Why It Matters That Tobacco Harm Reduction Brightens Smiles

    People who switch from cigarettes to smoke-free nicotine options have whiter smiles than those who continue to smoke, a study has found. Its implications are far more than just aesthetic.

    That’s because appearance can be an important motivation for people to quit smoking, as past research has shown. Other work has indicated that tooth discoloration is a major source of dissatisfaction among people who smoke.

    The new study is the first to investigate changes in oral health and dental aesthetics among people who’ve switched from cigarettes to harm reduction alternatives such as vapes.  

    Part of the SMILE project at the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR) at the University of Catania, Italy, the study involved a large group of international researchers. Over 400 participants in Italy, Poland, Moldova and Indonesia were offered tobacco harm reduction products of their choice.

    The ongoing research aims to help lower smoking rates by presenting compelling evidence that using harm reduction alternatives is better for oral health.

    Dr. Riccardo Polosa, professor of internal medicine at the University of Catania and founder of CoEHAR, is one of the authors, and Filter spoke with him to find out more. Our interview has been lightly edited for length and clarity.


    Kiran Sidhu: Why is this study important?

    Dr. Riccardo Polosa: This study is significant as it marks the first investigation into how e-cigarettes and heated tobacco products affect dental aesthetics. Utilizing a new methodology that allows precise measurement of dental color, findings revealed that cigarette smokers had about 35 percent more dental discoloration than non-smokers, former smokers, and those exclusively using e-cigarettes or heated tobacco products, who showed notably whiter teeth in comparison. 


    How can your findings be used to help people? 

    These insights are relevant both for research—enriching our understanding of the aesthetic impacts of non-combustible products—and for consumers. Given the concern many, particularly young people, have regarding the appearance of their smile, this evidence could encourage smokers who struggle to quit to consider switching to these less harmful alternatives, not only to improve their teeth appearance, but also potentially to lower their health risks.

    “For these individuals, a narrative emphasizing the benefits of a healthier and brighter smile could be a more persuasive incentive than the fear of future lung cancer.”

    The negative impact of cigarette smoking on oral health and teeth discoloration is  well-known, yet convincing smokers to quit remains a challenging and often fruitless struggle. I believe that highlighting [our] findings … could provide compelling new information for dentists and dental hygienists, and may carry significant implications for smokers who are particularly concerned about bad breath and/or the aesthetic appearance of their teeth.

    For these individuals, an oral health-focused narrative, emphasizing the benefits of a healthier and brighter smile, could be a more persuasive incentive to stop smoking than the fear of future lung cancer or cardiopulmonary diseases.


    I’ve read about dentists who are very anti-vape. Do you think this study will help change their minds?

    While it’s true that many dentists are skeptical about vaping, this perspective isn’t universal. I’ve encountered numerous dentists, dental hygienists and implantologists who are keen on encouraging patients to transition away from tobacco smoke by switching to combustion-free nicotine products.

    This variation in viewpoints highlights the complexity of the issue, which is often compounded by a lack of thorough understanding and the influence of low-quality research. A critical examination of existing studies is essential to navigate these opinions and foster a more informed stance on vaping within the dental and health care communities.

    The hope is to heighten awareness among dentists and dental hygienists about their pivotal role in smoking cessation and tobacco harm reduction. Dentists, perhaps more than other healthcare professionals, are in a unique position to monitor patients longitudinally and build trustful relationships. This positions them well to engage with patients who find it difficult or are unwilling to stop smoking, by introducing them to alternative options that can positively impact oral health and dental aesthetics.

    Dental discoloration, often a source of discomfort and embarrassment, particularly for younger individuals, is a sensitive issue. By focusing on the potential for aesthetic improvement, dentists can use the appeal of a brighter smile as a powerful motivator, thereby contributing significantly to the reduction of smoking-related harm.

    “The belief that the damage done by smoking is permanent, and that changing habits is pointless, is wrong, and our study proves it.”


    Some people who’ve smoked long-term may think it’s too late to repair the staining caused by smoking cigarettes. What would you say to them?

    To long-term smokers, I would say that it is never too late to make a healthy choice. The belief that the damage done by smoking is permanent, and that changing habits is pointless, is wrong, and our study proves it.

    The evidence shows that former smokers have whiter teeth than current smokers, and that using combustion-free products can lead to whiter teeth compared to conventional cigarette use.

    Success in reducing smoking-related harm hinges on patient awareness and engagement. Without genuine commitment and motivation from patients, no smoking cessation strategy can succeed. As mentioned earlier, this scientific evidence may serve as a powerful motivator.



    Photograph (cropped) by William Fortunato via Pexels

    Both The Influence Foundation, which operates Filter, and CoEHAR have received grants from the Foundation for a Smoke-Free World.

    • Kiran is a tobacco harm reduction fellow for Filter. She is a writer and journalist who has written for publications including the Guardian, the Telegraph, I Paper and the Times, among many others. Her book, I Can Hear the Cuckoo, was published by Gaia in 2023. She lives in Wales.

      Kiran’s fellowship is supported by an independently administered tobacco harm reduction scholarship from Knowledge-Action-Change—an organization that has separately provided restricted grants and donations to Filter.

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