Warning: Waterpipe Smoking Poses Significant Threat to Oral Health
Systematic Review Confirms Cytotoxic and Genotoxic Effects, Linking Waterpipe Use to Increased Cancer Risk
Waterpipe smoking, often perceived as a safer alternative to cigarettes, is a growing global concern, especially among young people. A new systematic review and meta-analysis published in the Sultan Qaboos University Medical Journal reveals alarming evidence: waterpipe smoking has cytotoxic (cell-killing) and genotoxic (DNA-damaging) effects on oral cells, strongly increasing the risk of mouth neoplasms (cancers).
Why the Concern? Carcinogens and Cellular Damage
The harmful effects stem from the waterpipe smoke itself, which is loaded with numerous carcinogens, including tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons, and high levels of carbon monoxide. For instance, one study found the volume of formaldehyde in waterpipe smoke to be five times higher than in a standard reference cigarette.
These toxic compounds inflict serious damage at the cellular and genetic level. Researchers observed that waterpipe smoking causes a series of detrimental changes in oral cells, which can be early indicators of cancer, such as:
Genotoxic Effects (DNA Damage): Chromosomal aberrations, increased levels of micronuclei (small DNA aggregates that separate from the main nucleus), and changes in DNA methylation. Notably, DNA methylation due to waterpipe use could reach 64%, which is considered significantly high.
Cytotoxic Effects (Cell Death/Abnormality): Increased pyknosis (cell shrinkage), karyorrhexis (nuclear fragmentation), and karyolysis (nuclear dissolution), which are all forms of cell death.
Histopathologic Changes: Abnormal thickening of the oral lining (acanthosis), epithelial dysplasia (pre-cancerous changes), and hyperparakeratosis (abnormal keratinization).
The Study: Reviewing the Evidence
To consolidate the available scientific literature, the researchers conducted a systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. They searched major databases for studies that compared the cytotoxic or genotoxic effects on the oral cells of regular waterpipe smokers versus non-smokers.
A total of 20 studies were included in the final review. The combined evidence from the analysis demonstrated a significant overall risk difference of 0.16 (95% CI: 0.09–0.23; $P<0.00001$), confirming the cytotoxic and genotoxic impacts on oral cells.
Strong Link to Oral Cancer and P53 Mutation
The findings strongly link waterpipe smoking to the development of oral cancer. In fact, the carcinogenicity observed in waterpipe smokers is similar to that of cigarette smokers.
Tumor Suppressor Protein: Mutations in the tumor suppressor protein p53, often called the 'guardian of the genome,' were found to be significantly higher in waterpipe smokers compared to non-smokers, even in clinically normal oral epithelium. This mutation is critical because p53 is essential for regulating cell death (apoptosis) and DNA repair.
Combined Risk: The risk of developing Oral Squamous Cell Carcinoma (OSCC) is even greater when waterpipe use is combined with other forms of tobacco, such as shammah (Arabian snuff).
Conclusion: A Call for Action
Despite the popular misconception that waterpipe smoking is less harmful, the scientific evidence is clear: it causes damaging cellular and genetic changes that elevate the risk of oral cancer. The study's authors conclude that waterpipe use has demonstrable cytotoxic and genotoxic effects on human oral cells.
In response to these findings, the authors urge for more restrictive legislation and an increased focus on tobacco cessation programs, particularly targeting youth who underestimate the dangers of waterpipe use.
Original Article Reference
Title: Cytotoxic and Genotoxic Effects of Waterpipe on Oral Health Status: Systematic review and meta-analysis
Authors: Ricardo Grillo, Mehdi Khemiss, Yuri S. da Silva 24
Journal: Sultan Qaboos University Medical Journal
DOI: https://doi.org/10.18295/squmj.6.2022.043 25