Pandey, Josh, and Mohapatra: Effect of tobacco consumption – A review


Tobacco comes from the leaves of Nicotiana tabacum which are raised, dehydrated and preventable cause of death, although it is Primarily a Risk factor. However, reduction in tobacco consumption is seen more effectively in developed countries as compared to developing countries. India is the second largest consumer and third largest producer of tobacco.1 Annually 7,00,000 deaths are recorded in India which are mainly attributed to tobacco consumption and is expected to rise around 1 million in next few decades.2 China followed by India are the major countries which contribute to smoking risks. (Figure 1)

Figure 1

Worldwide distribution of smokers; MPOWER package, 2008

In India, around 35% adults use tobacco and around 25% consume smokeless tobacco, 9% only smoke cigarettes while 5% use cigarettes as well as CIT.3 In India, annual incidence of oral cancer among males is as high as 10 per 100,000. Smokers are more prone to develop respiratory, cardiovascular and peripheral vascular diseases as compared to non-smokers. Approximately, one person dies due to tobacco consumption every six seconds.4, 5 Smoking is considered as a chronic relapsing condition, whose treatment is often difficult. As reported by American Heart Association, nicotine dependence is hardest to interrupt because its behavioural as well as pharmacological features those are equivalent to that of cocaine and heroin dependence.6

Second Hand Smoke

It is also called as passive smoking, involuntary smoking and environmental tobacco smoking. Second hand smoking is basically inhalation of tobacco smoke by persons other than the intended “active” smoker, which affect the children around (Figure 2).

Figure 2

Diseases and adverse health effects caused by second hand smoke

Third Hand Smoke

Third hand smoke refers to the chemical residual of tobacco smoke built up for weeks and months that clings to clothing, cushions, furniture, wall, carpet, hair, skin, and other materials after the cigarette is extinguished. This normally affects the young ones who quire toxins by tongue while playing (Figure 3)

Figure 3

Third hand smoking biggest risk to young children

Green Tobacco Sickness (GTS)

GTS is a form of nicotine sickness/poisoning that occurs due to nicotine dermal exposure with wet tobacco leaves. Commonly seen among people who harvest or cultivate tobacco. The overall prevalence of GTS is higher (86.2%) among tobacco cultivators. Symptoms mainly includes headache, weakness, giddiness, nausea, vomiting, abdominal pain and breathlessness.

Musculoskeletal effect Review of Tobacco Consumption

Tobacco consumption has many deleterious effects on the musculoskeletal system which in turn reduces the quality of life. Studies conducted by different researchers who studied the effect of smoking on musculoskeletal system has been depicted in Table 1.

Table 1

Effect of smoking on musculoskeletal system



Beyth et al., 20157

Average concentration of Bone marrow progenitor cells (BMPCs) in smokers is lower as compared to nonsmokers.

Bjarnason et al., 20098

Bone mineral density of smokers on treatment with estradiol increases but with a less pace as compared to nonsmokers

Breitling, 20159

The study was carried out on three different groups (i.e. never-smokers, former smokers and current smokers) and they showed an overall positive trend between calcium consumption and BMD

Callreus et al., 201310

The relative fracture risk and bone mineral density is same in never-smokers and former and current smokers; however, the bone mineral density of femoral neck gets reduced as smoking increases. The bone mineral density is not significantly lower in young women of a longer duration of time or just started. In case of smokers the reduced levels of bone mineral density last only for 24 months and becomes equal to those of nonsmokers with 24 months of time.

Cangussuet al., 201211

There was no significant difference between the postural balance among smokers and nonsmokers, in the study. However, the risk of fall was seen to be higher among smokers than nonsmokers in case of postmenopausal women

Caram et al., 201612

The results of the study showed that there is an inverse joint effect of smoking and COPD on health, composition of body and exertion.

Cetin et., 2009 13

Smokers have higher rate of osteopenia and osteoporosis as compared to nonsmokers. Less T-scores in smokers Higher activity of antioxidant enzymes in smokers than nonsmokers

Chassanidis et al., 201214

Smokers showed less reduction of expression of bone morphogenetic proteins (BMP-2, BMP-4 and BMP-6) Also non-fractured group showed higher expression of bone morphogenetic proteins than fractured group.

