Arnold, Shaheen, Rabalais 1

Amy Arnold
Kayla Shaheen
Kelsey Rabalais
Lori Rogers, RDH
Contemporary Dental Hygiene Care
April 17, 2014
Oral Effects of Hookah
Waterpipe tobacco smoking, also known as hookah, is a form of tobacco intake, in which
air is passed through tobacco mixture and then through a water-filled chamber before the smoker
inhales it. The hookah tradition started in the 16
th
century by an Indian physician. He believed
that by having the hookah smoke pass through water its harmful side effects would be decreased.
This tradition has spread to the United States and has gained the attention of adolescents and
young adults as a social activity. Just like any tobacco product, such as cigarettes and cigars,
hookah has many oral implications; such as esophageal cancers, oral squamous cell carcinoma,
and oral leukoplakia. Hookah can also result in gingival recession, tooth loss, and smokers
leukoplakia/smokers palate. The proper patient education can be given by the dental hygienist
though a thorough medical and dental history interview and by questioning the patients tobacco
usage.
Hookah smoking is a 500 year old tradition that originated in the Middle East. Today,
approximately 100 million people engage in hookah smoking world wide (Dais 3). In the United
States, family activities may include playing board games or card games. In Middle Eastern
countries it is a common practice for children and young adults to engage in hookah smoking as
a family activity (Dais 3).
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The components of a waterpipe consist of a head, body, a water bowl, and a hose with
mouthpieces attached. Tobacco sits on the head and is available in almost any flavor imaginable
(Eissenberg 308). The head contains the charcoal and tobacco. These two components are
separated by aluminum foil.
The head is filled with sweetened and flavored tobacco and then wrapped in perforated
aluminum foil. The bowl is half filled with water. Users inhale on the mouthpiece, and
charcoal-heated air is drawn through the tobacco, and the combined charcoal and tobacco
smoke travels down the body of the pipe, through the water, into the hose and
mouthpiece, and into the users mouth and lungs (Eissenberg 309).
The hookah waterpipe is able to have more than one hose, which makes this form of tobacco
smoking a social activity.
Due to the rapid increase of hookah consumption in the United States, hookah bars have
become a popular place for adolescents and young adults to socialize with friends. Hookah is
reasonably priced and has over 100 flavors. These factors contribute to its influence on younger
crowds. Being that hookah can be purchased for just a few dollars, and one session can last for
one to six hours, this is a very inexpensive way for the youth to socialize, especially among
college students (Griffiths, et al 123). Along with its pleasant taste, the aroma is not as
overpowering as cigarette or cigar smoke. Although hookah smoking is a popular activity, there
seems to be a misconception that it is safer, or even better for you, than cigarette smoking.
Hookah smokers believe that having the tobacco pass through water will filter out toxins,
but this statement is not true.
The water filtration system, however, only cools the smoke, enabling the user to inhale a
greater amount of smoke over a long period of time than is typical of traditional smoking
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practices. Even after it has passed through water, the smoke produced by a hookah
contains high levels of toxic compounds, including carbon monoxide, heavy metals, and
cancer-causing chemicals. Repeated inhalation of tobacco smoke only increases the
exposure to carcinogens, and, while the water may absorb some of the nicotine, users are
still at risk for addiction. Not only does waterpipe smoke contain many of the same toxins
found in cigarette smoke, the use of charcoal to heat tobacco in the waterpipe increases
the resultant health risks (Dais 4).
The charcoal and tobacco combination will produce high levels of toxic chemicals that are
carcinogenic. This combination is what sets hookah tobacco apart from other forms of tobacco
products. Because hookah smokers spend more time smoking, they are exposed to more tobacco.
