Cigars are widely recognized as detrimental to oral health, presenting risks that extend far beyond simple cosmetic concerns. The practice of smoking cigars directly impacts the tissues of the mouth, gums, and teeth, even if the user does not inhale the smoke into the lungs. This article focuses on the specific ways cigar use compromises the integrity and health of the oral cavity, from surface irritation to severe structural and cellular diseases.
Aesthetic Problems and Surface Irritation
Cigar smoke contains tar and nicotine, the primary agents responsible for teeth discoloration. Nicotine, initially colorless, reacts with oxygen to form a yellow or brown pigment that adheres to the tooth surface. Tar, a sticky byproduct of tobacco combustion, deepens the staining, creating a tenacious brown or black film on the enamel. This staining is exacerbated by the typically longer duration of cigar smoking sessions, allowing prolonged contact between the teeth and the smoke’s particulate matter.
The smoke also introduces abrasive materials and heat that directly irritate the oral environment. Insoluble particulate matter contributes to dental attrition. Continuous exposure to the heat and chemicals in the smoke causes physical irritation to the lips, tongue, and the mucosal lining of the cheeks. This chronic irritation can lead to an increase in plaque and tartar buildup, which is a major factor in bad breath (halitosis).
Damage to Gums and Supporting Bone
Cigar smoking significantly elevates the risk of developing periodontal disease, which includes gingivitis and the more severe periodontitis. The toxic agents in cigar smoke interfere with the normal function of gum tissue cells and suppress the immune response. This interference makes the gum tissues more vulnerable to bacterial infection and inflammation.
Nicotine is a potent vasoconstrictor that narrows the blood vessels, reducing blood flow to the gums. This impaired circulation starves the gum tissues of oxygen and nutrients, hindering their ability to fight off disease-causing bacteria. This reduced blood flow can also mask the early, visible signs of gingivitis, such as bleeding on probing. This suppression means gum disease may progress undetected until it reaches the advanced stage of periodontitis.
Periodontitis involves the destruction of the tissues and alveolar bone supporting the teeth. As the disease advances, gum tissue recedes, and deep pockets form between the teeth and gums, creating an environment for bacteria to thrive. Studies indicate that cigar smokers experience tooth and bone loss in the jaw at rates comparable to cigarette smokers. This structural damage eventually leads to tooth mobility and loss.
The Risk of Malignant Lesions
The most severe consequence of cigar use is the elevated risk of various cancers in the head and neck region. Regular cigar smokers are estimated to be 4 to 10 times more likely to die from oral, laryngeal, and esophageal cancers compared to non-smokers. Even when the smoke is not intentionally inhaled, the toxic and carcinogenic compounds are absorbed directly through the mucosal lining.
Cigar smoke contains many of the same carcinogens found in cigarette smoke, including nitrosamines, benzene, and polycyclic aromatic hydrocarbons. The extended contact time of the smoke with oral tissues means these cancer-causing agents have a prolonged opportunity to induce DNA mutations in the cells. This cellular damage can manifest initially as pre-cancerous lesions, which are often the first visible signs of risk.
These lesions include leukoplakia, which presents as white patches inside the mouth that cannot be easily scraped off. Erythroplakia appears as red, raised patches and carries a higher likelihood of transforming into a malignancy. Daily cigar smokers who do not inhale have an oral cancer risk seven times higher than non-smokers, underscoring the danger of the smoke’s direct contact with the oral mucosa.
Factors Making Cigars Especially Hazardous to Oral Health
The specific characteristics of cigars contribute to the heightened risk to oral tissues. Cigars typically contain a larger volume of tobacco than cigarettes, resulting in a greater overall exposure to toxic compounds due to the longer smoking time. Furthermore, most cigars lack a filter, meaning the full concentration of tar and other toxins is delivered directly to the mouth and throat.
A key difference is the pH of the smoke, which is more alkaline in many large and premium cigars. Nicotine is a weak base, and in this alkaline environment, a greater proportion of the nicotine exists in its un-ionized, or freebase, form. This freebase nicotine is efficiently absorbed directly through the lipid membranes of the buccal mucosa without the need for smoke inhalation. This mechanism ensures that even non-inhaling cigar smokers receive a dose of nicotine and are exposed to the full range of carcinogens directly at the oral surface.