How Smoking Affects Skin Health

Smoking is associated with a range of?detrimental health effects, the most well known?of which are?lung cancer and cardiovascular disease. There are many lesser known health effects as well, including effects?on the skin.

In many cases, these changes to skin are not life threatening, though they can change the physical appearance of the smoker. For example, smoking?is associated with premature ageing and wrinkles. Smoking is also associated with very serious skin conditions, including squamous cell carcinoma of the skin (a type of skin cancer) and psoriasis. Awareness of?the?changes to physical appearance and the serious skin conditions associated with smoking may help motivate individuals to quit smoking.

The precise ways in which tobacco smoke damages or changes skin are not fully understood, though scientific studies have produced evidence about a number of possible ways. Studies suggest that tobacco smoke exposure decreases capillary and arteriolar blood flow, possibly damaging?connective tissues?that help maintain healthy?skin. Skin fibroblasts (the cells in connective tissue that form collagen and elastin) are damaged by tobacco smoke.

There is also evidence that tobacco smoke is phototoxic. Smoke becomes more toxic in the presence of ultraviolet light (UV),?such as is found in?sunlight, and causes more damage to skin cells than either smoke or UV would cause on their own.

Have you quit smoking? Or are thinking about trying to quit? Use this tool to see what health benefits you have already achieved and what benefits you can expect in the future if you stick with it. For more information, see Health Benefits of Quitting Smoking Tool.

Ageing

As people?age, their skin also ages. The ageing process is influenced by a number of environmental factors. Sun exposure is the most prominent risk factor for premature ageing. Although it is much less well?known, cigarette smoking is also a risk factor for?premature skin ageing.

Several studies have reported that cigarette smoking causes an individual's skin?to age?even more than exposure to sunlight does. Studies have also reported that the effect of exposure to tobacco smoke and sunlight at the same time is more dangerous than the combined effect of either exposure alone, and that women are at greater risk than men.

The ageing of skin can be measured by a number of features. Most obviously, skin becomes wrinkled. Wrinkling is caused by changes to skin elasticity and concentrations of skin components such as collagen and elastin. Differences in skin features between individuals who do and do not smoke can therefore be measured by physical appearance, or by analysing skin tissues for concentrations of components.

Wrinkles

Numerous studies have found that premature wrinkling is associated with smoking. There is evidence that the more an individual smokes, the more the premature ageing effect occurs, so heavy smokers will experience more premature wrinkles than those who only smoke occasionally. One study, in which eight judges individually rated the age of smokers and non-smokers from their photographs, reported that smokers were, on average, rated as being 2.7 years older than their actual age, while non-smokers were rated at?0.7 years younger than their actual age.

Another study reported that moderate smokers were almost twice as likely to wrinkle prematurely than non-smokers,?and?heavy smokers were almost three times more likely to wrinkle prematurely.

Other studies have examined exposure to both cigarettes and sunlight, to assess the relative importance of each of these exposures in the development of wrinkles. Evidence from these studies suggests that smoking may be a more important factor in the development of wrinkles than sun exposure.

There is evidence?that individuals?exposed to both tobacco smoke and sunlight prematurely winkle more than individulas exposed to tobacco smoke or sunlight alone. One study found that smokers were 5.8 times more likely to develop wrinkles than non-smokers, while those with excessive sun exposure (i.e.?more than two?hours per day) were only 2.65 times more likely to wrinkle than those who were not excessively exposed to sunlight. Individuals who smoked heavily (35 pack years or more) and had excessive sun exposure were 11.4 times more likely than non-smokers with?less than?two hours per day of sun exposure to develop wrinkles. This is a considerably greater risk than the combined individual risks of?exposure (i.e. 5.8 for tobacco + 2.65 for sunlight = 8.45 times more likely). As tobacco smoke is phototoxic, this synergistic effect of combined tobacco smoke and sun exposure is unsurprising.

Another study reported that smoking?more than?20 cigarettes per day was associated with an almost 10-year increase in skin ageing. The study found no significant association between sun exposure and wrinkles.

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There is some evidence that women's skin is more affected by tobacco smoke exposure than men's skin. One study reporting a premature ageing effect in both sexes found that smoking men were 2.3 times more likely than non-smoking men, and smoking women more than 3 times as likely?as non-smoking women, to age prematurely. The study did not explore the possible reasons why women's skin was more sensitive to the detrimental effects of tobacco smoke than men's skin.

Skin tissue?composition

As skin ages, the composition of skin tissues changes. A number of studies have examined the skin tissues of smokers and non-smokers as a measure of premature ageing. A Dutch case control study?measuring the extent of elastosis (a condition in which skin loses elasticity as a result of connective tissue degeneration) and telangiectasia (a condition characterised by fine red lines in the skin caused by?the dilation of small blood vessels) in smokers and non-smokers reported that the likelihood of developing either condition increased with the number of cigarettes smoked. This was true for both men and women, although the effect was most apparent in men. Another study, which used computer assisted analysis to assess elastosis in four layers of facial skin, reported significantly greater elastosis in smokers compared to non-smokers.

Skin tone and colour

In addition to wrinkles, smoking increases an individual's risk of gauntness and facial discolouration.

There is evidence that smoking tobacco decreases the ability of skin to regenerate and repair wounds.This is particularly evident in patients undergoing surgery. For example, smokers who undergo face lift surgery are more likely than non-smokers to experience unsatisfactory wound healing.