Dorn et al., 201315

High frequency of smoking is associated with less bone mineral density of lumber spine and total hip among 13-19 age group of girls Higher symptoms of depression are associated with less BMD of lumber spine

Drage et al 200716

No significant association between bone marrow density of jaws, hips etc and years of cigarette smoking exists.

Eleftheriou et al., 201317

Smoking adversely affects the bone marrow density and calcaneal quantitative ultrasound High bone marrow density in case of moderate alcohol intake Physical activities improve the bone mineral density

Emaus et al., 201418

Life time bone loss was higher in smokers than in nonsmokers Body mass index effects the loss of bone in case of women

Fujiyoshi et al., 201619

According to this study, people who were current smokers showed lower levels of parathyroid hormone as compared to old smokers. Along with this smoker also showed lowest levels of serum calcium and excretion of calcium through urine in a day.

Kargin et al., 201620

Mean serum PTH level and C-terminal telopeptide levels were less in smokers than in nonsmokers.

Kassi et al., 201521

The study revealed that smokers had comparatively less 25(OH)D level than nonsmokers.

Kaume et al., 201422

Smoking-induced bone loss was lesser in women consuming antioxidant rich berries is less than in non-consuming group.

Kleppinger et al., 201023

According to this study the weight, fat mass and functional muscle mass increased within a period of 16 months after quitting cigarette.

Lucas et al., 201224

Lower levels of bone mineral density was observed in girls at the age of 17 years who consumed smoking at the age of 13 and same goes with those who consumed alcohol.

Myong, et al., 201325

A significant linear relationship exists between smoking and bone mineral density among Korean women.

Tamaki et al., 201026

Smokers showed less lumber spine bone mineral density as compared to smokers

Dinah et al., 200727

The success of operative management in case of nonunion carpal scaphoid was less in smokers as compared to nonsmokers.

Hernigou & Schuind, 201328

In case of both open as well as closed fracture smoking showed significant association with nonunion.

Campos et al., 201129

Smoking shows negative effect on expression of alveolar bone-related markers.

Adler et al., 200830

Smokers showed deep periodontal pockets as compared to nonsmokers.

Eren et al., 201531

Lesser platelet-derived growth factor-AB are seen in smokers as compared to nonsmokers

Heikkinen et al., 200832

Boys and girls who smoke showed higher calculus and periodontal pocket as compared to those who do not smoke.

Hugoson & rolandsson, 201133

Smokers showed more significant association with severe periodontitis as compared to gingivitis. Snus users showed less significant association with gingivitis and periodontitis.

Torrungruang et al., 201234

Periodontal conditions were compromised among smokers as compared to nonsmokers.

Ata-Ali et al., 201635

Peri-implant parameters were compromised among smokers as compared to nonsmokers.

Rodriguez-Argueta et al., 201136

Strong association exists between smoking and complications in case of implants.

Romanos et al., 201337

As compared to smokers’ long term success rate of dental implants was more in nonsmokers.

Shibli et al., 201038

Smokers showed less bone-to-implant contact and decreased bone density inside and outside the threaded area.

Sverzut et al., 200839

Smokers showed 3.2% of early implant loss in contrast to only 2.81%. nonsmokers.

Saevarsdottir et al., 201140

Current smokers showed lower response to treatment (MTX &TNF inhibitors).

Mattey et al., 201141

Smokers showed high scores of Bath AS Functional Index as compared to nonsmokers.

Adedoyin et al., 201042

Athletes who smoke showed high rate of exertion and fatigue index as compared to nonsmoker athletes.

Kim & Kim, 201243

Smokers are more dependent on internal oblique and transverse abdominis muscles as compared to nonsmokers.

Kumar et al., 201044

Smokers showed reduction in lumber extension strength as compared to nonsmokers.

Rom et al., 201545

According to this study the subjects who quit smoking showed improvement in body parameters as well as strength as compared to those who continued smoking.

Blackwell et al., 201646

Smokers showed early meniscus repair failure as compared to nonsmokers.

Sanden et al., 201147

Requirement of analgesics was more in smokers The ability to walk after surgical treatment of lumber spine in smokers was more difficult to improve than nonsmokers.

Hagnas et al., 201648

Babies of smoker mothers were more associated with low aerobic fitness than nonsmoker mothers.

Holmberg et al., 201149

The bone mineral density of individuals who were exposed to second hand smoking was less than nonsmokers.

