Shisha

 Shisha/Hookah Smoking

By: Brianne Boudreau

There are many different ways to ingest tobacco, such as cigarettes, pipes, chewing, or even hookah smoking. Some people may think that since hookah isn’t a cigarette, it may not be as bad, right? Well, unfortunately, that’s not the truth. The tobacco smoked in hookahs isn’t warmed up by a direct plane, like cigarettes or pipes, but it is heated up via a piece of charcoal, then when its inhaled, its passes by a water bowl built into the hookah stand to cool the smoke, which makes the smoke less harsh to the user (CDC, 2020). When burning charcoal, it produces carbon monoxide, which is then inhaled with the tobacco fumes (CDC, 2020). Using charcoal as the catalyst for tobacco increases health risks due to the use directly inhaling carbon monoxide (CDC, 2020). By ingesting so much carbon monoxide, it may cause some of the following symptoms, including: dizziness, feeling ill, tiredness and confusion, nausea, or difficulty breathing (National Health Services, 2019)

 

Oral status of hookah smokers

 

Hookah is different from smoking cigarettes because the hookah’s water bowl helps cool down the smoke before it's inhaled into the body. By doing so, it feels less harsh on the mouth and on the lungs, but unfortunately, that’s not the case. Even though the smoke is cooled down, there are still a lot of chemicals that are present in the tobacco and charcoal that’s used to heat it up. Hookah smoking has a detrimental effect on the oral cavity, such as periodontal disease, impaired inflammatory response, loss of clinical attachment levels (CAL), higher chance of candida infections, dry sockets, and a higher chance of getting oral cancer (Ramôa et al, 2017). Studies have shown that hookah smokers have deeper pockets, and higher plaque scores compared to people who do not smoke (Amer et al., 2018). 

Though different from cigarettes, Hookahs have similar toxins that are still inhaled into the body, such as nicotine and carcinogenic chemicals (CDC, 2020). The CDC says that an individual may be exposed to more toxins in one Hookah smoking session than smoking a cigarette due to the length of time it takes to smoke hookah (2020). When compared to cigarette smoking, studies have shown that hookah smoking has similar damaging effects on the oral cavity, such as similar oral cancers (Amer et al, 2018).

 

Dental hygienists need to be aware of the effects of smoking hookah when seeing clients. From experience, many people who smoke Hookah regularly do not see themselves as smokers, therefore, they will not indicate it on a health history form. It’s important to ask the clients probing questions, such as: “have you smoked anything that isn’t in the form of a cigarette?” Or “Have you smoked out of a shisha/hookah before? If so, do you do it frequently? And for how long are your hookah smoking sessions?”. These questions will hopefully help dental hygienists gain a better perspective on the client's oral, and overall health. 

 

From personal experience, from being in hookah bars, most people sit around for hours, inhaling on the same hookah, and taking puffs every few minutes or so, and sometimes, there are two to three people on one hookah. It’s very unsanitary and can spread disease really fast from one person to another. 

It’s easier said than done. Quitting smoking isn’t easy, no matter what type you use. Nicotine is very difficult to let go. If you’re ready to quit, please visit these following websites or call one of the following numbers below. 

 

-        Smokers helpline

o   Call: 1-866-366-3667

o   Text iQuit to 123456

o   Website: https://www.smokershelpline.ca

-        Self Help Resource

o   https://www.nicotinedependenceclinic.com/en/Pages/Self-Help.aspx

References 

Amer, H. W., Waguih, H. M., & El-Rouby, D. H. (2019). Development of field cancerization in the clinically normal oral mucosa of shisha smokers. International Journal of Dental Hygiene, 17(1), 39–45. https://doi-org.eztest.ocls.ca/10.1111/idh.12362

[CDC] Centre for Disease Control and Prevention. (2020, January 10). Hookah. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/index.htm#health-effects

National Health Services. (2019). Carbon monoxide poisoning. https://www.nhs.uk/conditions/carbon-monoxide-poisoning/

Ramôa, C. P., Eissenberg, T., & Sahingur, S. E. (2017). Increasing popularity of waterpipe tobacco smoking and electronic cigarette use: Implications for oral healthcare. Journal of Periodontal Research, 52(5), 813–823. https://doi-org.eztest.ocls.ca/10.1111/jre.12458