This Dental Interview question can be tricky. They often ask scientific questions, so don’t be surprised to see this one. This may be a subject you know about, or may be completely new – but let’s find out about Smoking and the link to Dentistry. As a Dental applicant, you much have a wider knowledge of Dentistry from your reading, so let’s dive in:

QUESTION: Smoking and Dentistry – what’s the link?

What does smoking do?

One of the strongest risk factors for periodontal (gum) diseases is smoking. It results in faster onset, greater severity and worsening progression of gum disease. Smoking creates a more favourable environment for periodontal pathogens. In other words, the toxins and by-products of smoking create an environment where the gum disease-causing bacteria can thrive and grow faster than good bacteria.


Smoking also results in other changes, too; there is a “dramatic change in vascular, inflammatory, immune and healing responses of the mouth”. This is according to research completed at King’s College London Dental Institute.


Are there any other Risk Factors for gum disease?

There are also other risk factors, such as age and genetics, that make some patients more likely to develop gum disease. The effects of smoking are dependent on the number of cigarettes smoked per day, how long he/she has smoked and also the amount of tobacco in the cigarettes (if “rolled-up” by the individual).


Smokers respond less successfully to periodontal (gum) treatment, and this is likely related to the fact that smoking compromises the healing process and the periodontal ligament (PDL) which attaches the tooth to the surrounding bone. This damage to the PDL means it cannot regenerate well. Gum disease leads to a damage of the underlying bone, and eventually the loss of that tooth.


Smoking and Alcohol

The act of smoking, along with severe alcohol misuse, is a well known major risk factor for oral cancer in the UK population. Smoking and alcohol have a synergistic relationship; the use of both in large quantities dramatically increases the risk and occurrence of oral cancer. Oral cancer can affect any part of the mouth, including the lips, tongue, cheek and throat.

Typical symptoms include red and white patches or ulcers, unusual lumps and swellings that cannot be explained by any other reason, and ulcers that do not heal within 2-3 weeks. These can be painful or painless, may bleed or may be inconspicuous, and the patient may or may not even be aware of the symptoms. Therefore, it is crucial that dentists perform full thorough examinations of the mouth and all of its soft tissues. This is to detect any possible lesions that appear suspicious. Early detection is a major factor to successful treatment of oral cancer.


The British Dental Association (BDA) reports around 5000 new cases of mouth cancer diagnosed annually in the UK, with roughly around 1800 deaths per year attributed to the disease.


Use of other tobacco agents, also cause mouth cancer. Chewing tobacco (also known as paan in Asian communities) is one example, and it is a mixture of tobacco and betel quid (areca nut). Betel quid is carcinogenic to humans and increases the risk of oral cancer as it is chewed non-stop throughout the day by many communities in the UK.


Are there any other Risk Factors for oral cancer?

In addition to cigarette smoking and alcohol misuse, there are many other risk factors for oral cancer. Dentists should ask if patients use waterpipes (also known as Shisha or Hookah). Shisha exposes users to tobacco smoke over a longer period of time than traditional cigarette smoking. This means they are inhaling greater amount of toxins over time. The use of Shisha is growing globally, especially amongst 18-24 year olds, and should be discussed with their dentist.

Furthermore, the patient’s age and history of any previous oral cancer are also non-modifiable risk factors; the greater the age and the previous history of oral cancer increase the risk for patients. Diet also plays a crucial role, not only in the incidence of gastrointestinal cancer, but increasing evidence now shows a relationship with oral cancer, too. Finally, there is new evidence that viruses, such as the Human Papilloma virus (HPV) may contribute to oropharyngeal cancers.


What advice should we give patients?

        Do not smoke; use any services available, such as the NHS Stop Smoking Service, to help

        Do not use smokeless tobacco, such as paan or chewing tobacco

        Reduce alcohol consumption to moderate levels

        Keep a good diet, with high fruit and veg (5 portions per day)

        Visit the dentist regularly for check ups which include a thorough oral screening assessment


Further Information

You can find further information to supplement your answer to this dental interview question on Smoking and the links to Dentistry here.


So how do you answer this as a dental interview question?

It is important to accept that you will not have all the knowledge. That is okay. The Dental interview question is designed to challenge you and put you under pressure.

Give your answer in a structured manner. Don’t forget that the examiners will not expect you to have a full answer. You must clearly outline your answer in the following way:

  • Explain that you have done some extra reading on the topic. Tell them the names of journals or articles.
  • Tell them you don’t know everything, but a general understanding
  • Start with the basic concepts and explain them in a way that a child would understand
  • Continue to more complex science once you have shown you understand the basics.
  • If there is something you do not understand, you should ask the interviewer. This will show that you are inquisitive, curious to learn and not afraid to ask questions. It will impress the examiners.

For further guidance on how to structure your answer, as well as over 150 dental interview questions and answers, visit the “Miscellaneous Questions” in our Interviews Section here.

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