A recent paper in the British Dental Journal entitled ‘Narghile smoking and its adverse health consequences: a literature review’ made me acutely aware that most of us have been turning a blind eye to this addictive habit.

For those who are unaware, shisha (also known as hookah, narghile, hubble bubble and water pipe), is a form of tobacco smoking that has been increasing in its popularity in recent times. It involves the use of moistened raw tobacco, usually flavoured, heated by charcoal, and subsequently smoked via a water chamber.

Worryingly, this habit seems to be common amongst the East-African Asian population that has settled in the UK, increasingly amidst females. It has been commented that this is due to peer pressure and advertising that promotes it as stylish, sophisticated, powerful and a sign of independence.

Smoking shisha can lead to a variety of adverse effects as it contains multiple aldehyde compounds which are toxic and carcinogenic (cancer-inducing). It is associated with decreased lung function, leading to a greater risk of chronic obstructive pulmonary disease (COPD; such as bronchitis or emphysema). There are also links to cancers of the bronchus, oesophagus, bladder and pancreas. Pipe sharing can cause various bacterial and viral infections due to transmission from one person to the other.

In the mouth, it is associated with periodontal (gum and bone) disease which is already a prevalent disease in our Asian community. It also leads to an increased risk of dry socket following tooth extractions. A few cases of oral cancer have been reported in shisha smokers.

There are numerous misconceptions about shisha smoking, the commonest being that it does not contain any tobacco at all. This is actually quite rare and is referred to as ‘herbal shisha’. Users are often inaccurately informed that the shisha is simply molasses (a by-product of processed sugar cane or beet), without any tobacco.

Another misconception is that the filtration of the tobacco smoke through the water removes all carcinogenic compounds. Although the water-soluble aldehydes may be filtered out, the insoluble tar compounds are certainly not.

Studies have shown that a single shisha smoking session (often lasting an hour or longer) releases aldehyde compounds which are equivalent to 17 cigarettes, and as little as three smoking sessions expose users to large quantities of carcinogenic benzene compounds. It has also been suggested that shisha smokers inhale a greater amount of nicotine than cigarette smokers due to the sheer volume of smoke inhaled.

This article was based, in the main, on a paper by Dar-Odeh and Abu-Hammad in the British Dental Journal, Volume 206, No 11, June 13th 2009.

Dr. Manoj Arunkumar Tank BDS (Brist) 2008