j.1600-051x.2002.290207.x. PMID: 11895540. Available here: https://pubmed.ncbi.nlm.nih.gov/11895540/
- Bokor-Bratić M. Uticaj pusenja na stanje parodoncijuma [Effects of smoking on the periodontium]. Med Pregl. 2002 May-Jun;55(5-6):229-32. Croatian. doi: 10.2298/mpns0206229b. PMID: 12170868. Available here: https://pubmed.ncbi.nlm.nih.gov/12170868/
- Obeid, P., Bercy, P. Effects of smoking on periodontal health: A review. Adv Therapy 17, 230–237 (2000). https://doi.org/10.1007/BF02853162. Available here: https://link.springer.com/article/10.1007/BF02853162
- Newman MG, Takei H, Carranza FA, Klokkevold PR. Carranza’s clinical periodontology. 10th ed. St. Louis: Mosby – Saunders; 2006. (5)
- Zhang Y, He J, He B, Huang R, Li M. Effect of tobacco on periodontal disease and oral cancer. Tob Induc Dis. 2019 May 9;17:40. doi: 10.18332/tid/106187. PMID: 31516483; PMCID: PMC6662776. Available here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662776
