Cigarette Smoke Tied to More Pronounced Marginal and Interproximal Staining Compared to THS Aerosol: Study
USA: Researchers have found that cigarette smoke causes clinically noticeable discoloration of composite veneers and leads to more pronounced marginal and interproximal staining compared with aerosol from tobacco heating systems (THS).
Ceramic veneers, however, show high color stability under both exposures when routine brushing is performed. Although THS results in less discoloration than cigarette smoke, careful interdental hygiene and smoking cessation remain essential to preserve esthetic outcomes.
These findings were reported in the Journal of Dentistry by Qirong Huang from the Eastman Institute for Oral Health, University of Rochester Medical Center, USA, and colleagues. The study examined how emissions from conventional cigarettes and heated tobacco products affect the color and surface staining of commonly used esthetic dental veneers.
Smoking is a well-recognized contributor to dental discoloration, yet the impact of newer heated tobacco products on restorative materials remains less clear. To address this, the investigators used a clinically relevant in vitro model to compare the effects of cigarette smoke and THS aerosol on ceramic and composite veneers under standardized conditions.
The study included 46 human premolars restored with either lithium-disilicate ceramic veneers or direct composite veneers. The teeth were arranged to simulate adjacent teeth and gingival tissues, closely reflecting clinical anatomy. Specimens were randomly assigned to three weeks of exposure to either cigarette smoke or THS aerosol. To replicate daily oral hygiene, all samples were brushed with a standard toothpaste after each exposure.
Color changes were assessed at baseline and weekly using spectrophotometric analysis, measuring both overall color difference (ΔE00) and the whiteness index for dentistry. Surface staining was evaluated across the gingival, mesial, distal, and body regions using a modified Lobene stain index, while cervical marginal discoloration was assessed using modified USPHS criteria.
Key Findings:
- Composite veneers exposed to cigarette smoke showed marked discoloration even after brushing, with color changes exceeding the clinically perceptible threshold.
- Ceramic veneers exhibited strong resistance to discoloration under both cigarette smoke and tobacco heating system aerosol exposure.
- Tobacco heating system aerosol caused minimal overall color change in both veneer types, but staining accumulated over time, especially in interproximal and gingival areas that are less accessible to brushing.
- Cervical marginal discoloration was consistently more pronounced in specimens exposed to cigarette smoke, irrespective of the veneer material used.
The authors noted that while THS aerosol appears to have a lower aesthetic impact than cigarette smoke, it is not free from risk. Both forms of tobacco exposure affected areas where plaque and stains are more likely to accumulate, underscoring the importance of meticulous interdental cleaning.
Several limitations were acknowledged, including the short three-week observation period, an intensive smoking protocol, and the absence of biofilm formation or mechanical loading, which may influence long-term outcomes in clinical practice.
Overall, the study highlights that cigarette smoking significantly compromises the appearance of composite veneers, whereas ceramic veneers offer greater color stability. Although switching from cigarettes to THS may reduce visible staining, complete tobacco cessation remains the most effective way to preserve veneer esthetics and oral health.
Reference:
Huang, Q., Zhao, X., Majeed, S., Scheuner, S., Favre, C., Ferreira, S., Zanetti, F., Sasso, G. L., & Ren, Y. (2026). Effects of cigarette smoke and Tobacco Heating System aerosol on discoloration and staining of ceramic and composite veneers. Journal of Dentistry, 106543. https://doi.org/10.1016/j.jdent.2026.106543
Next Story