Zadzinska et al., 201650

According to this study there are more chances of having offspring with shorter leg length in parents who smoke than in parents who do not smoke.

Dental Health

Primarily, mouth is exposed to tobacco and most significant effects of tobacco affects the oral cavity includes precancerous lesions, oral cancers, periodontal diseases and poor wound healing. Tobacco smoke also causes tooth decay, wearing of teeth, black pigmentation of oral tissues, Gingivitis, palatal erosions, black hairy tongue, keratotic patches. Cigarette smoking during gestation has six times greater chances of having babies with birth defects like cleft lip and cleft palate formation.51 Primary caries are seen among children in case of maternal tobacco consumption.52

Figure 4

Oral ulceration due to tobacco consumption


The issue of smoking, invariably triggers oral cancer in the brain but other issues cannot be too emphatically forgotten. Carcinoma is the most obvious terrifying condition, for which tobacco is a recognized risk factor but not causative agent. Present paper has been specifically designed to draw the attention of researches to the important studies on tobacco consumption and its effect on health other than cancer, for which tobacco is a causative agent by producing biological and physiochemical changes in humans. Multiple aspects are still not touched sinces they were beyond the scope of the present review.

Source of Funding


Conflict of Interest

The authors declare that there is no conflict of interest.



P Jha FJ Chaloupka Tobacco control in developing countriesOxford University Press2000


World Health Organization. Health topics: Tobacco


V Gajalakshmi R Peto T Santhanakrishna Kanaka P Jha Smoking and mortality from tuberculosis and other diseases in India: retrospective study of 43 000 adult male deaths and 35 000 controlsLancet200336293835071510.1016/s0140-6736(03)14109-8


Global Adult Tobacco Survey GATS India 2009-2010. Ministry of Health and [5] Family Welfare Government of India


S Amit A Bhambal V Saxena B Sakeena S Saxena A Vanka Tobacco cessation [13] and counseling. A dentist’s perspective in Bhopal city, Madhya PradeshIndian J Dent Res20112234003


M Marselos Fragides Ch Knowledge and attitudes of Greek pupils towards smoking Mat Med Greca198917210110


CG Chassanidis KN Malizos S Varitimidis S Samara T Koromila P Kollia Smoking affects mRNA expression of bone morphogenetic proteins in human periosteumJ Bone Joint Surg201294-B1014273210.1302/0301-620x.94b10.28405


LD Dorn SJ Beal HJ Kalkwarf S Pabst JG Noll EJ Susman Longitudinal impact of substance use and depressive symptoms on bone accrual among girls aged 11–19 yearsJ Adolesc Health2013524393910.1016/j.jadohealth.2012.10.005


NA Drage RM Palmer G Blake R Wilson F Crane I Fogelman A comparison of bone mineral density in the spine, hip and jaws of edentulous subjectsClin Oral Implant Res200718449650010.1111/j.1600-0501.2007.01379.x


KI Eleftheriou JS Rawal LE James JR Payne M Loosemore DJ Pennell Bone structure and geometry in young men: The influence of smoking, alcohol intake and physical activityBone2013521172610.1016/j.bone.2012.09.003


N Emaus T Wilsgaard LA Ahmed Impacts of Body Mass Index, Physical Activity, and Smoking on Femoral Bone Loss: The Tromsø StudyJ Bone Miner Res20142992080910.1002/jbmr.2232


A Fujiyoshi LE Polgreen MD Gross JP Reis S Sidney DR Jacobs Smoking habits and parathyroid hormone concentrations in young adults: The CARDIA studyBone Rep20165104910.1016/j.bonr.2016.04.003


NC Kargin K Marakoglu A Unlu L Kebapcilar EN Korucu Comparison of bone turnover markers between male smoker and non-smokerActa Med Mediterr201632231723


EN Kassi S Stavropoulos P Kokkoris A Galanos P Moutsatsou C Dimas Smokingisa significant determinant of low serum vitamin D in young and middle-aged healthy malesHormones (Athens)201514224150


L Kaume EE Gbur R DiBrezzo LR Howard L Devareddy Antioxidant-rich berries exert modest bone protective effects in postmenopausal smokers without improving biomarkers of bone metabolismJ Funct Foods2014912021010.1016/j.jff.2014.04.025


