Effect of environmental tobacco smoke on oral pigmentation: A systematic review

Document Type : Review Article(s)


1 Student of Dentistry, Department of Oral Medicine, School of Dentistry, Zanjan University of Medical Sciences, Zanjan, Iran

2 Assistant Professor, Department of Oral Medicine, School of Dentistry, Zanjan University of Medical Sciences, Zanjan, Iran

3 Assistant Professor, Department of Oral Pathology, School of Dentistry, Zanjan University of Medical Sciences, Zanjan, Iran


BACKGROUND AND AIM: Oral pigmentation is a condition in which the color of oral mucosa such as gingival mucosa changes. Some exogenous and endogenous factors may lead to oral pigmentation. Secondhand smoke (SHS) or environmental tobacco smoke (ETS) is indirect smoking of an active smoker’s exhalation that can lead to cardiovascular, respiratory system, and some oral diseases. The aim of this review study is to assess the effect of SHS on oral pigmentation.
METHODS: Data in this study were collected from PubMed, MEDLINE, and Scopus databases with the Medical Subject Headings (MeSH) keywords (Passive Smoking, Secondhand Smoke, Environmental Tobacco Smoke, Smoke Pollution, Involuntary Smoking, and Pigmentation) in the English language among the studies conducted in the period of 1990 to 2019. All records were imported into the EndNote software and duplicate articles were removed. The titles and abstracts of all records were pre-screened and among the articles remained, the relevant ones were selected for review based on the inclusion and exclusion criteria. To assess the quality of the studies, the Strengthening the Reporting Observational Studies in Epidemiology (STROBE) checklist was used.
RESULTS: Based on the STROBE checklist, the quality of the studies was assessed and finally, seven studies were included in the review, with six of them conducted about children and young adults and one about women. 6 (85.7%) articles showed a strong correlation between ETS and oral pigmentation and 1 (14.2%) showed no correlation.
CONCLUSION: ETS probably was correlated to the oral pigmentation.


  1. Cicek Y, Ertas U. The normal and pathological pigmentation of oral mucous membrane: A review. J Contemp Dent Pract 2003; 4(3): 76-86.
  2. Becker SW. Melanin pigmentation: A Systematic study of the pigment of the human skin and upper mucous membranes, with special consideration of pigmented dendritic cells. AMA Arch Derm Syphilol 1927; 16(3): 259-90.
  3. Laidlaw GF, Cahn LR. Melanoblasts in the gum. J Dent Res 1932; 12: 534-7.
  4. Halaban R, Cheng E, Svedine S, Aron R, Hebert DN. Proper folding and endoplasmic reticulum to golgi transport of tyrosinase are induced by its substrates, DOPA and tyrosine. J Biol Chem 2001; 276(15): 11933-8.
  5. Hanioka T, Tanaka K, Ojima M, Yuuki K. Association of melanin pigmentation in the gingiva of children with parents who smoke. Pediatrics 2005; 116(2): e186-e190.
  6. Moravej-Salehi E, Moravej-Salehi E, Hajifattahi F. Relationship of Gingival Pigmentation with Passive Smoking in Women. Tanaffos 2015; 14(2): 107-14.
  7. Hedin CA, Axell T. Oral melanin pigmentation in 467 Thai and Malaysian people with special emphasis on smoker's melanosis. J Oral Pathol Med 1991; 20(1): 8-12.
  8. Sridharan S, Ganiger K, Satyanarayana A, Rahul A, Shetty S. Effect of environmental tobacco smoke from smoker parents on gingival pigmentation in children and young adults: A cross-sectional study. J Periodontol 2011; 82(7): 956-62.
  9. Ponnaiyan D, Chillara P, Palani Y. Correlation of environmental tobacco smoke to gingival pigmentation and salivary alpha amylase in young adults. Eur J Dent 2017; 11(3): 364-9.
  10. Axell T, Hedin CA. Epidemiologic study of excessive oral melanin pigmentation with special reference to the influence of tobacco habits. Scand J Dent Res 1982; 90(6): 434-42.
  11. Soliman N, Mikhael F. Passive smoking and alveolar bone density. Aust J Basic Appl Sci 2009; 3(2): 713-9.
  12. Aligne CA, Moss ME, Auinger P, Weitzman M. Association of pediatric dental caries with passive smoking. JAMA 2003; 289(10): 1258-64.
  13. Argacha JF, Adamopoulos D, Gujic M, Fontaine D, Amyai N, Berkenboom G, et al. Acute effects of passive smoking on peripheral vascular function. Hypertension 2008; 51(6): 1506-11.
  14. John EM, Savitz DA, Sandler DP. Prenatal exposure to parents' smoking and childhood cancer. Am J Epidemiol 1991; 133(2): 123-32.
  15. NN B Hasmun, Drummond BK, Milne T, Cullinan MP, Meldrum AM, Coates D. Effects of environmental tobacco smoke on the oral health of preschool children. Eur Arch Paediatr Dent 2017; 18(6): 393-8.
  16. Baab DA, Oberg PA. The effect of cigarette smoking on gingival blood flow in humans. J Clin Periodontol 1987; 14(7): 418-24.
  17. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Int J Surg 2014; 12(12): 1495-9.
  18. Hajifattahi F, Azarshab M, Haghgoo R, Lesan S. Evaluation of the relationship between passive smoking and oral pigmentation in children. J Dent (Tehran) 2010; 7(3): 119-23.
  19. Yadav R, Deo V, Kumar P, Heda A. Influence of environmental tobacco smoke on gingival pigmentation in schoolchildren. Oral Health Prev Dent 2015; 13(5): 407-10.