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 peri-implantitis, as well as impacting negatively on the 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 waterpipes 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.

Keywords: electronic cigarettes; oral cancer; periodontal disease; smoking; waterpipe.

Figure 1. Waterpipe photograph and scheme

Generally, the waterpipe head is fired-clay, the body is metal, the bowl is glass or plexiglass, and the hose is plastic or leather. The user inhales from the mouthpiece, causing a pressure drop in the bowl. As a result, air is drawn over the charcoal and through the head, heating the tobacco and producing a charcoal and tobacco smoke mixture that is drawn through the body, into the bowl and through the water, into the hose and is subsequently inhaled by the user.

Figure 2. Examples of electronic cigarettes

Cigalikes are ECIGs that visually resemble traditional tobacco cigarettes. They often have a single low power setting, and can be disposable, and often contain a prefilled cartridge. An open system ECIG has a single power setting, but usually a refillable cartridge and is not disposable. The advanced personal vaporizer has multiple power settings that can be altered by the user and has a refillable cartridge.