Smoking, Vaping and Hookah: Effects on Teeth, Gums and Implants

ByDr. Ali Cem Ulubey, DDS
Prevention Smoking and oral health
Written by Dr. Ali Cem Ulubey, DDS · Ulubey Dental Clinic, Antalya
Last updated 26 October 2026
Dr. is a courtesy title; our dentists are licensed dentists in Türkiye, not medical doctors (not GDC-registered).

This page is general information and does not replace an examination.

Quick answer

Smoking raises the risk of gum disease (periodontitis) by about 85%[1], stains the teeth[13] and makes mouth cancer more likely[2]. In smokers, implant failure was 6.35% versus 3.18% in non-smokers[4], and dry socket after extraction 13.2% versus 3.8%[5]. E-cigarettes and hookah (shisha, qalyan, nargile) are not safe alternatives[3][10]. Before oral surgery at Ulubey Dental Clinic in Antalya we ask you to stop ideally at least 4 weeks before; if you cannot, cut down as much as possible (no more than 6–8 cigarettes a day); and not to smoke for at least 1 week after, until the wound has closed.

Gum diseaseSmoking raises the risk of periodontitis by about 85% (risk ratio 1.85)[1].
ImplantsFailure 6.35% in smokers vs 3.18% in non-smokers (107 studies)[4].
Dry socket13.2% in smokers vs 3.8% in non-smokers[5].
HookahOral cancer odds about 4 times higher in waterpipe smokers (meta-analysis)[12].
Before surgeryStopping about 4 weeks or more before surgery lowers complications[6].
In this guide

How smoking affects teeth, gums and mouth

The World Health Organization states that all forms of tobacco use are harmful and that there is no safe level of exposure[3]. In the mouth, the main effects are:

  • Gum disease. A systematic review of long-term studies found that smoking increases the risk of periodontitis by 85% (risk ratio 1.85) and has a detrimental effect on both its start and its progression[1]. Periodontitis is the gum disease that destroys the bone around the teeth; our guide to gum disease explains it.
  • Stains. Tooth discoloration is more common in people who smoke, and brown stains are usually linked to smoking or chewing tobacco[13].
  • Mouth cancer. The NHS lists smoking or chewing tobacco, betel nut or paan among the factors that make mouth cancer more likely, together with drinking a lot of alcohol[2].
  • Healing. Smoking can delay healing and increase the risk of infection at a wound[6], which matters after any extraction or implant.

Bad breath is another common complaint; our guide to bad breath explains the causes and what helps.

Vaping and e-cigarettes

The World Health Organization states that electronic cigarettes are harmful to health and are not safe[3]. For the mouth, the research is newer and weaker than for cigarettes, but it points in one direction:

  • A meta-analysis of 10 studies found that e-cigarette users are at greater risk of periodontal disease than non-smokers, but at lower risk than cigarette smokers[8].
  • A systematic review of 8 studies in adolescents and young adults linked vaping with higher caries risk, more gum inflammation, changes in saliva and in mouth bacteria; the certainty of the evidence was low and many users also smoked[9].
  • A 2026 systematic review of 31 studies found that e-cigarette users had worse gum measurements than non-smokers; bone loss around implants was notably high in e-cigarette users, although robust long-term evidence for implants exists only for cigarettes[10].

The honest summary: vaping appears less harmful to the gums than cigarettes, but it is not risk-free[10], and switching is not the same as stopping.

Hookah, shisha, qalyan and nargile

Hookah is called shisha in the UK, qalyan (قلیان) in Iran and nargile in Türkiye; researchers call it waterpipe tobacco smoking. The World Health Organization lists waterpipe tobacco among the tobacco products that are harmful[3]. The water does not make it harmless; the studies show:

  • A systematic review of 20 studies in the Journal of the American Dental Association found waterpipe smoking associated with gum inflammation, Candida (oral thrush), periodontitis, dry socket, premalignant lesions and oral cancer[11].
  • A meta-analysis of 50 studies found waterpipe smoking significantly associated with oral cancer (odds ratio 4.17)[12].
  • A 2026 systematic review found the gum measurements of waterpipe smokers comparable to those of cigarette smokers and worse than non-smokers, with particularly high plaque and pocket depths[10].

