Increasing popularity of waterpipe tobacco smoking and electronic cigarette use: Implications for oral healthcare

Abstract

Cigarette smoking increases the risk of developing several systemic conditions including cancer, cardiovascular and pulmonary diseases. Cigarette smoking is also detrimental to oral health as it increases the incidence and severity of oral cancer, periodontal diseases, and periimplantitis, as well as impacting negatively dental patients’ response to therapy. Therefore, consideration of smoking behavior and recommendation of smoking cessation are important parts of dental treatment planning. However, cigarettes are no longer the most popular form of tobacco use among adolescents in the United States and globally. In recent years, tobacco smoking using a waterpipe (“hookah”, “shisha”) and use of electronic cigarettes (ECIGs) has increased significantly. Thus, dental clinicians likely will treat more patients who are waterpipe and/or ECIG users. Yet, the literature on the health effects of waterpipe and ECIGs use is sparse. Both waterpipe and ECIGs deliver the dependence-producing drug nicotine. Waterpipe tobacco smoking has been associated with periodontitis, dry socket, premalignant lesions and oral and esophageal cancer. The health effects of long-term ECIG use are unknown. The purpose of this review is to inform healthcare professionals about waterpipe and ECIGs, highlight emerging evidence on the biological effects of these increasingly popular tobacco products, and introduce perspectives for dental patient management and future research.

Waterpipe smoking cessation: knowledge, barriers, and practices of primary care physicians- a questionnaire-based cross-sectional study

“…However, there exists compelling evidence about the harms of waterpipe smoking and detrimental effect on long-term health outcomes [7,8]. More specifically, several systematic reviews and metaanalyses have demonstrated the association between WTS and increased risk of lung cancer, cardiovascular diseases, abnormal pulmonary function, low birth weight, and periodontal diseases [4,[9][10][11]. Despite the evidence, the incorrect public perception of reduced harm is possibly driven by the introduction of flavored waterpipe tobacco (also known as Maassel), the advancement of global communication particularly the internet, and the lack of enforcement of waterpipe tobacco control policies [6,12].…”

Periodontal disease - risk factors and treatment options

“…25 Added to this, studies have reported an increase of electronic cigarette and water pipe smoking and long term research is required on the effects of these innovative habits on the oral cavity. 26 There is a growing body of evidence from studies that genetic factors predispose individuals to periodontal disease. This is seen especially in the rare and more severe forms of periodontitis like early onset periodontitis, now classified as aggressive periodontitis, 27 where family studies have provided good evidence for a prominent genetic role.…”

Toxicological impact of waterpipe smoking and flavorings in the oral cavity and respiratory system

“…Abundant evidence has shown that pre-malignant and malignant oral lesions (such as leukoplakia and oral squamous cell carcinoma, respectively) are more often manifested in cigarette smokers compared with non-smokers (Llewellyn et al, 2004, Nayak et al, 2012, Chher et al, 2016, Ramoa et al, 2017). Similar effects of oxidative stress and inflammation are seen in plasma and lungs of smokers and patients with chronic obstructive pulmonary disease (COPD) (Rahman et al, 1996, Rahman et al, 2002).…”

“…There is a dearth of studies that have assessed the influence of WS on oral mucosal and periodontal tissues (Ramoa et al, 2017). It is often perceived that WS is less hazardous to health compared with cigarette smoking as the tobacco smoke in the former gets filtered through water, which absorbs a considerable amount of nicotine (Jacob et al, 2013, Jukema et al, 2014, Maziak et al, 2015b); however, results by Javed et al (2016a) showed that WS is as hazardous to periodontal health as traditional cigarette-smoking.…”