By Dr. Amrita Gogia - 

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Smoking, a recognized risk factor for countless diseases across the body, has detrimental effects on oral health as well. Although we largely understand the relationship between smoking and oral health issues such as gum disease and oral cancer, the specifics of smoking's impacts are befuddling and include an important variable: bacteria in the mouth. 

Smoking's Attack on the Oral Cavity

Smoking has a complex and multifaceted effect on oral health as it increases the risk for multiple oral diseases, including:

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* Gum disease (Periodontitis): Smoking is an independent risk factor for the onset, extent and severity of periodontitis, a type of gum disease that affects the soft tissue and bone related to teeth. Smokers have a higher risk of developing periodontitis, experience a higher extent and severity of periodontitis than non-smokers, and periodontitis is more likely to develop more rapidly. Additionally, smoking can negatively affect the successful treatment of gum disease

* Tooth loss: Periodontitis can ultimately lead to tooth loss. Smokers lose teeth at a higher rate than non-smokers.

* Oral cancer: Smoking is a significant risk factor for oral cancer, including cancers of the lip, tongue, cheek, floor of the mouth, and throat. The risk for oral cancer increases as the duration and intensity of smoking increase.

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• Increased risk of delayed wound healing: Smoking can inhibit the body's healing process after dental treatment, resulting in a longer healing time for the oral tissue following treatment, like a tooth removal or gum surgery.

* Other oral health complications: Smoking can also result in staining and discoloration of teeth, halitosis (bad breath), and lower saliva production (dry mouth), which further contribute to oral discomfort and disease.

The Oral Microbiome: A Complex and Fragile Ecosystem Disturbed by Smoking

The oral cavity contains a diverse community of microorganisms, which is referred to as the oral microbiome. These microorganisms include bacteria, fungi, viruses, and protozoa. This microbiome is a complex ecosystem of microbes that is important for maintaining oral health, assisting in digestion, and protecting against pathogens. However, smoking disrupts the delicate balance of the oral microbiome that favours the growth of harmful bacteria.

Smoking modifies the oral microbiome in several ways:

* Bacterial Composition Changes: Smoking promotes the growth of harmful bacteria associated with gum disease, such as Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Treponema denticola.

•Biofilm Development: Smoking helps biofilms, or plaque, develop on teeth and gums. It help the bacteria grow and make it more difficult to remove them through proper brushing and flossing.

* Decreased Oxygen: Smoking decreases the oxygen levels in the mouth, which creates an anaerobic environment that will favour the growth of certain bacteria implicated in periodontitis.

* Immune Response Reduction: Smoking depresses the immune response that would help the body fight off the bacterial infection in the mouth.

* Smoking can also increase the acidity of saliva, further contributing to imbalances in the mouth and growth of bacteria.

Problems Associated with Oral Health: The Link to Systemic Diseases.

The oral cavity is not separate from our body. The oral cavity is associated with various systemic diseases, and many issues associated with oral health are due to infectious gum disease. Infections and inflammatory molecules in the body can enter the systemic circulation and influence systemic diseases, including but not limited to the following:

* Cardiovascular disease: Association with an increased risk of heart disease, strokes, and other complications associated with cardiovascular disease. This may be due to the inflammatory sequence of infection (via oral bacteria) that can lead to damage of blood vessels, blood flow, and promote blood clots.

* Respiratory infections: Oral bacteria can also be dangerous if they can reach the lungs. For example, this can lead to aspiration pneumonia and bronchitis, especially if the immune system is compromised.

* Diabetes: gum disease (infection or systemic disease) can affect blood sugar management in individuals with diabetes. Conversely, diabetes can exacerbate existing gum disease.

* Pregnancy complications: Studies have also associated gum disease with preterm birth and low birth weight.

* Other systemic disease: There is new research on oral bacteria contributing to other systemic conditions, such as rheumatoid arthritis, Alzheimer's disease, and certain cancers.

Your Oral Health and Wellness: Quitting Tobacco and Practicing Good Oral Hygiene 

The safest and healthiest way to protect your oral health is to quit using tobacco. Quitting the use of tobacco can decrease the risk for oral disease and can improve overall health outcomes. Quitting tobacco should first be considered; second, making sure you practice good oral hygiene is also very important:

* Brush your teeth at least two times daily using fluoride toothpaste.

* Floss at least once daily to reduce plaque and food debris from between your teeth.

* Visit your dentist for check-ups and cleanings regularly.

* Using an antimicrobial mouthwash may help to control oral bacteria as well. 

Your dentist can provide you with individualized recommendations and suggestions so that you may achieve oral health that is optimal for you!

Dr. Amrita Gogia is the Associate Director & HOD of Dentistry at Medanta, Gurugram, holding a Master of Dental Surgery (M.D.S.) and a B.D.S. Her expertise and leadership drive excellence in dental care.