Smoking and dental implants

If you are considering dental implant treatment to replace your missing teeth, a question you can expect your dentist to ask is, ‘do you smoke?’  We are all familiar with the effects of smoking on general health.  It is one of the biggest causes of death and illness in the UK.  According to the NHS, every year around 78,000 deaths in the UK are attributed to smoking, with many more people living with smoking-related illnesses.*  These include coronary heart disease, stroke, pneumonia and various cancers.

Many people don’t appreciate the damage that smoking has on oral health.  It can lead to tooth staining, gum disease, tooth loss and, in more severe cases, mouth cancer.  Tobacco can also negatively affect dental implant treatment.  It impacts on healing, osseointegration (fusion with the jawbone) and the maintenance of oral hygiene around the implants.


Can I have dental implants if I smoke?

You may be able to have dental implant treatment if you are a smoker.  But not everyone will be eligible.  Your implant dentist will decide if you are a candidate. 

Smoking can adversely affect the success of your implants.  Your dentist may encourage you to stop smoking completely or to significantly reduce the amount you smoke, before starting implant treatment.  Many dentists advise that you should cut the number of cigarettes to less than 10 a day.  If you are a heavy and long-time smoker, some dentists may even refuse to treat you.  It is important that your dentist conveys all the possible complications of having dental implant treatment if you are a smoker.  They will need your informed consent before starting treatment.

Dr Onkar Dhanoya, principal dentist at Honour Health, Newcastle Upon Tyne comments, “When planning dental implant treatment, I recommend that my patients stop smoking three months prior to implant placement.  In my opinion, there is no ‘safe’ number of cigarettes, either before the treatment or afterwards.”

Certain measures can be taken to improve the success of your treatment.  After a thorough review of your dental problems, medical history and your smoking and social habits, the dentist will make a full assessment of your mouth and check the health of your remaining teeth.  To ensure the best possible outcome, it is vital that your oral hygiene is good, and your gums are healthy.  Any pre-existing oral health issues, such as periodontal (gum) disease or plaque must be treated and under control.

Dr Steve Larcombe, Principal Dental Surgeon at Winchester Dental Implant Centre explains, “I have patients who are smokers with implants still in function after 20 years.  I always advise my patients, that if they can’t stop smoking completely, they need to cut down to below ten cigarettes a day, for three months before treatment commences.”

Smoking and bone grafts

One of the key requirements for dental implant treatment is having enough bone in your jaw.  A solid, reliable base is needed to anchor the implant.  If your bone volume needs to be increased, you may be able to have it built up.  A successful bone graft allows your jaw to be strong enough to support dental implants.  Cigarette smoking may adversely affect healing and jeopardise the success of bone grafting and subsequent dental implant placement.

How does smoking affect dental implants?

Smoking is one of the major causes of tooth loss and may have contributed to the reason you now need dental implants.  It also restricts healing dramatically.  Nicotine in smoke constricts blood vessels and reduces blood flow and oxygen to the soft tissues, which can affect the immune response.  This slows the process of healing and impacts on the long-term health of gum and bone.  Smoking impairs osseointegration and increases the risk that implants may not heal properly after they are placed, making them more likely to fail over time.

Dr Onkar Dhanoya explains, “I strongly advise that patients refrain from smoking altogether after the placement of their implant(s).  There is a much higher rate of implant failure for patients who smoke, compared to non-smokers.”

The smoke you inhale may burn the tissues in your mouth.  Over time, this thickens the top layer of skin cells and produces keratoses (scaly patches of skin), that can damage or block salivary glands.  Saliva is needed to wash away plaque and acid, which can damage the gums and bone supporting your implants.  The lack of saliva can also lead to a dry mouth which can promote bacteria. 

How long should I wait to smoke after dental implant treatment?

You will be given instructions by your dentist explaining how to look after your mouth immediately after treatment.  It is important to refrain from smoking for as long as possible.  To allow healing and early osseointegration, it would be beneficial not to smoke for at least three months after the implants have been placed.  Waiting this length of time before having a cigarette will be difficult for some patients and you should discuss and agree timescales with your dentist.

Dr Greg Theodorou, W Dental Smile Studio, Woodley, Reading adds, “I encourage implant patients to give up smoking completely.  However, if this is not possible, then I recommend that patients cut down to half the amount they are smoking.  I advise them not to smoke, if possible, after their treatment.”

