Triple M's Hot Breakfast

Media item: radio segment

Programme: Triple M's Hot Breakfast, Melbourne

Date broadcast: 31 March 2014

This page records the media item. The audio is the property of the broadcaster and is not reproduced here, and no individual is identified.

What follows is general information on one of dentistry's most consequential modifiable risk factors, and its newer relative: smoking, and vaping.

What smoking does to the mouth

Smoking is a major risk factor for periodontitis — one review of the disease puts it that smoking “significantly increases risk for periodontitis and severity of the condition” — and it is a leading cause of the two worst things that happen in a mouth.

Gum disease

Smokers have more periodontitis, more severe periodontitis, and lose more teeth to it. See What is gum disease? and Periodontal (gum) disease.

And the mechanism includes a genuinely dangerous trap: smoking masks the disease. Nicotine constricts blood vessels, so smokers' gums bleed less. Bleeding on probing is the earliest and most reliable warning sign of gum disease, and in a smoker it is suppressed.

So periodontitis in a smoker is routinely more advanced than it looks, and it is discovered later. The practice's page on the warning sign itself is at Bleeding Gums, and When do you need deeper cleaning? covers what treatment involves.

Treatment also works less well. Smokers respond less to periodontal treatment, heal more slowly after it, and relapse more often — which is one reason advanced cases are referred to a registered specialist periodontist (Specialist Periodontists).

Oral cancer

Tobacco use and alcohol consumption are both established risk factors for oral cancer, and together they matter more than either alone. The Victorian Government's own patient advice is that checking for signs of mouth cancer is “especially important for those who smoke or regularly drink alcohol, and even more so for those who do both”. See Oral cancer: signs, risk factors and how your dentist can help and What are the causes, symptoms and treatment of mouth cancer?

Smokeless tobacco, betel quid and areca nut carry their own well-established risks, and are used in some communities in Australia.

The rule that saves lives: any ulcer, white patch, red patch or lump that has not healed in three weeks needs examining. Early oral cancer is far more survivable, and it is frequently painless at the stage it is most treatable — Oral cancer: how your dentist can help with early detection and The cause of mouth ulcers and their usual treatments.

Everything else

• Implant failure rates are substantially higher in smokers. Many practitioners will discuss this frankly before agreeing to place implants — What do I need to know about dental implants?
• Healing after extractions is slower, and smoking is among the clearest controllable risk factors for dry socket — I've just had oral surgery: what can I expect during recovery? and How long does it take to recover from wisdom teeth surgery?
• Staining, of teeth and of restorations, which whitening only partly addresses — How can I improve the whiteness of my teeth?
• Bad breath, both directly and through the gum disease — see Bad Breath and What causes bad breath and how can I fix it?
• Dry mouth, which accelerates decay — My mouth is always dry and The stages of dental decay
• Reduced taste and smell.
• Smoker's melanosis and other mucosal changes.
• Nicotine stomatitis, from pipe and heavy smoking.

Vaping

A newer question, and it deserves a straight answer rather than either alarm or reassurance. The article is The effects of vaping on your oral health, and there is an older one at Are e-cigarettes bad for my teeth?

What is established:

• Vaping is not harmless. The evidence on oral effects is still developing, but studies have reported gum inflammation, dry mouth, and changes to the oral microbiome in people who vape.
• The aerosol is not water vapour. It contains propylene glycol and glycerine — both humectants, which dry the mouth — plus flavourings and, in nicotine products, nicotine, which constricts blood vessels exactly as it does in smoking.
• Sweet flavourings and dry mouth together are a decay risk, and reports of decay patterns in heavy vapers have appeared — How does sugar affect your dental health?
• Nicotine is nicotine. Its effects on gum blood flow and on healing do not depend on how it is delivered.
• Devices have caused injuries, including burns and facial trauma from battery failures — Emergency Dentistry.

What is not established: the long-term cancer risk. Vaping has not existed long enough for that evidence to exist, which is a reason for caution rather than reassurance.

Australian regulation has changed substantially. Access to vaping products, particularly nicotine vapes, is regulated and has been tightened. Check current requirements with the TGA or the Victorian Department of Health, because the rules have moved repeatedly.

The honest clinical position: for an adult smoker who cannot stop any other way, regulated nicotine replacement or a supervised approach is preferable to continuing to smoke. For someone who does not smoke — particularly a young person — there is no version of this that is a good idea, and Australian regulators have been explicit about the youth uptake problem.

What happens when you stop

This is the part worth knowing, because it is genuinely encouraging. Health problems linked to poor oral hygiene and Dental health and general wellbeing put it in a wider frame.

