Effects of smoking and vaping on oral health

People who smoke or vape have a higher risk of gum problems, tooth loss, complications after tooth removal and surgery in the mouth, and developing mouth cancer. They are more likely to get infections and do not heal as well as non-smokers/non-vapers.

Quitting smoking and vaping reduces the risk of developing gum disease and mouth cancer, and improves the person’s response to gum treatment.

It is very important for people who smoke to visit their dentist regularly to keep their teeth and gums healthy and check for signs of mouth cancer.

It is also important for people who vape to visit a dentist regularly to detect and treat any oral health problems. If you vape, make sure to tell your dentist this.

Less adults smoke now than they used to, but it still remains a problem. In 2022/2023, 11.1% of Australian adults reported smoking, while 20.6% of 18-24 year olds reported vaping.

Vaping is used recreationally and therapeutically as an alternative to smoking. Due to the source of intake, the oral health effects are similar to those of smoking.

How does vaping and smoking affect teeth, gums and oral health?

The most common oral problems affecting people who smoke or vape are:

• Gum (or periodontal) disease.
• Mouth cancer.
• Whitening of the soft tissue in the mouth (called smoker’s keratosis).
• Poor healing after tooth removal (known as dry socket).
• Tooth decay.
• Tooth loss.
• Poor healing after mouth and gum surgery.
• Xerostromia (dry mouth).
• Altered taste sensations.
• Bad taste in the mouth and bad breath (called halitosis).
• Tooth erosion (acid damage to the teeth).
• Tooth discolouration.
• Aphthous ulcers.

Oral health risks of vaping

Smoking e-cigarettes or water pipes (known as vaping) – may seem less harmful than smoking regular cigarettes. Yet this may not be the case for the health of your mouth.

When you vape, you inhale e-liquids (also called vaping juice) which, even when labelled ‘nicotine-free’, can contain harmful substances. These include:

• Nicotine.
• Heavy metals.
• Volatile organic compounds (VOCs).
• Cancer-causing chemicals.

The risk of vaping devices causing problems in your mouth is much higher if they contain nicotine.

The long-term effects of vaping are not fully known. There is significant emerging evidence of the impact of vaping on oral tissues.

The main one is xerostomia or dry mouth which leads to taste changes as well as increased risk of tooth decay, tooth erosion (acid damage), tooth sensitivity, and gum disease.

This is primarily due to the propylene glycol (PG) and vegetable glycerine (VG) vapourising into acidic compounds that cause teeth to dissolve or erode. When the vapor combines with the added sweetened flavourings they can create a sticky residue that sticks to teeth increasing the risk of tooth decay.

The additives in vaping liquids can also cause discolouration on teeth.

Vaping may be seen as a way to quit smoking. Yet vaping may make it harder to quit smoking completely which increases the risk of diseases associated with tobacco use, such as mouth cancer.

Vaping and smoking and gum (periodontal) disease

Gum disease (also called periodontal disease) is caused by an infection that destroys the bone surrounding and supporting your teeth. Bacteria and food debris accumulated on teeth, in the form of dental plaque, causes gum disease if not removed daily.

The two stages of gum disease are gingivitis and periodontitis. Gingivitis is the early stage of gum disease, where the gum becomes irritated by the plaque. Periodontitis is the more advanced stage of gum disease, when that irritation starts to damage the structures that hold the tooth to the gum. Teeth may become loose, fall out by themselves, or a dentist may have to remove them.

Preventing tooth loss is important

It is important to prevent tooth loss. Losing teeth towards the back of your mouth can create problems with chewing food.

Losing teeth at the front of the mouth affects your ability to eat, your appearance, and can create problems with speech.

Teeth also play an important part in holding the shape of the lower part of the face.

Vaping and smoking increases gum disease risk

Vaping and smoking alters the blood supply to the gums, preventing the body’s immune system from fighting the bacteria that are present in the plaque on teeth. This makes the gum disease progress faster and less likely to respond well to treatment.

The risk of gum disease is higher with the level of nicotine consumed while smoking and vaping. The risk of developing severe infections associated with gum disease also increases, leading to a bad taste and a bad smell from your mouth as well as pain.

Will my gums get better if I stop vaping/smoking?

Yes. The good news is that people who quit smoking or vaping have the same risk of developing gum disease and responding to gum treatment as non-smokers.

Once you quit smoking, do not be alarmed if your gums bleed more. Seek treatment from a dentist or dental hygienist. They can also show you how to care for your teeth at home.

Smoking and symptoms of gum disease

If you smoke, it is important to see your dentist for regular check-ups. Symptoms of gum disease to watch for include:

• Red, swollen, tender, bleeding gums.
• Discharge (pus) coming from your gums.
• Gums that are loose and pull away from your teeth.
• A bad taste or bad breath.
• Loose teeth. This can change the feel of your bite when your teeth are placed together or make dentures fit differently.
• Spaces opening between your teeth.

Vaping/smoking and slow healing after dental treatment

Nicotine use makes it harder for the immune system to fight infections. This slows down healing after tooth removal or injuries in the mouth.

Vaping/smoking may lead to:

• Dry socket – a slow healing tooth socket after a tooth removal which is very painful.
• Increased pain after oral and gum surgery.
• Less success if you have dental implants.

Contact your dentist if you have any problems after dental treatment.

Mouth cancer and vaping/smoking risk

Mouth cancer (or oral cancer) is cancer of the mouth including the tongue, cheek, roof or floor of the mouth, and lips. Smoking is one of the main risk factors for mouth cancer.

More than 746 Victorians are diagnosed with mouth cancer every year.

People who smoke and drink alcohol have an even greater risk of developing mouth cancer than those who just do one or the other.

Eventually, those who have quit smoking or vaping have the same risk of developing mouth cancer as non-smokers, so it is never too late to quit.

Mouth cancer in people who smoke is most likely to occur on the side of the tongue, the floor of the mouth and lips. It can also happen in other areas of the mouth.

Early diagnosis is important so treatment can start as early as possible before the cancer advances or spreads to other parts of the body. Treatment for mouth cancer includes surgery, radiotherapy and chemotherapy.

Symptoms of mouth cancer

Please see your dentist or doctor immediately if you notice any:

• Persistent ulcer in your mouth or on your lip that does not disappear after 7 to 10 days, particularly if the ulcer is not painful.
• White or red patch in your mouth.
• Swelling in your mouth.
• Dentures suddenly not fitting properly.

Preventing teeth and gum problems

If you vape or smoke, there are some things you can do to prevent tooth and gum problems, including:

• Try to quit smoking and vaping – speak to your doctor, dentist or call Quitline for guidance and support.
• Clean your teeth and gums twice a day with a soft toothbrush and fluoride toothpaste.
• Use dental floss (for small gaps) or interdental brushes (for big gaps) once a day to clean between your teeth.
• Visit your dentist every 6 to 12 months. They can provide advice about the proper care of your teeth and gums at home and find problems early. Regular visits can help to keep your teeth and gums healthy.
• Avoid having a dry mouth. Drink plenty of water and chew sugar-free gum to stimulate saliva flow. This is especially important if you take medications that cause dry mouth.
• Limit alcohol and avoid recreational drugs.

Where to get help

• Your doctor
• Your dentist
• Quitline Tel. 13 7848 (13 QUIT).
• Australian Dental Association ‘Find a dentist’ or Tel. (03) 8825 4600.
• Oral Health Victoria provide dental services through the Royal Dental Hospital of Melbourne and community dental clinics, for eligible people. For more information about public dental services, Tel. (03) 9341 1000 or 1800 833 039 outside Melbourne metro.