The World Health Organization (WHO) reports a staggering 8 million deaths annually linked to smoking-related complications. Despite widespread awareness campaigns, over 1.3 billion individuals still use tobacco products, with a significant majority residing in low to middle-income countries. The reality is stark: there’s no safe level of smoking. Even secondhand smoke can lead to serious health issues like cardiovascular disease and cancer.
The mouth, our first line of defense, is teeming with a diverse community of microorganisms known as the oral microbiome. These tiny organisms work in harmony, protecting our oral health, aiding digestion, regulating our immune system, and promoting overall well-being. However, this delicate balance can be disrupted, leading to the development of periodontitis (gum infections), inflammation, and even more serious diseases like heart disease, cancer, liver, and kidney disease.
Several factors can disrupt the composition of the oral microbiome, including poor oral hygiene, dietary habits, alcohol consumption, and, most notably, smoking. Our research, examining the oral health of 128 individuals participating in a 2014/2016 vascular and metabolic health study, revealed distinct differences in the bacteria present in the mouths of smokers compared to non-smokers.
Smokers exhibited significantly higher levels of harmful bacteria, including Fusobacterium, Campylobacter, and Tannerella forsythia. These bacteria are known culprits in gum disease and may heighten the risk of heart disease by triggering inflammation and other adverse effects within the body.
But how does smoking disrupt this vital ecosystem? Tobacco and cigarettes contain a cocktail of toxic substances, including nicotine, tar, radioactive chemicals, lead, and ammonia. Many of these substances are formed as tobacco burns. As a cigarette is smoked, these chemicals enter the oral cavity, transforming the surrounding environment. They reduce oxygen levels, alter the pH (level of acidity), and inhibit the production of saliva.
Saliva plays a crucial role in maintaining oral health. It keeps the mouth moist, aids digestion, and possesses vital antibacterial properties that combat harmful germs. A dry mouth, coupled with low oxygen levels, creates a breeding ground for harmful bacteria to thrive. This overgrowth disrupts the balance of healthy bacteria normally found on the surfaces of the teeth, tongue, and palate.
Nicotine, a prevalent toxin in cigarettes, increases the number of proteins on the surface of specific harmful bacteria, such as P. gingivalis. These proteins, or receptors, give these bacteria an advantage over beneficial microorganisms, allowing them to attach firmly to surfaces, multiply into colonies, and form biofilms. Dental biofilms are complex communities of microorganisms that can form on teeth and other hard surfaces. If left unchecked, they contribute to plaque formation, periodontitis, gum disease, and tooth decay.
These abnormal colonies can influence the immune system, leading to slow healing, inflammation, and even antibiotic resistance. The chronic inflammation caused by gum disease can result in tooth loss and destruction of gum tissue, which has been linked to systemic diseases like cardiovascular disease.
Another bacterium, Streptococcus mutans, can flourish in heavy smokers. Although often present in healthy individuals, when the oral environment is disrupted, it can multiply and become part of dental biofilms, leading to tooth decay and oral cancer.
Are vapes and e-cigarettes a safer alternative? Electronic cigarettes, or vapes, operate using a battery and heating element that vaporizes a liquid containing flavorings and harmful chemicals like nicotine and lead. While early research suggests that e-cigarettes may not be a good alternative to smoking tobacco, their impact on the oral microbiota remains poorly understood. However, studies have observed increased growth of bacteria such as Fusobacterium and Bacteroidales in individuals who vape. Both of these bacteria can cause periodontitis (gum disease).
The crucial takeaway is that the harmful chemicals found in cigarettes and other tobacco products can lead to serious diseases, often originating in the oral cavity. But the good news is that these diseases can be prevented, and the risk can be significantly reduced. While it may take time, quitting smoking can help restore the healthy diversity of the oral biome, reducing the risk of gum disease, promoting saliva production, and improving overall health.
Prevention is always better than cure. Governments and organizations like the WHO must continue to raise awareness about the dangers of smoking, particularly among young people. By understanding the detrimental effects of smoking on our oral health, we can make informed choices to safeguard our well-being.
