“Smoking is hateful to the nose, harmful to the brain and dangerous to the lungs”.
Smoking and Health 
Smoking causes many diseases and compromises general health. 1 person every 6 seconds is killed worldwide due to tobacco related diseases (6 million annually). Nicotine, an addictive compound present in tobacco smoke cause people to continue to smoke. Along with nicotine around 7,000 other chemicals are present in cigarette. Tobacco smoke also contains 70 types of cancer causing agents.
Vulnerable chemicals in tobacco smoke
Acetone- paint stripper
Ammonia – toilet cleaner
Arsenic and Phenol- rat poison and disinfectant
Butane – lighter fluid
Carbon monoxide- exhaust fumes
Naphthalene- mothballs, etc.
Effects of smoking tobacco on the body
Effects of Smoking on Oral Health
SMOKERS are 4 times more likely to develop oral health issues than non smokers.
Smoking increases the risk of root caries, gums and periodontal diseases, oral precancerous and cancerous lesions. It also causes alter taste sensation, staining of teeth and dental implants, delayed wound healing and increases bone resorption.
The exact etiology on how smoking causes wound healing is not known but various components like nicotine, carbon monoxide and hydrogen cyanide contributes in delay wound healing.
Tobacco also affects daily routine procedures done in the oral cavity, from nonsurgical periodontal procedures to orthognathic surgeries. It reduces blood supply of the alveolus after extraction and cause dry socket, common in smokers due to fibrinolytic activity.
Smoking and Implants 
A dental implant is a tooth like devise which resemble a tooth and replaces missing teeth.
A dental implant is a prosthetic device placed beneath the bone to provide anchorage and support for dental prosthesis. It works on the mechanism called osseointegration, where bone fuses tightly to material like titanium with bone and can be use on single or multiple teeth.
An individual with good oral health and sound general health are the ideal candidates for dental implants.
There are various factors to be considered for a successful implant placement from a good surgery to proper prosthesis and proper maintenance. More importantly, patients related factors like general patient health, quality and quantity of the bone, oral hygiene, habits like smoking, etc plays an important role in determining the likelihood of implant.
According to a study, smoking is the main patient related factor associated with implant failure with failure rate of 6.5% to 20% more compared to non smokers.
The adverse effects of tobacco smoking in implant may be due to multiple factors and their mechanism may be from both local and systemic biological routes.
In case of smokers, the failure and success of implants depend on the quality of trabecular bone and mandibular implants have higher success rate compare to maxillary implants due to low bone quality. Local factors, like absorption of nicotine in bloodstream increases implant failure and implant failure decreases in posterior mandibular regions due to tongue coverage. Some studies show that higher the use of tobacco, higher the rate of implant failure.
The exposure of peri-implant tissues to tobacco is the main cause of implant failure and not due to poor healing or osseointegration. It causes more marginal bone loss and decrease the success rate of bone graft around implant. Again failure in grafted maxillary sinus is two folds in smoker than non smokers.
In a study, by Bain and Moy various protocols are followed to reduce the rate of implant failure. Protocols like cessation of smoking 1 week before surgery and 2 months after implant placement. These will reverse the aggravated effect of blood viscosity, platelet adhesion and increase bone healing quality due to proper blood flow and oxygen to the blood. The use of antibiotics before and after surgery will also aids in the success rate of the implant by preventing infection along with proper oral care.
Conclusion
Smoking increases the risk of implant failure to an extent but is not an absolute contraindication. In this modern era, where technology in implant systems are fast and forwarding certain measures like conservative or minimal surgical techniques hydroxyapatite implants, proper counseling about cessation of smoking (permanently if not temporary during implant treatment citing the adverse effects of smoking on overall general health, oral health and implant failure), maintaining proper general and oral care are few measures to be followed to reduce the rate of implant failure to minimal.
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