In the days immediately after implant treatment, you must avoid rinsing your mouth and try not to touch the surgical site with your tongue or fingers.  This may cause bleeding by dislodging the blood clot that has formed.  Don’t spit, suck on straws or smoke.  This can disturb blood clots and slow down the healing process.

Smoking and dry socket

If you smoke and are due to have a tooth extracted, possibly before having a dental implant placed, you need to be aware of the risk of ‘dry socket'.  This is a painful dental condition that can sometimes occur after you have a permanent adult tooth removed.  Dry socket is when the blood clot at the site of the tooth extraction fails to develop or is dislodged before healing.  The blood clot acts as a protective layer, covering the underlying bone and nerve endings.  It also helps with the growth of new bone and soft tissue.

Smoking and using other tobacco products increase your risk of dry socket.  Chemicals in tobacco products may prevent or slow down healing and infect the surgical site.  The physical force of sucking on a cigarette can also dislodge a blood clot prematurely.  Exposure of the nerves and bone can result in intense pain and leaves the socket open to food debris and bacteria.

Are e-cigarettes harmful to tooth implants?

E-cigarettes have been marketed as the safer version of traditional cigarettes.  However, the full health effects of e-cigarettes on the body are not known.  E-cigarettes contain a small heating unit that vaporises liquid.  No smoke enters the mouth, but a steam containing nicotine and other chemicals is inhaled.  Commonly reported side effects of e-cigarette use are mouth and throat dryness and irritation.  These factors do not help the healing process after dental implant treatment and may create an environment that encourages tooth decay.

A review published in August 2015 by Public Health England found that e-cigarettes are 95 per cent less harmful to health than tobacco and a major influence in helping people quit smoking.

Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE states, “There has been a major trend recently towards the use of e-cigarettes, and they are now the number one quitting aid used by smokers.  Getting smokers to use safer forms of nicotine such as these can be highly effective in helping people to quit and is something which we fully support.  We need to spread the message that e-cigarettes, while not risk free, are much less harmful than smoking, as currently nearly half the population are not aware of this.”

How to take care of your dental implants when you smoke

If you have dental implants and continue to smoke, you will have to pay closer attention to your oral health and implant maintenance.  Smoking can cause gum disease to accelerate faster.  Smokers can also be more susceptible to dental plaque.

Neglected implants develop plaque and tartar and can also be affected by bacteria, which may result in gum disease.  Left untreated this can lead to peri-implantitis, which is comparable to periodontal disease around natural teeth.  The condition is likely to cause soreness, bleeding, general discomfort and eventual bone loss around the implants.  Both natural teeth and dental implants depend on healthy surrounding tissues for support.

You should aim to clean around each implant twice a day.  You should brush all the surfaces of the implant tooth, or teeth that you can access with a conventional toothbrush, either manual or electric.  For the surfaces you can’t reach, floss, or an interproximal brush and/or an oral irrigator device may be used.

One of the effects of smoking is staining on the teeth due to the nicotine and tar in tobacco.  Patients who smoke and have dental implants should avoid the range of toothpastes on the market that contain excessively abrasive ingredients.  Baking soda, stain removers and smoker’s toothpastes can create wear on acrylic and can remove the glaze on porcelain.

Dr Onkar Dhanoya adds, “I advise my dental implant patients to avoid abrasive toothpastes, as they can damage the implant surface.  In fact, I recommend all my patients avoid these types of toothpastes, which can cause harm to the enamel.”

Regular check-ups and visits to the hygienist are a very important part of maintaining the health of your dental implants.  For the first few months after your implants have been placed, your dentist may ask to see you more frequently.  You may be referred to a dental hygienist for extra treatment, thorough cleaning and to keep a closer check on the health of your mouth.

The best thing you can do for the longevity of your dental implants and overall health, is to give up smoking completely.  This is not an easy option for many people, but the right support and planning can help you to kick the habit.

If you are a smoker and want dental implants, it's worth talking to a dentist to get their advice.  Book a free, initial consultation with your local implant practice.

This article was written with advice from:
Dr Onkar Dhanoya
Dr Steve Larcombe
Dr Greg Theodorou