The effects of tobacco use on oral health.

OBJECTIVE To review the effects of tobacco use on oral health, with particular emphasis on the effects of periodontal diseases, dental implant failures, and risk of development of oral cancers and precancers. DATA SOURCES Medline literature search (1977-2002). STUDY SELECTION Key words for the literature search were 'tobacco smoking', 'periodontal disease', 'dental implant', and 'oral cancers and precancers'. DATA EXTRACTION Evidence-based literature review. DATA SYNTHESIS The prevalence and severity of periodontal diseases in their various forms are higher among smokers than among non-smokers. The success of dental implant treatments is significantly influenced by addiction to tobacco smoking. The failure rate of implant osseointegration is considerably higher among smokers, and maintenance of oral hygiene around the implants and risk of peri-implantitis are adversely affected by smoking. The risks of developing oral cancers and precancers are greater in smokers. Betel nut chewing and smokeless tobacco produce similar risk to cancer incidence as tobacco smoking. Cessation of tobacco use has a beneficial effect on halting the progression of periodontal diseases and on the outcome of periodontal therapy. CONCLUSIONS Medical and dental teams should be aware of oral problems associated with tobacco use. Counselling on smoking cessation and smoking prevention programmes should be an integral component of medical and dental teaching and practice.