There are a number of possible ways by which exposure to tobacco smoke may inhibit the skin's ability to regenerate and repair. Nicotine, one of the toxic components of tobacco smoke, is a vasoconstrictor (an agent which causes the blood vessels to contract). When blood vessels are constricted they transport less blood through the body, and therefore reduce the supply of nutrients upon which the skin depends to regenerate. Similarly, carbon monoxide, another toxic component in tobacco smoke, reduces oxygen flow through the body, thus reducing the supply of oxygen needed by damaged cells?to regenerate.

Moisture

Dry skin can feel uncomfortable because it is less flexible than moisturised skin. Unmoisturised skin becomes unattractive and may take on a red, flaky or scaly appearance. Dry skin is also more likely to crack or itch than well-moisturised skin.?

Evidence about the effects of smoking on the moisture content of skin is limited, but the available evidence suggests that smoking reduces moisture in the skin. An Israeli study examining skin moisture found that women who smoked more than?ten cigarettes per day had significantly lower mean moisture values than non-smokers.

Skin blood flow

Cigarette smoking reduces skin blood flow by increasing the release of a hormone called vasopressin.Vasopressin is produced naturally by humans. One of its functions is to reduce blood flow. Studies have shown that concentrations of vasopressin in the blood rise immediately after smoking tobacco.

A review of all published studies examining the associations between skin health and smoking reported that smoking increases the risk of skin lesions in people with diabetes, lupus and AIDS.

Exposure to sunlight is the predominant risk factor for squamous cell carcinoma of the skin (a type of skin cancer). There is considerable evidence that smoking also increases the risk of skin cancer. A Dutch study found that cigarette and pipe smokers were twice as likely as non-smokers to develop squamous cell carcinoma of the skin, when other risk factors (e.g. age and sun exposure) were taken into account. Interestingly, there was no significant association between cigar smoking and squamous cell carcinoma. The same study reported that current smokers were more likely to develop the condition than former smokers.

The Nurses' Health Study, a large study conducted amongst nurses from the US, found that nurses who smoked were 50% more likely to develop squamous cell carcinoma of the skin, compared to non-smoking nurses. A number of other studies have also identified smoking as a risk factor for squamous cell carcinoma of the skin.

Tobacco smoke exposure increases the risk of developing psoriasis, a rare skin condition characterised by the formation of silvery, plaque-like scales on the arms and legs (particularly at?the elbows and knees). Smokers with psoriasis?are less likely than non-smokers?to improve following treatment.

A recent review of literature on the topic reported that women who smoked were 3.3 times more likely to develop psoriasis than non-smoking women. While no significant association between smoking and development of psoriasis in men was found, there was evidence that men who smoked?at least ten cigarettes per day were more likely to have severe psoriasis. Decreased improvement rates following treatment were noted in both men and women.

For more information on smoking and its health effects, and some useful tools, videos and animations, see Smoking. Scollo MM, Winstanley MH [eds]. Tobacco in Australia [3rd edition].?Chapter 3: The health effects of active smoking [online]. Melbourne: Cancer Council Victoria. 21 November?2008 [cited 18 May 2009]. Available from URL: http://www.tobaccoinaustralia.org.au/Grady D, Ernster V. Does cigarette smoking make you ugly and old? Am J Epidemiol. 1992; 135(8): 839-42.Behnam SM, Behnam SE, Koo JY. Smoking and psoriasis. Skinmed. 2005; 4(3): 174-6.Placzek M, Kerkmann U, Bell S, Koepke P, Przybilla B. Tobacco smoke is phototoxic. Br J Dermatol. 2004; 150(5): 991-3.Kennedy C, Bastiaens MT, Bajdik CD, Willemze R, Westendorp RG, Bouwes Bavinck JN. Effect of smoking and sun on the aging?skin. J Invest Dermatol. 2003; 120(4): 548-54.Yin L, Morita A, Tsuji T. Skin aging induced by ultraviolet exposure and tobacco smoking: Evidence from epidemiological and molecular studies. Photodermatol Photoimmunol?Photomed. 2001; 17(4): 178-83.Ernster VL, Grady D, Miike R, Black D, Selby J, Kerlikowske K. Facial wrinkling in men and women, by smoking status. Am J Pub Health. 1995; 85(1): 78-82.Boyd AS, Stasko T, King LE Jr, Cameron GS, Pearse AD, Gaskell SA. Cigarette smoking-associated elastotic changes in the skin. J Am Acad Dermatol. 1999; 41(1): 23-6.Raitio A, Kontinen J, Rasi M, Bloigu R, Roning J, Oikarinen A. Comparison of clinical and computerized image analyses in the assessment of skin ageing in smokers and non-smokers. Acta Derm Venereol. 2004; 84(6): 422-7.Koh JS, Kang H, Choi SW, Kim HO. Cigarette smoking associated with premature facial wrinkling: Image analysis of facial skin replicas. Int J Dermatol. 2002; 41(1): 21-7.Leung WC, Harvey I. Is skin ageing in the elderly caused by sun exposure or smoking? Br J Dermatol. 2002; 147(6): 1187-91.Freiman A, Bird G, Metelitsa AI, Barankin B, Lauzon GJ. Cutaneous effects of smoking. J Cutan Med Surg. 2004; 8(6): 415-23.Wolf R, Tur E, Wolf D, Landau M. The effect of smoking on skin moisture and on surface lipids. Int J Cosmet Sci. 1992; 14(2): 83-8.Waeber B, Schaller MD, Nussberger J, Bussien JP, Hofbauer KG, Brunner HR. Skin blood flow reduction induced by cigarette smoking: Role of vasopressin. Am J Physiol. 1984; 247(6 Pt 2): H895-901.Rowe JW, Kilgore A, Robertson GL. Evidence in man?that cigarette smoking induces vasopressin release via an airway-specific mechanism. J Clin Endocrinol Metab. 1980; 51(1): 170-2.Silverstein P. Smoking and wound healing. Am J Med. 1992; 93(1A): 22-4S.de Hertog SA, Wensveen CA, Bastiaens MT, Kielich CJ, Berkhout MJ, Westendorp RG, et al. Relationship between smoking and skin cancer. J Clin Oncol. 2001; 19(1): 231-8.Grodstein F,?Speizer FE, Hunter DJ. A prospective study of incident squamous cell carcinoma of the skin in the Nurses' Health Study. J Natl Cancer Inst. 1995; 87(14): 1061-6.Aubry F, MacGibbon B. Risk factors of squamous cell carcinoma of the skin. A case-control study in the Montreal region. Cancer. 1985; 55(4): 907-11.Flynn TC, Petros J, Clark RE, Vieham GE. Dry skin and moisturizers. Clin Dermatol. 2001; 19(4): 387-92.