If you smoke hookah, tell your dentist, just as you would mention cigarettes. For surgery, hookah counts as smoking.

Cigarettes, vapes and hookah compared

Cigarettes, e-cigarettes and hookah: what the evidence shows for the mouth
CigarettesE-cigarettes (vaping)Hookah (shisha, qalyan, nargile)
GumsPeriodontitis risk about 85% higher[1]Higher risk than non-smokers, lower than cigarettes[8]Gum measurements comparable to cigarette smokers[10]
ImplantsFailure 6.35% vs 3.18% in non-smokers[4]Too little long-term data; bone loss high in recent studies[10]No robust long-term implant data
Dry socket13.2% vs 3.8% in non-smokers[5]No reliable dataAssociated with dry socket[11]
Mouth cancerA recognised risk factor[2]Long-term data lackingOdds ratio 4.17 for oral cancer[12]
Strength of evidenceStrong (large meta-analyses)Low to moderate; newer studiesModerate; mostly observational

Sources as cited per cell. “No reliable data” means no study of adequate quality was found, not that there is no risk.

Smoking before and after extractions and implants

Smoking is one of the clearest risks for oral surgery. A meta-analysis of 107 studies found implant failure in 6.35% of implants in smokers versus 3.18% in non-smokers[4], and a systematic review found dry socket in 13.2% of smokers versus 3.8% of non-smokers after extraction[5]. In general surgery, quitting approximately 4 weeks or more before surgery lowers the risk of complications, and every tobacco-free week after 4 weeks improves outcomes by 19%[6]; stopping at least 3–4 weeks before an operation reduced wound-healing complications[7].

Our smoking rule for extractions and implants

Before surgery: stop as early as possible, ideally at least 4 weeks before. If you cannot stop, cut down as much as possible; we ask for no more than 6–8 cigarettes a day. This is a fallback, not a safe level.
After surgery: no smoking for at least 1 week, until the wound has closed. Smoking reduces the blood supply to the healing tissue, and the suction of drawing on a cigarette can disturb the clot. For implants and bone grafts, staying smoke-free for longer is better. Hookah is smoking too, so the same rule applies; if you vape, tell us before surgery.

Smoking is not an absolute bar to implants, but it raises the risk; our guide to who can get dental implants covers smoking together with diabetes, gum disease and bone. Day-by-day care after surgery is in our guides to tooth extraction aftercare and dental implant aftercare, and our page on dry socket explains what to do if the socket becomes very painful a few days after an extraction.

Smoker’s stains, cleaning and whitening

Tobacco stains sit mostly on the tooth surface, and Cleveland Clinic lists quitting smoking among the ways to reduce surface discoloration[13]. A professional cleaning removes much of the surface stain and tartar; whitening lightens the natural colour of the teeth. Our guide to yellow and stained teeth explains which stains respond to which treatment.

Smoker’s stains: options and prices at Ulubey Dental Clinic
OptionWhat it doesPrice
Deep cleaning (scaling and polish)Removes tartar and surface stain€80
Opalescence whiteningOne in-clinic session, no light, no home kit€150
Philips Zoom + NiteWhite home kitIn-clinic lamp session (up to 4 × 15 minutes) plus 6-day home trays€350

Ulubey Dental Clinic, October 2026; prices as listed on our dental treatment prices page.

What these prices include
  • Deep cleaning: scaling and polish in one visit.
  • Philips Zoom: the in-clinic session, the Philips NiteWhite home kit for 6 days and custom-made upper and lower trays.
  • No fee: the consultation and the panoramic X-ray.
  • Not included: treatment of decay or gum disease found at the examination, which is quoted separately and done first.