A Kleppinger MD Litt AM Kenny CA Oncken Effects of Smoking Cessation on Body Composition in Postmenopausal WomenJ Women's Health20101991651710.1089/jwh.2009.1853


R Lucas S Fraga E Ramos H Barros Early Initiation of Smoking and Alcohol Drinking as a Predictor of Lower Forearm Bone Mineral Density in Late Adolescence: A Cohort Study in GirlsPLoS ONE201271010.1371/journal.pone.0046940


JP Myong HR Kim SE Choi JW Koo Dose-related effect of urinary cotinine levels on bone mineral density among Korean femalesOsteoporos Int201324413394610.1007/s00198-012-2107-6


J Tamaki M Iki Y Satoetal Smoking among premenopausal women is associated with increased risk of low bone status: The JPOS StudyJ Bone Miner Metab20102833207


AF Dinah RH Vickers Smoking increases failure rate of operation for established non-union of the scaphoid boneInt Orthop2007314503510.1007/s00264-006-0231-7


J Hernigou F Schuind Smoking as a predictor of negative outcome in diaphyseal fracture healingInt Orthop2013375883710.1007/s00264-013-1809-5


JMD Campos AJ Prati FR Cirano SP Pimentel GP Pastore VG Pecorari Smoking Modulates Gene Expression of Type I Collagen, Bone Sialoprotein, and Osteocalcin in Human Alveolar BoneJ Oral Maxillofac Surg20157311212331


L Adler C Modin J Friskopp L Jansson Relationship between smoking and periodontal probing pocket depth pro-fileSwedish Dent J200832415763


Gl Eren HO Turkolu H Atmaca FG Atilla Evaluation of GCF MMP-1, MMP-8, TGF-β1, PDGF-AB, and VEGF levels in periodontally healthy smokersTurk J Med Sci2015454850610.3906/sag-1405-112


AM Heikkinen R Pajukanta J Pitkäniemi U Broms T Sorsa M Koskenvuo The Effect of Smoking on Periodontal Health of 15- to 16-Year-Old AdolescentsJ Periodontol200879112042710.1902/jop.2008.080205


S Beyth R Mosheiff O Safran A Daskal M Liebergall Surgeon General’s Report 2004. Health consequences of SmokingCigarette Smoking Is Associated with a Lower Concentration of CD105(+) Bone Marrow Progenitor Cells,” Bone Marrow Research201516


K Torrungruang V Gongsakdi L Laohaviraphab K Likittanasombat W Ratanachaiwong Association between cigarette smoking and the intraoral distribution of periodontal disease in Thai men over 50 years of ageJ Investig Clin Dent2012321354110.1111/j.2041-1626.2011.00105.x


J Ata-Ali AJ Flichy-Fernández T Alegre-Domingo F Ata-Ali M Peñarrocha-Diago Impact of heavy smoking on the clinical, microbiological and immunological parameters of patients with dental implants: a prospective cross-sectional studyJ Investig Clin Dent201674401910.1111/jicd.12176


OF Rodriguez-Argueta R Figueiredo E Valmaseda-Castellon C Gay-Escoda Postoperative Complications in Smoking Patients Treated With Implants: A Retrospective StudyJ Oral Maxillofac Surg20116982152710.1016/j.joms.2011.02.082


GE Romanos K Gaertner E Aydin GH Nentwig Long-Term Results After Immediate Loading of Platform-Switched Implants in Smokers Versus Nonsmokers with Full-Arch RestorationsInt J Oral Maxillofac Implat2013283841510.11607/jomi.3223


JA Shibli A Piattelli G Iezzi Effect of smoking on early bone healing around oxidized surfaces: a prospective, controlled study in human jawsJ Periodontol201081457583


AT Sverzut GAV Stabile M Moraes R Mazzonetto RWF Moreira The Influence of Tobacco on Early Dental Implant FailureJ Oral Maxillofac Surg20086651004910.1016/j.joms.2008.01.032


S Saevarsdottir S Wedren M Seddighzadeh Patients with early rheumatoid arthritis who smoke are less likely to respond to treatment with methotrexate and tumor necrosis factor inhibitors: observations from the epidemiological investigation of rheumatoid arthritis and the Swedish rheumatology register cohortsArthritis Rheumatol20116312636