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How Smoking Affects the Mouth

The role of smoking in the development of lung cancer and cardiovascular disease is well known. It also has a part to play in several diseases and lesions in the mouth; the most common being gum disease. The chance of dental implant failure is more common among smokers than among non-smokers, and gum disease around these implants in those who smoke is also more prevalent.

The following oral diseases and conditions are caused by, or can be attributed to smoking:

Staining of teeth and dental fillings;Reduction of the ability to smell and taste;Bad breath;Smoker's palate, where the palate becomes white and a number of little spots project from the surface, each bearing a small red spot at the centre that marks the opening of the duct of the gland;Smoker's melanosis, which is associated with cigarette and pipe smoking, and is seen as brown spots inside the mouth;Coated tongue, which is the condition wherethere is a coloured layer composed of mainly food particles, bacteria, and debris from epithelium in the mouth;Oral thrush, which is a type of fungal infection that occurs in the mouth;Gum disease;Tooth decay (dental caries);The failure of dental implants; and/orOral precancer and cancer.

These lesions most likely result from the:

Irritants, and toxic and cancer causing compounds found in the smoke;Dryness in the mouth following high temperatures of inhaling smoke;pH change;Change in immune response; and/orChange in ability to handle viral and fungal infections.

Have you quit smoking? Or are thinking about trying to quit? Use this tool to see what health benefits you have already achieved and what benefits you can expect in the future if you stick with it. For more information, see Health Benefits of Quitting Smoking Tool.

Cigarette smoking and its relationship with gum disease has been the topic of interest in the last 10-15 years.

Smokers have a 2.5 to 3.5 times greater risk of severe gum disease, which is recognised by the amount of bone lost around a particular tooth due to gum disease. Smokers also tend to lose more teeth than non-smokers.

The effect of smoking on gum disease is also dependent on the amount of cigarettes or cigars consumed (both quantity and duration of smoking).

Some research in previous decades thought that severe gum disease in smokers was caused by poor dental hygiene, and was made worse by smoking. It is now known that smoking, when adjusted for poor dental hygiene still causes more gum disease than in non-smokers.

How does smoking contribute to gum disease?

Bacteria

Three common bacteria are involved in gum disease. Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Prevotella intermedia, are all present in higher amounts in smokers than non-smokers.

Although we do not know if there is a greater amount of bacteria in total, there is a lot of research that indicates the type of bacteria in smokers is more likely to cause gum disease. This is due to a higher quantity of "bad" bacteria that is present in smokers.

Blood vessels in gums

There is less inflammation and bleeding in smokers than in non-smokers. The reason for this is due to a constriction in blood vessels in the facial area. This constriction does not simply go away once people stop smoking but lasts for a while after smoking has stopped. The reduction in inflammation around the gums may also lead to a false sense of security that the gums are healthy, as one of the indicators dentists use to measure gum health is the amount of inflammation around the gums.??

The way our body responds to bacteria

Smoking alters the way the body responds to the bacteria that is in plaque. It reduces the ability of the body to respond well to the bacteria and thus causes gum disease.

There are many compounds in smoke that can cause a reduction in the immune system (e.g. nicotine).

The main way our body responds to bacteria is through inflammation, and neutrophils are the most critical cell in protection against gum disease. Smokers have more neutrophils in the body in total; however fewer neutrophils reach the gums mainly due to the effects of nicotine. As neutrophils cannot control the bacteria as well as usual (due to the fewer amount reaching the gums), there is a much higher chance gum disease will occur.

The destruction of the gums also occurs much faster in smokers due to the presence of a higher number of matrixmetalloproteinases?(MMPs), elastase, interleukin-1 and prostanglandin-2. These are components of the body's immune response that are involved in inflammation, loss of collagen, and loss of bone.

