World Oral Health day, on 20 March, is a day to promote the important contribution of oral health to overall health. We should always keep in mind the association of oral pathology and diseases in different parts of the body. As president of the ENSP, I would like to take the opportunity on this special day to highlight the close relationship between tobacco use and oral health1,2.

Tobacco in all forms and the associated nicotine are harmful to the body, causing damage to our health from the oral cavity to the lungs, bladder, and the reproductive system, to mention only a few of the most common pathologies associated with the use of both e-cigarettes and cigarettes. The oral cavity is the route through which nicotine and tobacco usually enter our body; it is precisely here where significant damage begins.

The deleterious effects of tobacco use on the oral cavity vary greatly. They can range from staining of teeth, which can be reversed, to oral cancer which in Europe has a 50% mortality rate mainly due to delayed diagnosis. Other consequences are halitosis or bad breath, loss of taste or smell, and more importantly a delay in wound-healing with all the ensuing complications for dental interventions1,2.

The most frequent condition caused by tobacco is periodontal disease. The different types worsen the prognosis after surgery and lead to poorer results, increasing the number of implant placement failures. Refractory periodontitis is another type of periodontitis that causes continued attachment loss in spite of adequate treatment and proper oral hygiene. Some other pathologies frequently linked to tobacco use are oral candidiasis, palatal nicotinic stomatitis and the so-called ‘smoker's melanosis’. Compared to smokers of conventional cigarettes, smokers of e-cigarettes present a higher rate of nicotine stomatitis, hyperplastic candidiasis and ‘black hairy’ tongue3-8. The precancerous lesions found in smokers should also be mentioned. These are lesions that can develop into cancerous ones. Hence, the importance of prevention, early detection and treatment cannot be emphasized enough.

All the above facts have made most dental professionals highly aware of their importance in giving advice to patients on smoking cessation, helping them to quit and preventing patients from starting tobacco or nicotine use1,9.

Dental professionals are becoming more involved in the daily struggle against the tobacco industry in order to improve the health of their patients and that of the general population. In this way they are aligned with the rest of the health professionals, non-governmental organizations and Health Departments in the fight against an agent that in Europe alone annually kills 0.7 million people with a concomitant daily healthcare burden of €65 million, not to mention the pain and long suffering experienced by smokers and their families.