Prices are indicative; your final written quote follows the examination and X-rays and is valid for 30 days. Unless the treatment plan changes, the written price does not change.

Whitening is only for adults aged 18 and over. For at least 3 days afterwards we ask for a “white diet”, which includes no tobacco; if you keep smoking, the stains come back. Details are on our teeth whitening and professional teeth cleaning pages.

Help to quit

Stopping is the single most useful step for your gums, your implants and your general health. Support exists in most countries:

  • UK: the NHS Better Health service offers tools and practical advice to help you quit[14].
  • Türkiye: the Ministry of Health runs the ALO 171 quit-smoking helpline and a network of quit-smoking clinics (Sigara Bırakma Poliklinikleri)[15].
  • Elsewhere: your family doctor or pharmacist can tell you what support and medicines are available.

Do not start or change any quit-smoking medicine without your doctor or pharmacist.

How we care for smokers at our clinic

Ulubey Dental Clinic is run by two dentists, Dr. Ali Cem Ulubey and Dr. Surur Ulubey; there are no rotating dentists. If you smoke, vape or use hookah:

  • Tell us honestly at the first visit. It changes the plan and the advice, not whether we treat you.
  • Gums first: we check the gums and take a panoramic X-ray for every patient; gum disease is treated before cosmetic or implant work.
  • Surgery rule: ideally stop at least 4 weeks before; otherwise no more than 6–8 cigarettes a day; none for at least 1 week after.
  • Guarantee terms: results also depend on smoking, uncontrolled diabetes and gum health; a fixture guarantee does not mean every implant integrates. The full terms are in our written dental guarantee.

Frequently asked questions

How does smoking affect my teeth and gums?

Smoking increases the risk of gum disease (periodontitis) by about 85%, stains the teeth, slows healing after extractions and implants, and is a risk factor for mouth cancer. In studies, implant failure was 6.35% in smokers versus 3.18% in non-smokers, and dry socket after extraction 13.2% versus 3.8%. Stopping lowers these risks.

Is vaping better for my teeth than smoking?

Probably less harmful, but not safe. A meta-analysis of 10 studies found e-cigarette users at greater risk of gum disease than non-smokers but at lower risk than cigarette smokers, and studies in young people link vaping with more gum inflammation and caries risk. The World Health Organization states that e-cigarettes are harmful to health. Stopping is better than switching.

Is hookah (shisha, qalyan) safer than cigarettes for the mouth?

No. Passing the smoke through water does not make it harmless. A systematic review linked waterpipe smoking with gum inflammation, oral thrush, periodontitis, dry socket, premalignant lesions and oral cancer, and a meta-analysis found about four times higher odds of oral cancer. Gum measurements in hookah smokers were comparable to cigarette smokers in a 2026 review.

How long before dental surgery should I stop smoking?

Ideally at least 4 weeks before. In general surgery, quitting about 4 weeks or more before an operation lowers complications. If you cannot stop, cut down as much as possible; at our clinic we ask for no more than 6–8 cigarettes a day, which is a fallback, not a safe level. After surgery, do not smoke for at least 1 week.

How long after a tooth extraction or implant can I smoke?

At our clinic we ask you not to smoke for at least 1 week, until the wound has closed. Smoking reduces the blood supply to the healing tissue, and the suction can disturb the blood clot; dry socket was 13.2% in smokers versus 3.8% in non-smokers. After implants and bone grafts, staying smoke-free for longer is better.

Can teeth whitening remove smoking stains?

Often, yes. A professional cleaning (€80 at our clinic) removes tartar and much of the surface stain, and whitening (€150 Opalescence or €350 Philips Zoom with the NiteWhite home kit) lightens natural teeth in adults aged 18 and over. For at least 3 days afterwards no tobacco is allowed, and if you keep smoking the stains come back.

