The oral exposome and environment-related diseases of hard and soft oral tissues: a comprehensive review

Background The oral cavity is continuously exposed to environmental, lifestyle-related, microbial, and systemic influences capable of altering tissue homeostasis and contributing to chronic oral disease. Environmental exposures may interact through inflammatory, microbial, and metabolic pathways affecting both hard and soft oral tissues. This review critically synthesizes current evidence on environment-related oral diseases within the framework of the oral exposome, focusing on environmental determinants, biological mechanisms, tissue alterations, and implications for oral surgery, implantology, regenerative procedures, and precision oral medicine. Materials and methods A comprehensive narrative review was conducted through electronic searches of PubMed, Scopus, and Web of Science for studies published up to April 2026. English-language articles evaluating relationships between environmental exposure and oral tissue alterations were included. Evidence regarding environmental pollutants, smoking, alcohol consumption, dietary factors, occupational exposures, and other external determinants was critically analyzed together with host-related modifiers, including salivary dysfunction, microbial dysbiosis, systemic disease, and chronic inflammatory conditions. The review considered exposure-associated alterations involving dental hard tissues, periodontal and peri-implant structures, oral mucosa, salivary homeostasis, and oral microbial ecology. Results The strength of evidence varied substantially across exposure–outcome relationships. The most mature human evidence concerned conventional tobacco smoking and selected carcinogenic exposures, whereas associations involving air pollution, heavy metals, occupational toxicants, electronic cigarettes, endocrine-disrupting chemicals, and emerging contaminants showed greater heterogeneity and, for several outcomes, relied substantially on observational, experimental, or mechanistic evidence. Across these different levels of evidence, recurrent pathways included oxidative stress, inflammation, microbial dysbiosis, epithelial dysfunction, and altered tissue homeostasis. Conclusions The oral exposome provides a useful framework for understanding the multifactorial nature of oral disease and the interaction among environmental exposure, microbial ecology, host response, and tissue homeostasis.