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

Abstract

Waterpipe smoking (WS), an emerging trend has major health concerns. It is prevalent worldwide as a recreational activity both indoors and outdoors. The aim of this review was to assess the impact of waterpipe smoke on the oral and respiratory system (oral cavity and pulmonary tissues). A number of studies have shown that periodontal health status is compromised in waterpipe smokers when compared with nonsmokers. Some studies have associated WS with oral premalignant and malignant lesions; however, due to the poor quality of these studies, the presented outcomes should be interpreted with caution. Although cigarette smoking has been considered as a potential risk factor for dental caries; there are no studies in indexed literature that have shown an association to exist between dental caries and WS. Inhaled waterpipe smoke imposes oxidative stress and inflammatory responses and compromises the ventilatory capacity of the lungs and may lead to an increased risk of decline in lung function. WS may cause oral and pulmonary diseases, such as periodontal disease and chronic obstructive airway disease, respectively. The association between WS and development of dental caries and oral pre-cancer and their relationships with chronic airways disease requires investigations. This review discusses the current evidence of waterpipe smoke effects on the oral health and respiratory system based on basic and clinical science and provides future directions for research and regulatory science on how WS can affect the oral cavity and the respiratory/pulmonary system.

Keywords:

• Dental
• hookah
• narghile
• oral
• periodontal
• pulmonary
• smoking waterpipe
• cancer
• COPD

Acknowledgements

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by the NIH 1R01HL135613, NIH 1R01HL085613 and NIH 1R01HL085613-S1 (to I.R.) and NIH-FDA-CTP 1R01DA042470. Research reported in this publication was supported by NIDA/NIH and FDA Center for Tobacco Products (CTP).