Smoking Still a Driving Factor for Tooth Loss

It has been decades since smoking was “cool,” but it still remains a significant cause of tooth loss in adults.

In recent years, advances in preventive dentistry, such as new techniques for removing dental plaque, have reduced the rates of tooth loss in almost all demographics. Dentists have been preoccupied with whether other factors, namely ageing and diabetes, contribute more to tooth loss. Recent research provides a clear answer: smoking continues to remain a significant determinant of tooth loss.

Most Recent Scientific Evidence Linking Smoking and Tooth Loss

An influential 2025 study in the Journal of Clinical Periodontology used advanced statistical modelling (instrumental variable analysis) to calculate the causal effect of smoking on tooth loss. It found that smoking regularly increased the risk of losing six or more teeth by 10.7%. In contrast, stopping smoking reduced the risk of tooth loss by 7.6%.

A 2019 systematic review confirmed that current smokers are 2.6 times more likely to lose teeth than those who never smoked. Importantly, those who stopped smoking had tooth loss risk levels comparable to those who never smoked, which highlights the benefits of cessation.

A 2023 study further investigated the interaction between smoking and tooth loss in relation to the oral microbiome. It showed that smokers had reduced microbial diversity and increased colonisation by bacterial species such as Prevotella and Streptococcus, which are strongly associated with periodontal disease (an advanced form of gum disease and a direct cause of tooth loss). Tooth loss itself reduced the biome diversity, compounding the risk of oral disease, including oral cancer.

Smoking is on Decline, but Still Causes Tooth Loss

In the UK, smoking trends are going downward. According to official government figures, about 20% of adults (aged 18 and over) smoked in 2011. By 2023, this figure was down to 11.9%, or about 6 million adults. Smoking is less common than in previous decades. However, this has not lessened the role it plays in tooth loss.

Medically, tooth loss is directly caused by caries and periodontal disease. Smoking is a major contributing factor to periodontal disease. The habit can accelerate the breakdown of periodontal ligaments (gum tissue) that hold teeth. Smokers also experience reduced healing and masked inflammation, which worsens the outcomes for gum disease.

So smoking is no longer the biggest single cause in absolute numbers, but it is still the biggest preventable lifestyle risk factor for periodontal-related tooth loss.

For individual smokers, smoking is the most considerable risk factor for tooth loss. Compared to non-smokers, the risk of tooth loss in smokers is still disproportionately high.

In the UK, smoking remains one of the strongest predictors of tooth loss in populations where smoking rates are still high, such as Scotland and deprived areas.

Other Diseases Continue to Contribute to Tooth Loss

The total population burden of smoking-related tooth loss in the UK is smaller than it once was. A 2021 government survey in England, Wales, and Northern Ireland showed that only about 6% of older adults had no natural teeth. This is a dramatic drop from 37% in 1968. In 2009, 73% of older adults had at least 21 natural teeth, but in 2021, this number had increased to 85%. The tooth loss rates in the UK are clearly improving when judged by the numbers.

However, tooth loss rates worsen when accounting for demographics and access to healthcare. Those in low-income areas in the UK, with limited access to dental care, are more likely to experience tooth loss as older adults. Moreover, people with chronic health conditions, especially diabetes, are more likely than the general population to experience tooth loss.

Factors such as the increasing prevalence of type II diabetes and obesity are causing more risk for tooth loss in adults, even if they do not smoke. When chronic diseases are combined with smoking, the risk is alarmingly high.

For patients, the message is straightforward. Every cigarette increases the risk of losing teeth, and every step towards quitting helps preserve them.