It is clear that nicotine and various compounds in tobacco may impose detrimental effects on the blood system, inflammatory process and immune system. This results in a progression of gum disease, and a poor response to treatment.

Effects of smoking on gum treatment

Smokers respond less favourably than non-smokers to treatment of any kind to try and control the progression of gum disease. Heavy smokers (smoking > 10 cigarettes per day) in general exhibit a lower degree of healing following treatment for gum disease than ex-smokers and nonsmokers.

Effects of stopping smoking on treatment for gum disease

The effect of smoking on the gums is reversible to some extent when people stop smoking. Stopping smoking will allow for normal healing and repair of the gum tissues when bacteria are introduced to the area (usually in the form of dental plaque).

Significantly greater proportions of implant failures occur in smokers (failure rate 11%) than in non-smokers (failure rate 5%).

We are not sure exactly why there is a poorer rate of success in smokers compared to non-smokers. However, it has recently been suggested that the increase in the number of implant failures in smokers is not the result of poor healing during the surgical part of the implant, but is due to the exposure of tobacco smoke to the gums around the implant. Peri-implantitis is the name given to gum disease around an implant, and chronic peri-implantitis results in implant failure when left untreated.

Programs designed to stop smoking show considerable promise in improving the success rate of dental implants in smokers, with significant differences in failure rates between:

Non-smokers and smokers; andSmokers who adopted the smoking cessation protocol and those who continue smoking.

Smoking tobacco has the following effects on saliva. Smoking:

Immediately stimulates salivary flow;Does not affect saliva flow rates in the long term;In the long-term, slightly reduces pH (makes the mouth more acidic) and buffering power, which means that the chance of getting tooth decay and dental erosion is slightly higher; andIs associated with lower amounts of salivary cystatin (thought to contribute to maintaining good dental health).

Research shows there are higher counts of two bacteria that are linked with tooth decay in smokers than non-smokers, namely, Lactobacillus spp. and Streptococcus mutans.

It is interesting to note that smoking during pregnancy is also associated with a higher chance of tooth decay in preschool children.

Numerous studies in various populations have shown that smokers have a substantially higher risk of oral cancer than nonsmokers. The risk is higher when a greater amount of tobacco smoke is consumed. There is also a clear benefit in cancer risk reduction when people stop smoking.

Although we do not know exactly how smoking causes cancer, the toxic elements of smoking do cause harm to cells, which could easily lead to cancer.

Combining smoking and excessive alcohol intake increases the risk of getting oral cancer,?and it has been estimated that 75-90% of all cases of oral cancer are explained by the combined effect of smoking and alcohol use. This could be because:

Alcohol dissolves certain toxic compounds in tobacco smoke which are linked to cancer; and/orAlcohol increases the permeability of the epithelium inside the mouth.

Oral precancer

Oral leukoplakia, which can be regarded as "pre-cancer" is far more common in smokers than in non-smokers. Leukoplakia is essentially any white lesion whose cause is not known, and there is a chance that these lesions can become cancer.

For more information, see Oral Cancer.

Aesthetics, smell and taste

Smoking causes discolouration of the teeth (more than from the consumption of coffee and tea), dental fillings and dentures. This affects the appearance of the mouth.

Smoking is also a common cause of bad breath and affects the ability for us to be able to taste and smell.

Smoker's melanosis

Smoker's melanosis is associated with cigarette and pipe smoking, and is seen as brown spots inside the mouth. Smoker's melanosis occurs in 5-21.5% of smokers. The pigmentation in the mouth is a result of tobacco smoke causing:

Stimulation of melanin production (brown pigment in our skin and mouth); orThe binding of the melanin to the compounds in tobacco smoke.

The amount of pigmentation is increased in heavy smokers.

Nicotinic stomatitis (smoker's palate)

Nicotinic stomatitis is seen in the mouth as a number of bumps, which may have red centres, and occurs on the top of the mouth, which looks whitish in appearance overall.

This appearance is due to irritated salivary glands with inflamed ducts, which enter into the mouth. Nicotinic stomatitis is a response to heat (not the chemicals in tobacco); thus, there is no chance of cancer as a direct result of this lesion. Nicotinic stomatitis usually goes away once the person stops smoking. The top of the mouth returns to how it should look within 1-2 weeks of stopping smoking.

Hairy tongue

Hairy tongue is characterised by an overgrowth of little "hairs" on the tongue known as papillae. The papillae may be stained white, yellow, brown, green, or black depending on the source of the staining. With tobacco use, the color is generally brown or black. This condition is of concern as it does not look very nice, and also may contribute to bad breath.

Kindly written by Dr Akhil Chandra BDSc. (Hons UWA)

Dentist, Whitfords Dental Centre and Editorial Advisory Board Member of the Virtual Dental Centre

