Qhen you think about the harm of smoking, the lungs, heart or skin immediately come to mind. Much less often the mouth. Yet it is precisely there that tobacco can leave some of the deepest and most silent damage: gums that recede, teeth that lose support, wounds that heal more slowly and, in some cases, injuries that should never be underestimated. On the occasion of World No Tobacco Day on May 31stThe Dr Massimiliano Readentist at the ERREESSE Dental Medical Clinic in Ferrara, draws attention to an aspect that is still little considered: the link between smoking, oral health and the risk of precancerous lesions.
Smoking changes the bacteria in your mouth even before symptoms appear
According to the most recent research, the tobacco modifies the oral microbiomei.e. the set of bacteria present in the mouth, favoring a more aggressive environment for the gums and tooth support tissues. Some studies show that in smokers even apparently healthy areas already present bacterial alterations similar to those observed in people with advanced periodontal disease.
And there is a counter-intuitive detail: smoking can reduce gum bleeding. That is, the mouth may appear less inflamed than it really is.
Periodontitis and tooth loss: the risk increases by up to 85%
«The first big problem is the periodontitis» explains Dr. Rea. «A chronic inflammation that progressively destroys the gum, ligament and bone around the tooth».
The scientific literature is now very clear. A systematic review published in 2023 estimates that smoking increases the risk of periodontitis by approximately 85%. As the disease progresses, the risk also becomes that of losing teeth. A 2026 meta-analysis showed that active smokers have a risk of tooth loss that is approximately 41% higher than non-smokers. «Smoking», underlines Rea, «does not only ruin the color of the teeth, but slowly demolishes the entire masticatory system, piece by piece».
Slower healing after implants and extractions
The tobacco also affects the healing ability of tissues. After a tooth extraction, gum surgery or the insertion of an implant, smokers tend to recover more slowly. The reason is mainly linked to the reduction of tissue oxygenation and the alteration of repair mechanisms. Scientific literature from 2024 confirms that the damage caused by smoking on post-operative healing is well documented, even if there is not yet a definitive consensus on the ideal time to stop smoking before oral surgery. Even heated tobacco products don’t seem completely harmless. In fact, some recent experimental studies suggest that they can slow down the activity of gingival fibroblasts, the “worker cells” involved in tissue healing.
The white or red spots that should not be ignored
The most delicate chapter, however, concerns precancerous lesions of the oral cavity. The best known are the leukoplakiawhich appears as a white patch, and theerythroplakia, which instead presents with reddish areas of the mucosa. These are not always tumors, but they are alterations that require medical attention.
A study published in JAMA Otolaryngology observed that approximately 8.4% of leukoplakias evolved into oral cancer. For erythroplakia the observed risk was even higher, reaching 50% in the small groups analyzed. According to a 2025 meta-analysis, the risk increases especially when the lesions are large, irregular, located on the edge of the tongue and in smokers.
The message, therefore, is simple: a white or red spot that does not go away should not be “kept an eye” alone in front of the mirror for months. It needs to be evaluated.
Quitting smoking really helps your mouth too
The good news is that stopping smoking also produces concrete benefits for oral health. Research shows that quitting progressively reduces the risk of tooth loss and also lowers the risk of mouth, throat and laryngeal cancers. According to data from the American CDC, within 5-10 years of cessation the oncological risk can be halved.
“If you smoke and notice receding gums, teeth that move, wounds that don’t heal well or persistent stains on the oral mucosa, don’t wait,” concludes Rea. «In dentistry, arriving first can mean saving a tooth. Sometimes much more.”