Tobacco and Dental Implants
Tobacco has been long recognized as a significant health hazard. Cigarette smoking, in particular, has been implicated with several cancers including oral, lung, and bladder. Additionally, smokers have a much higher incidence of hypertension, coronary artery disease, pulmonary infections, and emphysema. In fact, children that live in smokers’ households have a 8 times greater incidence of presentations to the emergency room with respiratory problems than children of nonsmokers. Cigarette smoking also greatly influences oral health and has particular effects on the success rates and health of dental implants.
Most patients assume that this has to do with the irritating effects of the smoke itself in the oral cavity, but, in fact, the problem goes much deeper. It is well recognized that smokers have very poor small and terminal blood supply. It is for this reason that smokers often have cold fingers due to loss of blood vessel supply to those areas. But this small blood vessel loss also affects every area of the body including the skin and jaws. It is well recognized that the skin of smokers ages prematurely and this has to do with the lack of small blood supply to repair the damage produced by sun and aging.
Face-lifts and other facial cosmetic procedures in smokers are often contraindicated due to the unpredictable healing in these patients. The problem from the nicotine and other vasoconstrictive chemicals found in cigarette smoke that are absorbed in the lungs and that cause constriction particularly of the small blood vessels. This effect can last for hours after a single cigarette and when someone smokes multiple cigarettes a day, the chronically constricted vessels quickly atrophy and disappear. For this reason, the nicotine patch is not an appropriate substitute for smoking during the time of implant treatment.
The effects of this poor blood supply are especially noted at implant interfaces where that blood supply is called upon to promote bone ingrowth into the surface of the titanium implant. Although statistics vary with regards to implant failure rates in smokers, in general, implant failure rates in one-pack per day smokers can range from 10-30%. This means roughly that for every four implants placed, at least one can fail. In fact, cutting back smoking does not appear to help because the small blood vessel supply does not reappear as long as someone is smoking even to a small degree. A prudent measure to assure a blood supply that is comparable to that of a non-smoker’s is to have a patient completely discontinue smoking for three months prior to implant placement.
If a patient, after counseling, is simply unwilling or unable to quit smoking, implants may still be offered. In that instance, additional informed consent is obtained and the patient will sign a waiver in which he or she expresses their understanding that they recognize that their smoking can increase the failure rate of their implants throughout their lives.
Smoking is a terrible health problem in this country. We as dental professionals have the opportunity to educate our patients regarding the substantial health hazards of smoking. In the state of New York, it is now the law that physicians must discuss the hazards of smoking and offer some options to help the patient quit their habit. Failure to do so can result in action against the physician by the medical board.
Previous studies have shown that many physicians and dentists routinely do not address the hazards of tobacco use with their smoking patients. We have a tremendous obligation and responsibility to point out to our patients these health risks, and we are in a unique position to do so. Doing so may not only add years to their lives, but also add life to their years!