Doll R, Hill AB. Smoking and carcinoma of the lung; Preliminary report. Br Med J. 1950; 2(4682): 739-48.Sham AS, Cheung LK, Jin LJ, Corbet EF. The effects of tobacco use on oral health. Hong Kong Med J. 2003; 9(4): 271-7.Haas R, Haimbock W, Mailath G, Watzek G. The relationship of smoking on peri-implant tissue:?A retrospective study. J Prosthet Dent. 1996; 76(6): 592-6.Van Dyke TE, Sheilesh D. Risk factors for periodontitis. J Int Acad Periodontol. 2005; 7(1): 3-7.Bergstrom J. Cigarette smoking as risk factor in chronic periodontal disease. Community Dent Oral Epidemiol. 1989; 17(5): 245-7.Grossi SG, Zambon JJ, Ho AW, Koch G, Dunford RG, Machtei EE, et al. Assessment of risk for periodontal disease. I. Risk indicators for attachment loss. J Periodontol. 1994; 65(3): 260-7.Machuca G, Rosales I, Lacalle JR, Machuca C, Bullon P. Effect of cigarette smoking on periodontal status of healthy young adults. J Periodontol. 2000; 71(1): 73-8.Alexander AG. The relationship between tobacco smoking calculus and plaque accumulation and gingivitis. Dent Health (London). 1970; 9(1): 6-9.Ismail AI, Burt BA, Eklund SA. Epidemiologic patterns of smoking and periodontal disease in the United States. J Am Dent Assoc. 1983; 106(5): 617-21.Eggert FM, McLeod MH, Flowerdew G. Effects of smoking and treatment status on periodontal bacteria: Evidence that smoking influences control of periodontal bacteria at the mucosal surface of the gingival crevice. J Periodontol. 2001; 72(9): 1210-20.Palmer RM, Wilson RF, Hasan AS, Scott DA. Mechanisms of action of environmental factors: Tobacco smoking. J Clin Periodontol. 2005; 32 Suppl 6: 180-95.Walter C, Saxer UP, Bornstein MM, Klingler K, Ramseier CA. [Impact of tobacco use on the periodontium-an update (I)-Part 1: Epidemiologic und pathogenetic aspects of tobacco-related periodontal diseases]. [Article in French, German]. Schweiz Monatsschr Zahnmed. 2007; 117(1): 45-60.Bergstrom J, Preber H. The influence of cigarette smoking on the development of experimental gingivitis. J Periodontal Res. 1986; 21(6): 668-76.Bergstrom J, Preber H. Tobacco use as a risk factor. J Periodontol. 1994; 65(5 Suppl): 545-50S.Newman M, Takei H, Klokkevold P; Carranza F (ed).?Carranza's Clinical Periodontology (10th edition). St Louis: Saunders, Elsevier; 2006.Geng Y, Savage SM, Razani-Boroujerdi S, Sopori ML. Effects of nicotine on the immune response. II. Chronic nicotine treatment induces T cell anergy. J Immunol. 1996; 156(7): 2384-90.Sorensen LT, Nielsen HB, Kharazmi A, Gottrup F. Effect of smoking and abstention on oxidative burst and reactivity of neutrophils and monocytes. Surgery. 2004; 136(5): 1047-53.Pauletto NC, Liede K, Nieminen A, Larjava H, Uitto VJ. Effect of cigarette smoking on oral elastase activity in adult periodontitis patients. J Periodontol. 2000; 71(1): 58-62.Seow WK, Thong YH, Nelson RD, MacFarlane GD, Herzberg MC. Nicotine-induced release of elastase and eicosanoids by human neutrophils. Inflammation. 1994; 18(2): 119-27.Preber H, Linder L, Bergstrom J. Periodontal healing and periopathogenic microflora in smokers and non-smokers. J Clin Periodontol. 1995; 22(12): 946-52.Grossi SG, Skrepcinski FB, DeCaro T, Zambon JJ, Cummins D, Genco RJ. Response to periodontal therapy in diabetics and smokers. J Periodontol. 1996; 67(10 Suppl): 1094-102.Bostrom L, Linder LE, Bergstrom J. Influence of smoking on the outcome of periodontal surgery. A 5-year follow-up. J Clin Periodontol. 1998; 25(3): 194-201.Norderyd O, Hugoson A. Risk of severe periodontal disease in a Swedish adult population. A cross-sectional study. J Clin Periodontol. 1998; 25(12): 1022-8.Grossi SG, Zambon J, Machtei EE, Schifferle R, Andreana S, Genco RJ, et al. Effects of smoking and smoking cessation on healing after mechanical periodontal therapy. J Am Dent Assoc. 1997; 128(5): 599-607.Esposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. (II). Etiopathogenesis. Eur J Oral Sci. 1998; 106(3): 721-64.Bain CA, Moy PK. The association between the failure of dental implants and cigarette smoking. Int J Oral Maxillofac Implants. 1993; 8(6): 609-15.Lambert PM, Morris HF, Ochi S. The influence of smoking on 3-year clinical success of osseointegrated dental implants. Ann Periodontol. 2000; 5(1): 79-89.Bain CA. Smoking and implant failure - benefits of a smoking cessation protocol. Int J Oral Maxillofac Implants. 1996; 11(6): 756-9.EU Working Group on Tobacco and Oral Health Consensus Meeting, Copenhagen, October 1997. Oral Dis. 1998; 4(1): 48-67.Lie MA, Loos BG, Henskens YM, Timmerman MF, Veerman EC, van der Velden U, et al. Salivary cystatin activity and cystatin C in natural and experimental gingivitis in smokers and non-smokers. J Clin Periodontol. 2001; 28(10): 979-84.Axelsson P, Paulander J, Lindhe J. Relationship between smoking and dental status in 35-, 50-, 65-, and 75-year-old individuals. J Clin Periodontol. 1998; 25(4): 297-305.Sakki T, Knuuttila M. Controlled study of the association of smoking with lactobacilli, mutans streptococci and yeasts in saliva. Eur J Oral Sci. 1996; 104(5-6): 619-22.Williams SA, Kwan SY, Parsons S. Parental smoking practices and caries experience in pre-school children. Caries Res. 2000; 34(2): 117-22.Reibel J. Tobacco and oral diseases. Update on the evidence, with recommendations. Med Princ Pract. 2003; 12 Suppl 1: 22-32.McCoy GD, Hecht SS, Wynder EL. The roles of tobacco, alcohol, and diet in the etiology of upper alimentary and respiratory tract cancers. Prev Med. 1980; 9(5): 622-9.Franceschi S, Talamini R, Barra S, Baron AE, Negri E, Bidoli E, et al. Smoking and drinking in relation to cancers of the oral cavity, pharynx, larynx, and esophagus in northern Italy. Cancer Res. 1990; 50(20): 6502-7.La Vecchia C, Boyle P, Franceschi S, Levi F, Maisonneuve P, Negri E, et al. Smoking and cancer with emphasis on Europe. Eur J Cancer. 1991; 27(1): 94-104.Lesch CA, Squier CA, Cruchley A, Williams DM, Speight P. The permeability of human oral mucosa and skin to water. J Dent Res. 1989; 68(9): 1345-9.Schepman KP, Bezemer PD, van der Meij EH, Smeele LE, van der Waal I. Tobacco usage in relation to the anatomical site of oral leukoplakia. Oral Dis. 2001; 7(1): 25-7.Silverman S Jr, Gorsky M, Lozada F. Oral leukoplakia and malignant transformation. A follow-up study of 257 patients. Cancer. 1984; 53(3): 563-8.Eriksen HM, Nordbo H. Extrinsic discoloration of teeth. J Clin Periodontol. 1978; 5(4): 229-36.Ness L, Rosekrans Dde L, Welford JF. An epidemiologic study of factors affecting extrinsic staining of teeth in an English population. Community Dent Oral Epidemiol. 1977; 5(1): 55-60.Pasquali B. Menstrual phase, history of smoking, and taste discrimination in young women. Percept Mot Skills. 1997; 84(3 Pt 2): 1243-6.Frye RE, Schwartz BS, Doty RL. Dose-related effects of cigarette smoking on olfactory function. JAMA. 1990; 263(9): 1233-6.Taybos G. Oral changes associated with tobacco use. Am J Med Sci. 2003; 326(4): 179-82.Neville BW, Damm DD, Allen CM, Buoquot JE. Oral and Maxillofacial Pathology. Philadelphia: WB Saunders; 1995.Yuca K, Calka O, Kiroglu AF, Akdeniz N, Cankaya H. Hairy tongue: A case report. Acta Otorhinolaryngol Belg. 2004; 58(4): 161-3.