Smoker and planning treatment?
Send a photo or panoramic X-ray: we check your gums first and tell you honestly what smoking means for your plan. Messages are usually answered within 4 hours; a written quote usually within 24 hours after photos or X-rays arrive.
Message on WhatsApp (+90 540 324 00 04) Who can get dental implants

Sources

  1. Leite FRM, Nascimento GG, Scheutz F, López R. Effect of smoking on periodontitis: a systematic review and meta-regression. Am J Prev Med. 2018;54(6):831-841. PMID 29656920. pubmed.ncbi.nlm.nih.gov/29656920
  2. NHS. Causes of mouth cancer (page last reviewed 19 June 2023; accessed 26 October 2026). www.nhs.uk/conditions/mouth-cancer/causes
  3. World Health Organization. Tobacco: fact sheet (accessed 26 October 2026). www.who.int/news-room/fact-sheets/detail/tobacco
  4. Chrcanovic BR, Albrektsson T, Wennerberg A. Smoking and dental implants: a systematic review and meta-analysis. J Dent. 2015;43(5):487-498. PMID 25778741. pubmed.ncbi.nlm.nih.gov/25778741
  5. Kuśnierek W, Brzezińska K, Nijakowski K, Surdacka A. Smoking as a risk factor for dry socket: a systematic review. Dent J (Basel). 2022;10(7):121. PMID 35877395. pubmed.ncbi.nlm.nih.gov/35877395
  6. World Health Organization. Smoking greatly increases risk of complications after surgery (news release, 20 January 2020; accessed 26 October 2026). www.who.int/news/item/20-01-2020-smoking-greatly-increases-risk-of-complications-after-surgery
  7. Wong J, Lam DP, Abrishami A, Chan MT, Chung F. Short-term preoperative smoking cessation and postoperative complications: a systematic review and meta-analysis. Can J Anaesth. 2012;59(3):268-279. PMID 22187226. pubmed.ncbi.nlm.nih.gov/22187226
  8. Alkattan R, Tashkandi N, Mirdad A, Ali HT, Alshibani N, Allam E. Effects of electronic cigarettes on periodontal health: a systematic review and meta-analysis. Int Dent J. 2025;75(3):2014-2024. PMID 39863518. pubmed.ncbi.nlm.nih.gov/39863518
  9. Machuca-Portillo C, Caleza-Jiménez C, Suárez-Marchena C, et al. Association between e-cigarette use (vaping) and oral health in adolescents and young adults: a systematic review. J Clin Med. 2026;15(10):3886. PMID 42194847. pubmed.ncbi.nlm.nih.gov/42194847
  10. Di Palo MP, Di Spirito F, Giordano F, et al. Periodontal and peri-implant status among users of different inhaled tobacco and nicotine products: a systematic review. Dent J (Basel). 2026;14(9):562. PMID 42782949. pubmed.ncbi.nlm.nih.gov/42782949
  11. Munshi T, Heckman CJ, Darlow S. Association between tobacco waterpipe smoking and head and neck conditions: a systematic review. J Am Dent Assoc. 2015;146(10):760-766. PMID 26409986. pubmed.ncbi.nlm.nih.gov/26409986
  12. Waziry R, Jawad M, Ballout RA, Al Akel M, Akl EA. The effects of waterpipe tobacco smoking on health outcomes: an updated systematic review and meta-analysis. Int J Epidemiol. 2017;46(1):32-43. PMID 27075769. pubmed.ncbi.nlm.nih.gov/27075769
  13. Cleveland Clinic. Tooth discoloration (last updated 3 July 2025; accessed 26 October 2026). my.clevelandclinic.org/health/symptoms/10958-tooth-discoloration
  14. NHS Better Health. Quit smoking (accessed 26 October 2026). www.nhs.uk/better-health/quit-smoking
  15. T.C. Sağlık Bakanlığı (Ministry of Health of Türkiye). ALO 171 Sigara Bırakma Danışma Hattı (quit-smoking helpline; accessed 26 October 2026). alo171.saglik.gov.tr

This article is general patient information and does not replace a clinical examination or X-rays.

Editor contact: [email protected] · ulubeydental.com/contact-us

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