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How does cigarette smoking affect the success and longevity of permanent tooth replacement options — bridges, crowns, and implants?

Cigarette smoking has some very well known and serious effects on the vital organs of our body [1]. Most people also tend to anecdotally link cigarette smoking with bad oral hygiene but few know the extent of the destruction this habit can cause to your pearly whites.

If you are a heavy smoker and thinking of getting permanent teeth replacement then you must be aware of the drawbacks and risks involved with various options.

Cigarette smoking And Dental Implants

There is a common misconception that, since dental implants are made of titanium and cannot get decayed, they are somewhat invincible. That is further away from the truth than you can imagine! While it is true that dental implants cannot become decayed like natural teeth can, they are equally, if not slightly more, susceptible to periodontal disease [2].

Cigarette smoking plays a huge role in the success of dental implants and can affect each and every stage of treatment. It is one of the recognized risk factors associated with failure of the dental implants [3].

This does not mean that dental implants are not successful in cigarette smokers or that dental implants should not be placed in smokers. It does, however, mean that all other things considered equal, a smoker is much more likely to suffer from dental implant failure than a non-smoker.

If you are a heavy smoker [4] then you must tell this to your dentist during the time of treatment planning. Depending upon the frequency of your habit, state of dentition, and oral hygiene, the doctor may even advise against getting dental implants altogether.

Cigarette smoking with a systemic condition such as poorly controlled diabetes is a double whammy and is considered to be one of highest-risk situations leading to failure of dental implants [5].

Smoking interferes with the initial healing, shifts the microbial colony from a health-promoting one to a disease-promoting one, affects blood flow to the supporting bone and depresses the immune response of the body to minor infections [6].

This means that smoking will continue to affect the health of the dental implants at all stages and throughout the life of the implants.

Another important thing that doctors consider when planning the treatment for smokers is the frequency of smoking. An occasional or light smoker may respond to treatment in much the same manner as a non-smoker, however, a moderate to heavy smoker will definitely have a much higher risk of failure [7].

Since the cost involved with dental implant treatment can be quite significant, we recommend moderate to heavy smokers to quit or at least reduce their habit or maybe even consider other forms of treatment that are not as affected by changes to the microbiota and immune system response.

Cigarette Smoking And Dental Crowns And Bridges

For heavy smokers or those who also have systemic conditions like diabetes to contend with, choosing dental crowns and bridges for permanent tooth replacement is an excellent idea. A crown or a bridge is supported by the teeth and as long as those teeth remain healthy, there is nothing much else that will cause this prosthesis to fail [8].

Yes, there is evidence that an increased amount of tooth decay and gum disease occurs in smokers. There is also evidence that this destruction takes place at an increased rate as compared to non-smokers [9]. That is true for all the teeth though and if the dentist finds that the supporting teeth have enough bone support to be able to withstand the increased chewing forces that come from the bridge then patients can go ahead with this form of prosthesis without any second thoughts [10].

Maintaining oral hygiene is something that can be done meticulously even if you are a smoker and that should be enough to take care of the health of the supporting teeth.

The risks involved for heavy smokers are much lower when dealing with crowns and bridges as compared to dental implants. Of course, if the supporting teeth do need to be removed for any reason then eventually the option of extending that bridge may not remain at all.


Permanent tooth replacement in smokers is less successful than in non-smokers. Every form of dental treatment is affected by smoking, although some will be affected slightly more than the others. In patients who are heavy smokers, unwilling to quit the habit or have a poorly controlled systemic disease in the mix as well, dental crowns and bridges are a more conservative and safer option to replace missing teeth when compared to dental implants. Some patients may still opt to go in for dental implants but they need to be aware of the increased risk of failure beforehand.

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