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How Smoking Affects the Eyes

It is well known that the tobacco smoke generated by smoking a cigarette, pipe or other tobacco product can cause damage to the individual who is smoking, and also to the people exposed to the smoke.

The health conditions most commonly associated with tobacco smoke exposure are cancers and cardiovascular disorders. However, there is now a significant body of evidence showing an increased risk of a number of eye disorders, not only in those who smoke, but also in those who are frequently exposed to tobacco smoke.

Tobacco smoke is the smoke generated from smoking tobacco. There are two types of tobacco smoke: Sidestream smoke: Sidestream smoke is the smoke which comes from the tip of a burning cigarette. It contributes about 80% of tobacco smoke-related air pollution, and is 46 times more toxic than mainstream smoke.Mainstream smoke: Mainstream smoke is the smoke which comes from the filter of a burning cigarette, or is inhaled and exhaled by the smoker.

Tobacco smoke contains over 4,000 substances, including many known carcinogens, irritants and inflammatory agents.

Children

While children do not typically smoke cigarettes (at least until adolescence), many are exposed to environmental tobacco smoke, either because their parents smoke at home or in the car, or because they find themselves in environments where adults are smoking. This is commonly known as passive smoking.

Passive smoking has negative effects on the eyes of children exposed to tobacco smoke. The eye diseases and conditions associated with exposure to tobacco smoke in children include:

Strabismus

Strabismus is a condition in which the eyes become misaligned (e.g. crossed eyes). Maternal smoking during pregnancy is associated with a 6.55 times increased risk of strabismus amongst children.

Allergic conjunctivitis

Allergic conjunctivitis isa condition in which the conjunctiva becomes inflamed due to the presence of an allergen.While no studies have been conducted specifically to assess the relationship between allergic conjunctivitis and tobacco smoke exposure, a number of studies of allergic reactions in children have reported that the risk of developing allergic conjunctivitis increased by about 20% in children who are exposed to environmental tobacco smoke.

Adults

In adults, smoking cigarettes is associated with the following eye diseases and disorders:

Cataract

There is strong evidence that smoking particularly pipe smoking increases the risk of cataracts (clouding of the lens of the eye).A review of 27 studies examining the association between cigarette smoking and cataract reported a 3 times increased risk of nuclear cataract, and also evidence of an association between smoking and subcapsular posterior cataract. While studies have not yet demonstrated an association between environmental tobacco smoke exposure and cataract, it remains a potential risk factor.

For more information on cataracts, including the effect of smoking, exercise and nutrition on eyes, as well as some useful animations and tips to keep eyes healthy, see Cataracts.