• Bleeding gums may appear or worsen in the first weeks. This is not a bad sign. Blood flow is returning, and the inflammation that was there all along becomes visible. It settles as the gums heal.
• Periodontal treatment starts working better. Former smokers respond substantially better than current smokers.
• Healing after extractions and surgery improves.
• Implant success rates improve.
• Oral cancer risk falls over time, though it does not return immediately to that of a never-smoker.
• Taste and smell return, often within days to weeks.
• Staining can be removed, and stops recurring — Dental Cleans and Hygienists.

Dental practitioners are well placed to raise this — they see the mouth several times a decade and can show you the consequences directly, on your own radiographs (how safe are dental x-rays).

Support in Australia:

• Quitline: 13 7848 (13 QUIT) — free, confidential, evidence-based, and available in multiple languages
• Your GP, for nicotine replacement therapy and prescribed options
• A pharmacist, for over-the-counter nicotine replacement

Behavioural support and pharmacotherapy used together are more effective than an unassisted attempt, which is why Quitline and a GP are worth using in combination rather than one or the other.

And tell your dentist

Not for judgement — for the clinical consequences. Smoking status changes:

• how the gums are assessed, and how much to distrust the absence of bleeding
• the recall interval — how often should I go to the dentist?
• whether implants are advisable
• what to expect after an extraction
• how carefully the soft tissues are examined at every visit

And if you have stopped, say that too, including how long ago. It changes the picture.

Related pages: Bleeding Gums, Specialist Periodontists, General Dentistry, More than healthy teeth, Meshel & Tommy Show: Tommy talks wisdom teeth, and the rest of the media record.

Common questions

If my gums look fine, why does smoking still matter?

Because how gum disease looks is a poor guide to what it is doing, and smoking makes that worse. A review of periodontitis describes it as “a highly prevalent, but largely hidden, chronic inflammatory disease” in which, early on, “the condition is typically asymptomatic; it is not usually painful, and many patients are unaware until the condition has progressed enough to result in tooth mobility”. The destruction is “largely irreversible”. The same review names smoking as a major risk factor that “significantly increases risk for periodontitis and severity of the condition”. So the check that counts is the probe and the radiographs, not the appearance — and in a smoker, doubly so.

How survivable is oral cancer? The figures I find disagree.

They do, and the disagreement is mostly about what is being counted. A Royal Australian College of General Practitioners paper states that “oral cancer has a relatively low five-year survival rate, at around 50%, mostly due to diagnostic delays”. Cancer Council Victoria, using Victorian Cancer Registry data to 2025, reports that five-year relative survival for oral and oropharyngeal cancer in Victoria rose from 61% in 1983–87 to 75% in 2018–2022 — a broader disease group, one state, a recent period. What both agree on is the lever: an Australian study found an average diagnostic delay of about four months between symptom onset and first histological diagnosis.

What am I actually looking for, and how long is too long to wait?

The threshold is shorter than most people assume. The RACGP's guidance is that anyone reporting “unexplained and/or non-healing changes or symptoms in the mouth for more than two to three weeks (eg a persistent ulcer, red patches, lumps, a sore throat, or erythematous or speckled lesions)” should have an oral cancer screen; Better Health Channel puts it at an ulcer lasting “longer than 2 weeks”. The trap is that “initial lesions of oral cancer are generally painless”, so nothing prompts the visit. The highest-risk sites are the lateral margins of the tongue and the floor of the mouth — check under the tongue, not just the front.

Besides smoking, who is at raised risk?

The RACGP lists age over 45 (especially men), tobacco use, alcohol consumption, areca (betel) nut chewing — which it describes as “a growing trend in Australia” — and limited access to dental care. It advises risk-based screening case by case from 45 and for current or past users of alcohol, tobacco or betel nut. One figure cuts against assumptions: Cancer Council Victoria's 2018–2022 data records the highest age-standardised incidence, 26 per 100,000, in males born in the Australia and New Zealand region, and the lowest, 10.5, in males born in Southern and Central Asia. Risk tracks behaviour and access, not origin.

Does smoking change whether implants are worth doing?

It changes the odds at the stage that matters most. A meta-analysis of early implant failure concluded that the significant risk factors were “smoking habits, implants shorter than 10 mm, and implants placed in the maxillary region” — that is, failure before the crown is even fitted, during osseointegration. A 2020 analysis found early failures were approximately twice as common as late ones. So the risk is front-loaded into the surgical and healing window, which is also the window a period of stopping can most affect. Raise it before the plan is made, not after — it may change the sequence or the timing.

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. Directions are on Location; enquiries go through Contact Us.

Every practitioner's registration can be verified free on the AHPRA public register at ahpra.gov.au.

This page records a broadcast and its date, with general information. It is not a diagnosis or a treatment plan, and it is not advice about any specific smoking cessation product. Regulation of vaping products in Australia changes; confirm current requirements with the TGA or the Victorian Department of Health. No individual's clinical information is published here. Third-party broadcast content is not reproduced.

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