Can You Smoke with Braces? Cigarettes and Orthodontic Treatment

Getting a straight, confident smile often involves orthodontic treatment such as braces or clear aligners − devices that involve a large investment of both time and money. But certain lifestyle habits can complicate this journey in ways many people don’t realise. One of the biggest of these is cigarette smoking. 

While smoking rates in the UK have steadily declined over the years, approximately one in eight adults (11.9%) in the UK still smoke, according to ASH (Action on Smoking and Health). This represents a gradual decrease, but the health implications still remain stark. Smoking-cessation group Allen Carr says smoking-related illnesses tragically claim up to 80,000 lives annually in the UK. In fact, about one in two long-term smokers die as a direct result of their bad habit. 

For smokers considering wearing braces or aligners, the big question is: “Can you smoke with braces?” The straightforward answer is that while it’s physically possible to smoke during such orthodontic treatment, it’s strongly discouraged by dental professionals because of its negative effects on both your oral health and the treatment process itself.

In this blog post, we’ll explore these effects in detail and offer important information for anyone considering, or currently undergoing, orthodontic treatment who also smokes cigarettes or uses tobacco products.

Smoking’s Impact on Traditional Braces

There are many types of braces available these days. Traditional braces work by applying controlled force to gradually move your teeth into proper alignment. Whether metal or ceramic, these appliances are made up of brackets bonded to your teeth and connected by wires that guide tooth movement.

When smoking enters this equation, several issues arise. Firstly, the tar and nicotine in cigarettes cause significant staining on teeth and brace components, including brackets, wires and elastics. This staining isn’t just cosmetic – it’s a visible sign of chemical compounds sticking to your dental surfaces. What’s worse is that the parts of your teeth that are covered by brackets stay relatively protected from these stains, so you could be left with uneven colouring when your braces are removed. Patchwork-coloured teeth aren’t exactly the reward you want to be left with after having committed so much time to wearing braces, now are they?

Secondly, braces already make oral hygiene challenging by creating numerous small spaces where food particles can become trapped. Smoking compounds this problem by increasing the build-up of plaque and tartar around brackets and wires. Plus, the harmful chemicals in cigarettes can weaken tooth enamel, making your teeth more prone to decay. Combine this with the difficulty of cleaning thoroughly around braces, and you’ve got the perfect conditions for cavities to form.

These dental health issues aren’t merely uncomfortable − they can actively delay your orthodontic treatment as your orthodontist may need to sort these problems out before continuing with the alignment process.

A third concern is the potential weakening of the bonding agents that hold the brace brackets to your teeth. Some studies suggest that exposure to cigarette smoke may compromise these adhesives over time, causing brackets to loosen or detach. Again, this can disrupt the progress of your treatment and require more orthodontist appointments.

Smoking and Clear Aligners (Including Invisalign)

For their discreet appearance, clear aligners have become increasingly popular for teeth straightening. But it’s worth noting that smoking significantly impacts both their appearance and effectiveness.

One of the most immediate effects is aligner discoloration. Smoke rapidly stains the clear plastic yellow or brown, defeating the main aesthetic advantage of having ‘invisible’ treatment. And unlike your natural teeth, stained aligners can’t be whitened or cleaned effectively once discoloured. What does this lead to? The need for replacements, which will increase your treatment costs.

Appearance aside, the chemicals in cigarette smoke can degrade the plastic structure of aligners, making them more prone to warping, cracking or breaking. This affects their fit and compromises their ability to move teeth effectively, potentially extending treatment time.

While aligners are removable, they often have to be worn for many hours to be effective. One of the conditions for wearing Invisalign, for example, is not to remove them for between 20-22 hours every day. That’s why many of our patients smoke while their aligners are in place. The problem? Smoking while wearing them traps smoke particles and residue between the aligner and teeth, increasing plaque build-up − and risks of gum disease, cavities and persistently foul breath. The porous nature of aligner material means smells become trapped, leading to noticeably bad breath regardless of how thorough your oral hygiene practices are.

You may ask, “Well what if I remove my aligner to smoke?” That comes with the practical issue of reduced wear time. If you’re frequently removing them to smoke, you’re reducing the critical 20-22 hour wear time, potentially prolonging your overall treatment duration.

The Biology of How Smoking Affects Your Mouth During Orthodontic Treatment

Successful orthodontic treatment fundamentally relies on healthy gums and bones. Unfortunately, smoking directly harms both of these.

Reduced Blood Flow 

Perhaps the most significant biological impact is slower orthodontic progress. This is because smoking reduces blood flow and oxygen to your gums and bones, impairing your body’s ability to heal and remodel the bone necessary for teeth to move. Simply put, teeth take longer to shift positions in smokers, extending treatment time significantly. Conversely, faster healing means faster results – another good reason to consider quitting.

