The impact of water pipe smoking is largely the same as that of cigarette smoking, said researchers in the November issue of the Journal of Periodontology.
Researchers led by Suzan Natto, MD, Institute of Odontology, Karolinska Institute, Stockholm, conducted clinical examinations of 262 subjects, aged 17 to 60 years, at King Faisal Specialty Hospital and Research Center in Jeddah, Saudi Arabia. The examinations included assessments of oral hygiene, gingival inflammation and probing depth. Subjects reported their smoking behaviors through a questionnaire, and this information was confirmed by an interview. Researchers stratified subjects into water pipe smokers, cigarette smokers, mixed smokers and nonsmokers.
They found that incidence of periodontal diseases was 30 percent in water pipe smokers, 24 percent in cigarette smokers and 8 percent in nonsmokers.
"Research from this study shows that the relative risk for periodontal disease increased by 5.0-fold in water pipe smokers and 3.8-fold in cigarette smokers compared to nonsmokers," said Dr. Kenneth A. Krebs, president, American Academy of Periodontology. "Even though the smoke is filtered out by water, inhalation of toxic substances is similar to or even greater than that of cigarette smoking.
"Many people are misled in believing that water filters out the toxins and that nicotine is reduced in water pipe smoking," Dr. Krebs continued. "Not only does water pipe smoking include the same substances as cigarette smoke such as carbon monoxide and tar, tobacco used for water pipe smoking contains 2 to 4 percent nicotine versus 1 to 3 percent for cigarettes."
Researchers found increased levels of nicotine and cotinine in water pipe smokers’ plasma, saliva and urine, supporting their finding that water pipe smoking affects the periodontal tissues in the same way as cigarette smoking does.
"Although the precise mechanisms of action of tobacco smoke are not well understood, it seems highly likely that the periodontal bone is one of the most susceptible tissues," said Dr. Krebs. "This hypothesis will be further tested by investigating the periodontal bone height levels of various tobacco smokers in the presently studied population."
