tobacco control bmj Human rights and ethical considerations for a tobacco-free generation CDC Foundation's TEEN+ study on

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The transition to a more severe expression of smoking-associated disease is marked by the impaired ability of macrophages to kill bacteria or viruses, the loss of ability to remove dead cells, the degradation and chemical modification of the extracellular matrix, the increasing retention of oligoclonally expanded CD8+ T cells and the induction of interleukin-17-secreting effector T cells

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This chain reaction explains why some smokers develop such deep, persistent stainsand why effective whitening requires tackling both the surface grime and the underlying chemical changes

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