If you have come to talk with us about treatment for periodontal disease, oral surgery, placing implants, or other dental treatments that require a healing period, we have no doubt advised you to avoid smoking. If you're a smoker, you have probably heard this advice many times before. Perhaps knowing why we are giving the advice can help you follow through.

It is true that smoking contributes to cardiovascular disease, high blood pressure, and various cancers, but we want you to know about the negative impact that smoking has on healing, particularly in terms of dental treatment. Tobacco and tobacco smoke, even second-hand smoke, can really interfere with the tightly organized process that tissues go through during the healing process.

How Tissues Heal

The healing process goes through several stages, and the process is similar whether we are talking about a wound or a site of treatment. Sometimes the healing area is large enough that you can see this progress easily; at other times, the action may be on a microscopic level and too small to see.

First the area bleeds and clots, then the area mobilizes resources to fight infection, and finally the tissues rebuild themselves. To complete this process, the body employs a variety of cells and proteins, all of which must do their jobs in a particular order and at a particular time for the wound to heal properly. Unfortunately, tobacco can interfere with each of these stages.

How Tobacco Interferes with Healing

In the first healing stage, platelets, which are blood cell fragments, stick to each other and to rough areas in the wound to form a blood clot, which plugs any leaking blood vessels. Cigarette smoke can cause platelets to become excessively sticky, and this increases the chance that an abnormal blood clot will form. Smoking can also prevent oxygen from being transported from cell to cell. This slows healing because oxygen provides energy for the repair process.

Then, during the infection-fighting stage of healing, the nicotine in tobacco reduces the formation of macrophages, which are special white blood cells that remove bacteria and dead tissue from the healing area. Here, too, the lack of oxygen slows healing because oxygen helps kill anaerobic bacteria that may be infecting the area. This can be particularly damaging when we're treating gum disease because some of the bacteria that are active in causing gum disease are the anaerobic type.

In the rebuilding stage, when new tissues are supposed to form, tobacco slows the body ability to form new blood vessels. Tobacco also reduces the formation of fibroblasts, which are cells that help build the protein framework for the new tissue. Smoking also stimulates the formation of chemicals that slows down the formation of the new epithelial cells that will form the outer layer of the new tissue. Interfering with these last two aspects of new tissue formation can also lead to excess scar tissue.

Tobacco and Dental Treatment

You can see why, when you are receiving treatment for oral conditions, it is important not to use tobacco. Here are just a few examples of how tobacco interferes with oral healing:

(1) Periodontal (gum) disease and tooth loss:

During the early stage of any infection, the body tries to fight it off by bringing a variety of disease-fighting cells and nutrients to the area through the bloodstream. Since smoking interferes with blood flow to the mouth, periodontal disease, which is a bacterial infection, is much more likely to establish itself around the teeth, gums, and jawbone. Periodontal disease is also the most frequent cause of tooth loss in adults, and tooth loss is much more common in smokers than non-smokers.

(2) Periodontal disease treatment:

Periodontal disease causes the gum tissues to pull away from the teeth and the jawbone to recede. Smoking makes it much harder for these tissues to rebuild themselves, particularly the structures that keep the teeth attached to the jawbone and the gums attached to the teeth.

(3) Implants:

For implants to heal successfully, the jawbone must grow tightly around the implant to firmly integrate it into the jawbone. Since tobacco can interfere with healing, smoking can often lead to implant failure.

(4) Dry socket:

After a tooth is extracted, a blood clot forms in the socket, and this is crucial for both proper healing and your comfort. A condition called dry socket develops when the clot does not form correctly or is dislodged, and this can be very painful. Smoking is a common cause of dry socket.