Risk of Gum Disease

Are you aware that smoking dramatically increases the risk of gum disease? It does so by weakening the immune system and reducing blood flow, making it harder to fight off the bacteria that cause gingivitis and periodontitis (gum disease). Orthodontic appliances inherently increase the risk of gum inflammation, and smoking exacerbates this considerably. Severe gum disease can lead to gum recession and potentially tooth loss, severely compromising or even halting treatment altogether. It’s worth noting that even passive smoking increases periodontal disease risk.

Bone loss 

Smoking is a major risk factor for bone loss and can negatively impact the height and density of the alveolar bone – the ridge of bone on the upper and lower jawbones that holds the tooth sockets − even in young people. Healthy bones are crucial for supporting teeth as they move and for stability once treatment is over.

Poor Wound Healing

Equally concerning is smoking’s effect on wound healing, which is critical for procedures like tooth extractions that are sometimes needed before or during orthodontic treatment. Smokers face increased risks like dry socket after extractions, causing severe pain and complications that can delay treatment progress. It’s noteworthy that orthodontic miniscrews (sometimes used as anchors in complex cases) have a significantly higher failure rate in heavy smokers, too.

Less Saliva

Smoking also reduces saliva production, which is needed for washing away bacteria and neutralising acids in the mouth. A dry mouth allows bacteria to thrive, not only worsening bad breath but also increasing decay and gum disease risk. It also tends to exacerbate the discomfort often associated with orthodontic appliances.

Smoking’s Impact on Different Orthodontic Materials and Appliances

Different orthodontic materials react differently to cigarette smoke, but none are immune to its effects. Elastics and ligatures (the small rubber bands that hold wires to brackets) are prone to staining, so they may require more frequent replacement in smokers.

Aesthetic wires, designed to blend with teeth, can have both their colour stability and mechanical properties affected by smoke. Similarly, the bond strength of adhesives used to attach brackets may be compromised. This affects metal brace brackets, particularly.

Other devices like palatal expanders or bands can also accumulate stains, which can also indicate areas where harmful bacteria may be accumulating.

5 Practical Steps to Take If You Can’t Quit Immediately

While quitting smoking is unquestionably the best option for your orthodontic treatment (and overall health), we understand that this is a tough habit to break. It can take time. Here’s how to help minimise − though not eliminate − the negative effects:

1. Limit your smoking: Simply cutting down reduces exposure to harmful chemicals. Even reducing by half can make a meaningful difference to your oral health.
2. Remove aligners before smoking: For clear aligner wearers, this step is essential to prevent staining and trapping residue. Tip: Always store them safely in their case, not wrapped in tissue as it can harbour bacteria.
3. Brush and floss frequently: This becomes even more crucial for smokers with braces. Brush after every meal and use aids like floss threaders (for braces) or water flossers to clean around brackets and wires thoroughly.
4. Use mouthwash: An antibacterial mouthwash helps kill bacteria, reduce plaque and freshen breath, acting as a temporary cleaning solution when brushing isn’t possible. Remember, though, this shouldn’t replace brushing and flossing.
5. Visit your orthodontist regularly: Regular check-ups allow your orthodontist to monitor oral health, catch early signs of complications like gum disease or decay, and check appliance integrity. They can provide adjustments or replacements before small issues become major problems.

It’s important to understand that these are damage-control steps; the underlying biological impacts of smoking still occur even if you stick to these practices.

The Best Strategy: Quit Smoking 

This is undoubtedly the single most effective way to protect your oral health and ensure the best possible outcome from your dental treatment. The benefits of quitting for your orthodontic journey are significant, including:

• No more discoloration
• Lower risk of gum disease
• Faster healing
• Reduced risk of tooth decay and bone loss
• Healthier breath and confidence
• Improved stability of results in the long term
• Reduced risk of complications and lower costs
• Improved overall health

Fortunately, there are many resources available in the UK to support you in quitting. The NHS Stop Smoking Services offer free support, with people who use these services being three times more likely to quit successfully. Look into their Quit Smoking app, too. Some people also find success with Allen Carr’s Easyway method.

It’s worth noting that vaping and smokeless tobacco are not risk-free alternatives and are generally discouraged during orthodontic treatment due to their own set of oral health risks. While potentially less harmful than traditional cigarettes, they still present challenges to orthodontic success.

In Sum…

Smoking significantly impacts orthodontic treatment with both braces and aligners through staining, increased risk of gum disease and decay, slower progress, increased discomfort and potentially higher costs.

Quitting smoking offers the best path to a successful and cost-effective orthodontic journey and long-term oral health. If you can’t quit immediately, reducing consumption and following strict oral hygiene practices can help minimise some risks.

At Hampstead Orthodontic Practice, we maintain that regular visits to your orthodontist are vital, particularly if you smoke. If you’re navigating orthodontic treatment as a smoker, we’re here to support your journey − every step of the way.

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