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 Table of Contents  
EDITORIAL
Year : 2019  |  Volume : 7  |  Issue : 1  |  Page : 1-2

Waterpipe smoking: A traditional health hazard passed through generations


1 Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai, Tamil Nadu, India
2 Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan, Saudi Arabia
3 College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah, United States

Date of Web Publication12-Apr-2019

Correspondence Address:
Kamran Habib Awan
College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah 84095
United States
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/dmr.dmr_5_19

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How to cite this article:
Raj A T, Patil S, Awan KH. Waterpipe smoking: A traditional health hazard passed through generations. Dent Med Res 2019;7:1-2

How to cite this URL:
Raj A T, Patil S, Awan KH. Waterpipe smoking: A traditional health hazard passed through generations. Dent Med Res [serial online] 2019 [cited 2019 Apr 26];7:1-2. Available from: http://www.dmrjournal.org/text.asp?2019/7/1/1/256026





Waterpipe smoking (WPS) is a traditional form of tobacco smoking, which is closely associated with the Middle Eastern culture for hundreds of years. The habit is passed through generations from elders to youngsters, especially in social gatherings, which has imparted a false sense of safety among its users. Further, the use of flavored tobacco in WPS has led to its increased popularity among youngsters.[1],[2],[3] The World Health Organization (WHO) released an advisory note on the health hazards posed by WPS.[4] It includes respiratory, cardiovascular diseases, cancer, and adverse effects on pregnancy. Further, as most WPS users share a single waterpipe, there is an increased risk of communicable diseases.

Several known carcinogens associated with cigarette smoking including polycyclic aromatic hydrocarbons, heavy metals, volatile aldehydes, and phenols are also present in WPS.[5] Further, it is well-established that a single WPS session lasts significantly longer than smoking a single cigarette. Thus, a larger dosage of smoke and carcinogens is inhaled by the WPS user in comparison to a cigarette smoker. The difference in the level of dosages is such that the WHO has stated that 1 WPS session equates to smoking 100 cigarettes or more.[4]

Chronic WPS users have also been associated with severe periodontal diseases including periodontal pocket formation, attachment loss, and bone loss.[6] Further, it was noted that WPS users had three times greater risk of developing dry socket than nonsmokers.[7] At present, the association between WPS and the development of oral cancer is under debate.[8],[9] The lack of evidence is due to the improper study design as most studies have assessed individuals with concomitant use of cigarette, tobacco, and alcohol.[9],[10],[11],[12] Due to these additionally associated habits, it was not possible to assess the role of WPS as an independent risk factor for oral cancer.

Based on the current data (shared carcinogens with cigarette smoking and increased dosage of the same), WPS can be considered as potentially carcinogenic to the oral mucosa, although conclusive evidence of the same requires the study of molecular effects of WPS on oral epithelial cells usingin vivo andin vitro techniques.

To conclude, WPS poses serious health hazards and it is the responsibility of the health organizations to work with government agencies to formulate strategies to curb the growing popularity of WPS. Unlike cigarette smoking or alcohol consumption, usage of WPS does not have any social stigma, especially in the Middle East where it is accepted as a social norm. Thus, regional and national level educational and interventional programs emphasizing the detrimental effect of WPS are needed to combat the rampant use of WPS, especially among youngsters. It is also vital that the government agencies insist that facilities providing WPS should carry appropriate caution labels specifying the associated health hazards.[13] In addition, similar to cigarette smoking, WPS use must be banned in public spaces to reduce the risk of health hazards associated with secondary smoking. Given teenagers are the target population for WPS usage, it is of utmost importance that regulations are enforced to prevent the provision of WPS to individuals below the legal age.



 
  References Top

1.
Akl EA, Gunukula SK, Aleem S, Obeid R, Jaoude PA, Honeine R, et al. The prevalence of waterpipe tobacco smoking among the general and specific populations: A systematic review. BMC Public Health 2011;11:244.  Back to cited text no. 1
    
2.
Awan KH, Alrshedan A, Al Kahtani M, Patil S. Waterpipe smoking among health sciences university students: Knowledge, attitude and patterns of use. Saudi Dent J 2016;28:189-93.  Back to cited text no. 2
    
3.
Awan KH. Waterpipe smoking: A growing global threat. J Int Oral Health 2016;8:i-ii.  Back to cited text no. 3
    
4.
WHO Study Group on Tobacco Product Regulation (TobReg). Advisory Note. Waterpipe Tobacco Smoking: Health Effects Research needs and Recommended Actions by Regulators. WHO; 2005.  Back to cited text no. 4
    
5.
Primack BA, Carroll MV, Weiss PM, Shihadeh AL, Shensa A, Farley ST, et al. Systematic review and meta-analysis of inhaled toxicants from waterpipe and cigarette smoking. Public Health Rep 2016;131:76-85.  Back to cited text no. 5
    
6.
Kim KH, Kabir E, Jahan SA. Waterpipe tobacco smoking and its human health impacts. J Hazard Mater 2016;317:229-36.  Back to cited text no. 6
    
7.
Al-Belasy FA. The relationship of “shisha” (water pipe) smoking to postextraction dry socket. J Oral Maxillofac Surg 2004;62:10-4.  Back to cited text no. 7
    
8.
Warnakulasuriya S. Waterpipe smoking, oral cancer and other oral health effects. Evid Based Dent 2011;12:44-5.  Back to cited text no. 8
    
9.
Awan KH, Siddiqi K, Patil Sh, Hussain QA. Assessing the effect of waterpipe smoking on cancer outcome – A systematic review of current evidence Asian Pac J Cancer Prev 2017;18:495-502.  Back to cited text no. 9
    
10.
Al-Amad SH, Awad MA, Nimri O. Oral cancer in young Jordanians: Potential association with frequency of narghile smoking. Oral Surg Oral Med Oral Pathol Oral Radiol 2014;118:560-5.  Back to cited text no. 10
    
11.
Raj AT, Patil S, Sarode S, Sarode G. Oral health hazards of water pipe smoking: Current evidence. J Contemp Dent Pract 2017;18:539-40.  Back to cited text no. 11
    
12.
Raj AT, Patil S, Awan KH, Rajkumar C. Can waterpipe smoking cause oral cancer? World J Dent 2018;9:1.  Back to cited text no. 12
    
13.
Raj AT, Patil S, Gupta AA, Suveetha G. Flavored tobacco to E-cigarette's: How the tobacco industry sustains its product flow. Oral Oncol 2018;85:110.  Back to cited text no. 13
    




 

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