DL Mattey SR Dawson EL Healey JC Packham Relationship Between Smoking and Patient-reported Measures of Disease Outcome in Ankylosing SpondylitisJ Rheumatol2011381226081510.3899/jrheum.110641


RA Adedoyin CE Mbada AM Odiachi BOA Adegoke TO Awotidebe Differences in back extensor muscles fatigability for smoking and non-smoking athletesIsokinetics Exerc Sci20101831495510.3233/ies-2010-0377


LJ Kim N Kim Difference in lateral abdominal muscle thickness during forceful exhalation in healthy smokers and non-smokersJ Back Musculoskelet Rehabil201225423944


GP Kumar Assessment off atigue susceptibility of the lumbar extensor muscles amongst smokesBiomed Eng20102243216


O Rom AZ Reznick Z Keidar K Karkabi D Aizenbud Smoking cessation-related weight gain-beneficial effects on muscle mass, strength and bone healthAddiction201511023263510.1111/add.12761


R Blackwell LC Schmitt DC Flanigan RA Magnussen Smoking increases the risk of early meniscus repair failureKnee Surg Sports Traumatol Arthrosc20162451540310.1007/s00167-016-4002-8


B Sanden P Forsth K Michaelsson Smokers show less improvement than nonsmokers two years after surgery for lumbar spinal stenosis: a study of 4555 patients from the Swedish spine registerSpine J20113613105964


MP Hagnäs H Cederberg J Jokelainen I Mikkola U Rajala S Keinänen-Kiukaanniemi Association of maternal smoking during pregnancy with aerobic fitness of offspring in young adulthood: a prospective cohort studyInt J Obstet Gynaecol20161231117899510.1111/1471-0528.13789


T Holmberg M Bech T Curtis K Juel M Grønbæk K Brixen Association between passive smoking in adulthood and phalangeal bone mineral density: results from the KRAM study--the Danish Health Examination Survey 2007-2008Osteoporos Int20072212298999


E Żądzińska S Kozieł B Borowska-Strugińska I Rosset A Sitek W Lorkiewicz Parental smoking during pregnancy shortens offspring's legsHOMO201667649850710.1016/j.jchb.2016.06.002


NH Bjarnason TF Nielsen HL Jørgensen C Christiansen The influence of smoking on bone loss and response to nasal estradiolClimacteric200912596510.1080/13697130802587689


LP Breitling Smoking as an Effect Modifier of the Association of Calcium Intake With Bone Mineral DensityJ Clin Endocrinol Metab201510026263510.1210/jc.2014-2190


M Callreus F Mcguigan K Akesson Adverse effects of smoking on peak bone mass may be attenuated by higher body mass index in young female smokersCalcified Tissue Int201393651725


LM Cangussu J Nahas-Neto EAP Nahas ABCR Barral DA Buttros G Uemura Evaluation of postural balance in postmenopausal women and its relationship with bone mineral density- a cross sectional studyBMC Musculoskelet Disord201213110.1186/1471-2474-13-2


LMDO Caram R Ferrari AL Bertani Smoking and early COPD as independent predictors of body composition, exercise capacity, and health statusPLoS ONE20161110e0164290


A Cetin S Muhtaroglu R Saraymen A Ozturk I Muder-Ris Smoking-Induced Bone Defects May Be Due to Oxidative Damage in Postmenopausal WomenTurkiye Klinikleri J Med Sci20092948518


A Hugoson M Rolandsson Periodontal disease in relation to smoking and the use of Swedish snus: Epidemiological studies covering 20 yearsJ Clin Periodontol198338980916


SS Hiremath Textbook of preventive and community dentistryElsevier20111601


JS Gordon JA Andrews KM Crews TJ Payne HH Severson The 5A's vs 3A's plus proactive quitline referral in private practice dental offices: preliminary resultsTobacco Control2007164285810.1136/tc.2007.020271


© This is an open access article distributed under the terms of the Creative Commons Attribution License Attribution 4.0 International (CC BY 4.0). which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  • Article highlights
  • Article tables
  • Article images

Article History

Received : 28-02-2021

Accepted : 01-03-2021

Available online : 30-04-2021

View Article

PDF File   Full Text Article


PDF File   XML File   ePub File

Digital Object Identifier (DOI)

Article DOI

Article Metrics

Article Access statistics

Viewed: 247

PDF Downloaded: 112