Uveitis

Uveitis is a condition characterised by inflammation of the uvea (middle section) of the eye. While no studies have been conducted in humans, laboratory studies using rats have determined that endotoxin (a chemical found in tobacco smoke) can induce an inflammatory response and acute uveitis. Thus it is plausible that tobacco-smoke exposure can increase the risk of uveitis in smokers and those exposed to environmental tobacco smoke.

Age related macular degeneration

Smoking is a clearly established risk factor for age related macular degeneration (the deterioration of vision with age). Data from three large cross-sectional studies estimated a 3 times increased risk of age related macular degeneration in smokers compared to nonsmokers.

A review of studies examining the association between age related macular degeneration and smoking reported that smoking actually causes age related macular degeneration, rather than justbeingindirectly associated with the condition. That review also reported that the more people smoked, the more likely they were to develop age related macular degeneration.

The association between environmental tobacco smoke exposure and age related macular degeneration is less clear, and studies to date have presented conflicting results. These conflicting results may be because each of the studies used a different definition of passive smoking.

For more information on age related macular degeneration, including the effect of smoking, exercise and nutrition on eyes, as well as some useful animations and tips to keep eyes healthy, see Macular Degeneration.

Graves' ophthalmopathy (thyroid eye disease)

Graves' ophthalmopathy, also called thyroid eye disease,is a condition characterised by inflammation of the eye and fat in the eye socket. Studies have provided strong evidence of an association betweenthyroid eye disease and how much an individual smokes. Smokers with thyroid eye disease had poorer outcomes than nonsmokers. Data suggests that environmental tobacco smoke exposure increases the risk of Graves' ophthalmopathy, although the data is limited.

Ocular surface disorders

Smoking has been linked to an increase in disorders of the eye's ocular surface which result in symptoms such as itchness, redness and irritation of the eyes. Changes to the eye's ocular surface associated with smoking include changes to the lipid layer of the tear film, reduced tear secretion and reduced corneal and conjunctival sensitivity. Passive smoking can also increase the risk of these disorders. Ocular surface disorders include atopic keratoconjunctivitisand allergic conjunctivitis.

Reducing or eliminating exposure to environmental tobacco smoke and stopping smoking are the key ways to prevent tobacco smoke associated eye disorders.

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Have you quit smoking? Or are thinking about trying to quit? Use this tool to see what health benefits you have already achieved and what benefits you can expect in the future if you stick with it.?For more information, see Health Benefits of Quitting Smoking Tool.

You spend $ on cigarettes each month.

Which means that you spend $ each year.

With this amount of money you could have:

Since you first started you have spent $.

If you continue smoking, here is how much you will have spent:

Age : $

Age : $

Age : $

Age : $

Age : $

This information will be collected for educational purposes, however it will remain anonymous.

Reference: Smoking cessation guidelines for Australian general practice [online]. Canberra, ACT:?Australian Government Department of Health and Ageing;?2004 [cited 11 January 2011]. Available from: URL link
?For more information on smoking, its health effects and how to quit smoking,?as well as?some useful tools, videos and animations, see Smoking.Lois N, Abdelkader E, Reglitz K, et al. Environmental tobacco exposure and eye disease. Br J Ophthalmol. 2008;92(10):1304-10. [Abstract]Stone RA, Wilson LB, Ying GS, et al. Associations between childhood refraction and parental smoking. Invest Ophthalmol Vis Sci. 2006;47(10):4277-87. [Abstract | Full text]Cumming RG, Mitchell P. Alcohol, smoking and cataracts: The Blue Mountains Eye Study. Arch Ophthalmol. 1997;115(10):1296-303. [Abstract | Full text]Kelly SP, Thornton J, Edwards R, et al. Smoking and cataract: Review of causal association. J Cataract Refract Surg. 2005;31(12):2395-404. [Abstract]Smith W, Assink J, Klein R, et al. Risk factors for age related macular degeneration: Pooled findings from three continents. Ophthalmology. 2001;108(4):697-704. [Abstract]Thornton J, Edwards R, Mitchell P, et al. Smoking and age-related macular degeneration: A review of association. Eye. 2005;19(9):935-44. [Abstract | Full text]Klein R, Klein BE, Linton KL, DeMets DL. The Beaver Dam Eye Study: The relation of age-related maculopathy to smoking. Am J Epidemiol. 1993;137(2):190-200. [Abstract]Smith W, Mitchell P, Leeder SR. Smoking and age-related maculopathy. The Blue Mountains Eye Study. Arch Ophthalmol. 1996;114(12):1518-23. [Abstract | Full text]Khan JC, Thurlby DA, Shahid H, et al. Smoking and age related macular degeneration: The number of pack years of cigarette smoking is a major determinant of risk for both geographic atrophy and choroidal neovascularisation. Br J Ophthalmol. 2006;90(1):75-80. [Abstract | Full text]Thornton J, Kelly SP, Harrision RA, Edwards R. Cigarette smoking and risk of thyroid eye disease: A systematic review. Eye. 2007;21(9):1135-45. [Abstract | Full text]Edwards R, Thornton J, Ajit R, et al. Cigarette smoking and primary open angle glaucoma: A systematic review. J Glaucoma. 2008;17(7):558-66. [Abstract]

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How Arc Discharge Affects Health

Arc discharge is the discharge emitted from electric welding arcs. The exact levels of ultraviolet (UV) radiation produced by a welder depend on the length of exposure time, the type of current the welder uses, the shielding gas the welder uses and the type of metal being welded. The level of UV overexposure danger associated with various types of welding can be classified as follows:

Arc welding produces UV radiation at hazardous levels, from across the UV spectrum (i.e. UV-A rays with a wavelength of 400-315 nanometres, UV-B rays with a wavelength of 315-280 nanometres and UV-C rays with a wavelength of 280-100 nanometres).

