1. Oral Manifestations of Tobacco use

2. Oral Manifestations
Tobacco smoking is one of the most significant risk factors for periodontal disease.
Smokers have greater loss of attachment, bone loss, periodontal pocket depths, furcation involvement, dental calculus formation, and tooth loss than nonsmokers.
Surgical and nonsurgical interventions are less effective in those who smoke, and disease recurrence is more common than in nonsmokers.
The effects of smoking on the periodontium are evident at an early age, usually beginning at age 20 to 30.

3. Oral Manifestations
The negative effects of smoking on the periodontium are linked with an altered host response, pathogenic bacterial composition, and direct local (heat and chemical) damage to periodontal tissues.
Immunosuppressive effects result from decreased salivary antibodies and impaired neutrophil functioning.

4. Oral Effects of Tobacco Use
Oral and pharyngeal cancers
Chronic periodontitis
Failure of periodontal therapy
Failure of dental implants
Dental caries
Tooth abrasion
Stain
Calculus
Attrition
Halitosis
Impaired taste and smell
Delayed wound healing or dry socket
Hairy or coated tongue
Nicotine stomatitis
Oral leukoplakia
Xerostomia
Recession and LOA

5. Periodontal Effects
Clinically, smokers exhibit gingiva that is thickened and fibrotic with rolled borders and minimal redness. 
Smoking masks gingival inflammation by reducing gingival blood flow as a result of constriction of blood vessels of the gingiva.

6. Necrotizing Ulcerative Periodontitis Darby
Acute necrosis and ulceration of the interproximal papillae
Pseudomembrane - collection of debris, dead cells, and bacteria on the gingival surface that appears gray
Other symptoms include pain, bleeding, and cervical lymphadenopathy, odor and fever
Also caused by other conditions

7. Nicotine Stomatitis Benign lesion on hard palate
Increase in keratinization, raised red dots are seen at the openings of the ducts of the minor salivary glands on the palatal surface
Due to the effect of heat on the palatal mucosa

8. Smoker’s Melanosis
Melanin pigmentation is associated with smoking, and the intensity is related to the amount and duration of smoking. The pigmentation fades when smoking is discontinued. However, this may take months to years.
The anterior labial gingiva is the most commonly affected site. 
Woman are affected more frequently than men

9. Black Hairy Tongue
Clinical features—brownish to black appearance on the dorsal surface of the tongue 
Due to elongation of filiform papillae from irritation or inflammation
Also caused by other conditions

10. Leukoplakia
Also known as smokeless tobacco keratosis or tobacco pouch keratosis, in the area where the tobacco is habitually placed.
The mucobuccal fold is the most common location. The epithelium usually has a granular or wrinkled appearance in early lesions.
Long-standing lesions may be more opaquely white and have a corrugated surface

11. Content Sources
Darby ML and Walsh MW. Dental hygiene: theory and practice. 4th ed. St. Louis, MO: Elsevier; 2015.
Ibsen OAC and Phelen JA. Oral pathology for the dental hygienist. 6th ed. St. Louis, MO: Elsevier; 2013.