The belief that cigar smoking is safe if the smoke is not drawn into the lungs is a misunderstanding of tobacco toxicity. Even without intentional inhalation, puffing on a cigar exposes the body to harmful chemicals and nicotine. The smoke interacts directly with the mouth and throat, where components are absorbed into the bloodstream. This leads to localized tissue damage and systemic consequences. No level of tobacco use is considered safe, and the risks are comparable to cigarette smoking for certain diseases.
Direct Exposure: Oral and Upper Respiratory Risks
The most direct health risks of non-inhaled cigar use are concentrated in the areas that contact the smoke. Cigar smoking directly exposes the lips, tongue, mouth, throat, and larynx to toxic chemicals. Regular cigar smokers face risks for oral cavity and esophageal cancers similar to those of cigarette smokers.
The constant exposure to hot smoke and carcinogens increases the risk of cancers of the mouth, tongue, and lips. Swallowing smoke-filled saliva carries carcinogens down, increasing the risk for cancer of the esophagus and the voice box (larynx). Cigar smokers are four to ten times more likely to die from these cancers than non-smokers.
Localized exposure also affects oral health. Cigar smoking triples the rate of developing moderate to severe gum disease and contributes to gum recession. The smoke can cause leukoplakia, which are precancerous white patches inside the mouth. Tobacco toxins and heat contribute to tooth loss.
Systemic Effects: Nicotine Absorption and Cardiovascular Harm
Nicotine and various toxins are readily absorbed into the bloodstream through the mucous membranes lining the mouth, even without lung inhalation. The high alkalinity (pH) of cigar smoke allows nicotine to be absorbed effectively across the buccal mucosa. A single large cigar can contain as much tobacco as an entire pack of cigarettes, meaning substantial nicotine is absorbed through the mouth.
This absorbed nicotine quickly enters the bloodstream, leading to dependence and addiction. Nicotine is a stimulant that triggers the release of catecholamines, activating the sympathetic nervous system. This activation increases heart rate and raises blood pressure, placing a greater workload on the heart.
The absorption of nicotine and other toxins contributes to cardiovascular harm. Nicotine can impair the function of the blood vessel lining (endothelium) and cause systemic vasoconstriction, potentially reducing blood flow. Cigar use is linked to an increased risk of heart and blood vessel conditions, including stroke, atrial fibrillation, and heart failure. Carbon monoxide absorption also occurs, reducing the blood’s capacity to carry oxygen and stressing the cardiovascular system.
Unique Toxicity of Cigar Smoke
The distinct characteristics of cigar tobacco and its processing contribute to a highly toxic smoke composition. Cigar wrappers are made from tobacco leaves and are less porous than cigarette paper wrappers. This results in less complete combustion, leading to higher concentrations of toxic byproducts and tar per gram of tobacco smoked.
The fermentation and air-curing process used for cigar tobacco creates a higher concentration of nitrogen compounds. When smoked, these compounds release high levels of tobacco-specific nitrosamines (TSNAs), which are potent carcinogens. The levels of the most carcinogenic TSNAs (NNN and NNK) in cigar tobacco can be five to seven times higher than those found in commercial cigarettes.
A primary factor is the smoke’s higher alkalinity (pH level) compared to most cigarette smoke. This alkaline smoke means the nicotine is in a “free-base” form, which is easily absorbed through the mucous membranes of the mouth, throat, and nose. This efficient absorption allows cigar smokers to achieve significant nicotine intake without drawing the smoke into the lungs.