The sun also produces UV rays in the A, B and C spectrums. UV-A rays account for some 98% of an individual's solar UV exposure, however UV-B rays are responsible for much of the DNA damage which causes cancer.

UV-C rays from the sun are absorbed by the earth's ozone layer and individuals are thus not exposed to solar UV-C. As such, little is known about the relative dangers of UV-C, compared to UV-A and UV-B. However, while it is likely that much of the UV-C emitted from welding arcs is absorbed into the immediate atmosphere, UVC from welding arcs may also come into contact with, and be absorbed by, an individual's skin. This means that individuals in the close vicinity of arc discharge may still be exposed to arc generated UV-C. It is thought to be as dangerous to the skin as UV-B radiation.

Individuals operating electric welding arcs are most at risk of UV exposure from them, as they are positioned very close to the source of UV rays (e.g. the face and hands of the operator is typically very close to the welding arc). As arc welders generate significant heat, users may feel uncomfortable wearing heavy protective clothing and gloves, and therefore be less likely to wear them, increasing their risk of UV exposure.

Welders' assistants, for example, would hold pieces of metal in place in order that they can be welded, are often also in very close proximity to arc discharge and therefore at high risk of over-exposure to UV. Electric welding arcs also potentially create an exposure risk for individuals working in the direct environment of an arc welder (e.g. in the same factory) as well as onlookers or passers by.

Many individuals who use welding arcs are formally trained to do so. These individuals typically use arc welders frequently, in environments characterised by high levels of protection (e.g. face shields and gloves being worn). The limited available scientific evidence suggests that using an arc welder with adequate protection, as this group usually do, does not increase the risk of skin cancer.

However, many more individuals who are not trained as welders (e.g. those engaged in farming, art and other trades) may use arc welders occasionally. These individuals are usually not formally trained to use an arc welder and therefore may not be aware of the health risks associated with use or perceive their level of risk to be low because their use is occasional. Adequate protective clothing may not be available for these occasional welders. Untrained individuals are therefore thought to be more likely to use a welding arc in sub-optimal safety conditions (e.g. without wearing a protective face mask or gloves). These individuals are thought to be at a much higher risk of over-exposure to UV and the associated health risks.

There are no laws in Australia concerning the sale and use of arc welders. These tools are inexpensive and widely available at hardware stores. Thus arc welders can be purchased by individuals who have no training in their use and may be unaware of the health risks associated with arc discharge.

Australian workplace legislation requires that employers take adequate measures to protect workers from health risks, including health risks associated with arc discharge. In workplaces where arc welders are present, employers are required to establish engineering controls (e.g. erecting barriers to enclose UV emission) and administrative controls (e.g. erecting signs to warn of UV exposure), as well as to provide workers with personal protective clothing (e.g. protective face mask, full coverage clothing and gloves). In addition, the Australian Radiation Protection and Nuclear Safety Authority regulates the amount of UV radiation to which an individual can be exposed to in any eight hour period.

Engineering and administrative controls and personal protective clothing greatly reduce the levels of UV exposure associated with arc welding when they are implemented. However, as arc welders are also often used in workplaces where awareness of the health risks of arc discharge is low, these measures are not always implemented.

The health risk most commonly associated with exposure to UV radiation from arc discharge and other sources is skin cancer, including squamous cell carcinoma, basal cell carcinoma and melanoma. There are also a number of eye conditions associated with over-exposure to UV.

Other health risks associated with arc welding and its discharge, which are not related to the UV radiation emitted with arc discharge include:

Pulmonary and respiratory conditions: arc welding is associated with an increased risk of pulmonary disease and other respiratory conditions, which are thought to result from the inhalation of fumes generated by arc welding.Thermal burns: welders may occasionally become burnt when their skin contacts hot metal. Such burns may be serious injuries in themselves, but are also associated with DNA damage which can lead to cancer.

For more information on workplace health including office ergonomics series, useful tips on avoiding injuries in the workplace and costs on the workforce, see Workplace Health.

Vecchio, P. Hietanen, M. Stuck, B.E. et al, Protecting Workers from Ultraviolet Radiation, International Labour Organisation and World Health Organisation, 2007, [cited 2009, April 15] available from: http://www.who.int/uv/publications/protect_workers/en/index.html Dixon, A. "Arc welding and the risk of cancer" in Aust Family Phys, 2007, 36(3):255-6.Dixon, A.J. Dixon, B.F. "Ultraviolet radiation from welding and possible risk of skin and ocular malignancy" in MJA, 2004, 181(3):155-7.Australian Radiation Protection and Nuclear Safety Agency, Radiation Protection Standard: Occupational Exposure to Ultraviolet Radiation, 2006, [cited 2009, April 15] available from: http://www.arpansa.gov.au/Publications/codes/rps12.cfm

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