Dr Nigel Jones is based in Abergavenny and has treated Olympic silver medal winning cyclist Becky James, Swansea City players and members of the Ospreys rugby team.
As president of the British Society for Advanced Dentistry, he is one of the UK’s leading authorities on dental implants. He told ASH Wales about the impact of smoking on dental health, how it affects implants and why giving up works wonders for teeth.
What are the main ways in which smoking effects your dental health?
The main way in which smoking affects dental health is that nicotine reduces blood-flow within existing blood vessels, and the formation of new blood vessels. If we think of blood as being the carrier of nutrients and oxygen around our bodies to maintain health, then reducing blood flow by about two-thirds (which smoking does), means that the body has no reserves of oxygen and nutrients when under stress. It would be a little like tripling the size of Abergavenny without improving water supplies, sewerage, or energy production. Smokers take three times as long to recover from wounds, and therefore have three times as many infections. Major studies by Bain in 2002 and Albreksson in 2015 demonstrate that smokers have two to three times as many dental-implant failures as non-smokers. They also have the same failure rates with gums around natural teeth.
In your experience is there enough awareness among patients about the harmful effects of smoking on their dental health?
We have many sorts of studies in medicine, and one of the most reliable is the cohort study where a group of patients is studied for many years to see the long-term outcome of medication or life-style choices. The first big cohort study published in the 1960s looked at the effects of smoking in British doctors. It was this study that established the link between smoking and lung-cancer. I think that as with excessive alcohol consumption and obesity, most people are aware of the dangers, but choose to believe that in some way they will be immune. After all the visual warnings on packs of cigarettes are stark, but people still buy them.
Once smokers stop smoking, does dental health improve?
If smokers quit, then yes their oral health improves. Blood-flow increases along with the ability to grow new blood vessels faster in a number of months as the effects of nicotine wear off. The ‘sludging’ of the blood vessels due to the more sluggish blood flow in smokers can take two years or more to reduce, and so we need people to have stopped smoking for two years in order to offer guarantees on dental-implants. Of course, some smokers swap smoking for other habits such as sucking sweets, and so may see an improvement in the health of their gums, but increased tooth-decay.
What treatments are available if any, to repair the damage to smokers’ teeth?
Fastidious brushing and cleaning of teeth will prevent the build-up of plaque which causes the wounds at their gum edges, thereby reducing the incidence of infections and the need for repair. It’s a bit like owning a car when you live on the coast, you have to be much more careful to remove salt from the underside of the car to prevent rust.
Can you tell us about how smoking affects the healing process following a dental implants procedure?
As above, smokers heal at a third of the rate of non-smokers, and therefore have three times as many infections. We try to lessen the effects of smoking by burying the implants, and not immediately putting temporary teeth onto them, but it’s still a more risky procedure.
What advice would you give to smokers who are hoping to have dental implants?
It’s a bit like someone wanting to buy an all-electric car with the same range as a diesel car. It can’t be done. You either accept the increased risks posed to dental implants by smoking and the responsibility for fastidious cleaning; or you give up smoking.