Bone is what holds your teeth in, and what holds an implant in. Smoking wears it away faster.
When people think about smoking and teeth, they think of staining. The bigger issue is underneath: the bone that supports your teeth. Once you lose it, it doesn't come back, and that matters whether you're keeping your own teeth or replacing them.
Smoking and Your Own Teeth
Your teeth are held in by bone and gum. Gum disease (periodontitis) breaks that bone down, and smokers are more likely to develop it, tend to get it more severely, and often respond less well to treatment. Because smoking also dampens the bleeding that would normally warn you, the bone can be disappearing for years before anything feels wrong. We covered that in an earlier post.
Smoking and Implants
An implant relies on bone growing around it and staying healthy afterwards. A large systematic review and meta-analysis, covering around 150,000 implants, found that implants in smokers failed at more than twice the odds of implants in non-smokers (an odds ratio of about 2.4), and smokers lost around half a millimetre more bone around their implants. Other studies report more peri-implantitis too, which is inflammation and bone loss around an implant, rather like gum disease around a natural tooth.
To keep that in proportion: most of the studies were observational, and smokers differ from non-smokers in other ways. The odds are higher. That doesn't mean your implant will fail. But it's a real difference, and it's one you can influence.
What We'd Ask of You
If you're thinking about an implant and you smoke, we won't say no on principle. We'll talk it through honestly, check the health of your gums and bone first, and usually ask you to stop smoking before treatment and through the healing period. Implants are placed by our implant specialist during her sessions at the practice, and the timing is planned around that. Our implant post explains what the process involves.
It Isn't All or Nothing
If you've already lost some bone, stopping smoking still helps. It gives your gums a better chance of responding to treatment and protects the bone you have left. Help Me Quit Wales, the NHS stop smoking service, is free on 0800 085 2219 (helpmequit.wales). And if you're not ready, tell us anyway. We'd rather plan around the truth. It's the reason we ask about smoking at every check-up.
Source: Smoking and Dental Implants: A Systematic Review and Meta-Analysis (292 publications; pooled odds ratio for implant failure 2.40; mean marginal bone loss difference 0.58 mm).