This tobacco increases the risk of forming oral cancers due to the length of exposure time that
the tobacco is sitting in the mouth. One hookah session averages about one hour. This is much
longer compared to a five-minute cigarette-smoking episode (Eissenberg 123). After one
waterpipe smoking session compared to one cigarette; formaldehyde levels were detected to be
five times higher during one waterpipe smoking session, compared to one cigarette. Also, the
nicotine contents were ten times higher and the levels of benzopyrene were three times higher in
waterpipe smoke than in cigarette smoke (Dar, et al 1391). In fact, the World Health
Organization reports that one hookah tobacco smoking session exposes the user to about one
hundred times the smoke volume of a single cigarette (Nuzzo, et al 92). Smokers are unaware of
the high levels of toxins and carcinogens and perceive hookah as a lower potential for harm and
addictiveness.
Hookah smoking has been linked to a variety of oral implications. The absorption of
nicotine in greater amounts can raise the risk of oral squamous cell carcinoma, oral leukoplakia,
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periodontal disease, gingival recession, and tooth loss (Dais 4). The smoking of tobacco can
cause smokers leukoplakia or smokers palate which is a hardened area that forms on a mucous
membrane due to prolonged irritation. Such patches may become cancerous, and are often
surgically removed as a precaution (Dias 5). As stated earlier, hookah smoking is practiced for
longer periods of time than other forms of tobacco smoking; this factor separates hookah tobacco
from cigarettes and cigars, giving people an even greater chance for oral cancer. The length of
time, in addition to the frequency of the use will affect the level of risk for oral and systemic
complications. By sharing the hookah mouthpieces, the risk of contracting a communicable
disease, such as tuberculosis, hepatitis, or meningitis, is increased (Glynn 2). The herpes virus
can also be spread through the hookah mouthpieces. Although hookah has a few clinical signs,
like oral leukoplakia, staining is not one of them. These diseases can go undetected and
negatively effect the dental team if the signs and symptoms are not recognized. If the patient is
not asked the proper questions during a medical and dental history interview, these potential
problems can be easily overlooked.
The risks associated with hookah smoking are less understood because of the lack of
information available to study this issue. As oral health professionals, we are in a unique position
to recognize and educate the public about the dangers of waterpipe tobacco smoking. It is a fact
that hookah smoking is equal to or even worse than cigarette smoking and can speed up the
disease and cancer process. Special programs and help lines are still being researched and
developed for hookah smokers. This will serve as an important opportunity for the health care
professional to educate the public about the true danger of smoking tobacco products.


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Works Cited
Dais, Joyce. Straight Talk About Hookah Smoking. Dimensions of Dental Hygiene. Belmont
Publication, Inc., 11 November 2013. Web. 9 April 2014.
Dar, N A, F Islami, and P Boffetta. "Reply: False Positive Result In Study On Hookah Smoking
And Cancer In Kashmir: Measuring Risk Of Poor Hygiene Is Not The Same As
Measuring Risk Of Inhaling Water-Filtered Tobacco Smoke All Over The World."
British Journal Of Cancer 108.6 (2013): 1391-1392. Academic Search Complete. Web.
13 Apr. 2014.
Eissenberg, Thomas. "Tobacco Smoking Using A Waterpipe (Hookah): What You Need To
Know." AANA Journal 81.4 (2013): 308-313. CINAHL Complete. Web. 13 Apr. 2014.
Glynn, Tom. Hookahs are trendy, but are they safe? Cancer.org. 29 May 2012. Web. 9 April
2014.
Griffiths, Merlyn A., Tracy R. Harmon, and Mary C. Gilly. "Hubble Bubble Trouble: The Need
For Education About And Regulation Of Hookah Smoking." Journal Of Public Policy &
Marketing 30.1 (2011): 119-132. Business Source Complete. Web. 13 Apr. 2014.
Nuzzo, Erin, et al. "Associations Between Hookah Tobacco Smoking Knowledge And Hookah
Smoking Behavior Among US College Students." Health Education Research 28.1
(2013): 92-100. CINAHL Complete. Web. 13 Apr. 2014.