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: COPD; Dental; cancer; hookah; narghile; oral; periodontal; pulmonary; smoking waterpipe.

Figure 1. Summary of the impact of waterpipe smoke inhalation of pulmonary and oral tissues

Figure showing various markers of oxidative stress and inflammation by waterpipe smoking in human biological fluids including bronchalveolar lavage fluid (BALF) as well as pathophysiological responses. IL: Interleukin; TNF-α: Tumor necrosis factor alpha ^*Further studies are needed to assess the biomarkers of inflammation in the oral/periodontal tissues among waterpipe smokers