Treatment Options for Tobacco & Nicotine Damaged Teeth

According to the Global Adult Tobacco Survey India, ” Nearly 267 million adults (15 years and above) in India (29% of all adults) are users of tobacco, according to 2016-17.” It’s increasing year by year.
India ranks no. 1 in raw non-smoking tobacco consumption and ranks high in consumption of nicotine-related products. Tobacco is the main culprit for poor oral hygiene. Tobacco not only affects teeth but also impacts gingival & mucosal health.
Long-term use of nicotine and tobacco leads to wear and tear of teeth, pre-cancer conditions like oral submucous fibrosis, lichen planus. Oral cancer of the tongue, mucosa lips. 5% of total cancers are oral cancer. And it is life-threatening/fatal. The use of tobacco is rampant in small towns and villages. Smoking of tobacco is aggressive in cities.
Both forms of tobacco are equally hazardous. And there is an urgent need for more awareness regarding tobacco consumption and its effects on human beings.

Effects of tobacco chewing:-

Raw tobacco is usually chewed with areka nuts and bettle nut.. this combination is extremely addictive and affects oral mucosa, teeth, and surrounding soft tissues. It is a known carcinogenic substance and long-term usage leads to cancer.
It Erode teeth causing sensitivity and loss of tooth structure. It stains & discolors teeth and poor oral hygiene. The tobacco and bettle nut combination burns mucosa and soft tissue which leads to ulcerations. Burning sensation of mouth.

Effects of smoking tobacco:-

Cigarette and bidi smoking is more dangerous than chewing tobacco. It not only damages the oral cavity but also impacts the lungs severely. Temp of smoke is usually between 120-150 degrees. This smoke when inhaled burns mucosa and palate. Smoke particles deposit on teeth causing stained teeth. Long-term Smoking cigarettes/ bidi leads to lung cancer in many cases.

Treatment of teeth and oral cavity in tobacco addicted individual

  1. Encouragement to stop the tobacco usage

As a doctor of the oral cavity, the dentist should encourage, advise and recommend, complete stoppage of tobacco habits in an individual.

2. Clinical examination of worn-out teeth, Evaluation of loss, and analysis of different treatment modalities is the first step in treatment.

3. If there is a loss of vertical dimensions of jaws due to worn-out teeth, then full mouth rehabilitation is necessary to facilitate the complete restoration of function as well as aesthetics for the patient. It is a very extensive treatment, takes a few weeks to months to complete. Patient cooperation is a must. In this treatment, we restore the height of teeth with facebow, centric relations, protrusion records.
Followed by temporary crowns for a few weeks. Once the patient adopted the new set of teeth. We replace them with permanent teeth.


4. Sometimes patient is unable to open the mouth completely and unable to eat spicy food. This happened due to oral submucous fibrosis. A precancerous condition where muscles of the cheek become hard and fibers from inside muscles.
It is a severe condition and the patient is unable to open his mouth completely. Treatment includes injections of steroids in stiff fibers. Mouth opening exercises.

5. Stains and calculus over teeth is very much common in tobacco chewing. It is removed with plain scaling and root planing.

6. Erosion and attrition of teeth due to grinding of hard beetle nut with tobacco is also seen. This leads to loss of tooth structure and pain sensitivity. Treatment includes root canal treatment of affected teeth followed by crowns.

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