News Release

Avoid the hookah and save your teeth

Study provides convincing evidence that tobacco smoking is a risk factor for periodontal disease. These findings included water pipe smoking.

Peer-Reviewed Publication

American Academy of Periodontology

Chicago – Smoking a hookah also known as a water pipe is becoming an increasingly trendy menu item in Mediterranean restaurants, cafes and bars. People should be warned to "skip this course" according to a study that appeared in the November issue of the Journal of Periodontology.

Researchers found that the impact of water pipe smoking is largely the same magnitude as that of cigarette smoking. The prevalence of periodontal diseases was 30 percent in water pipe smokers, 24 percent in cigarette smokers and eight percent in non-smokers.

"Research from this study shows that the relative risk for periodontal disease increased by 5-fold in water pipe and 3.8-fold in cigarette smokers compared to non-smokers," said Kenneth A. Krebs, DMD and AAP president. "Even though the smoke is filtered out by water, inhalation of toxic substances is similar to or even greater than that of cigarette smoking."

"Many people are mislead in believing that water filters out the toxins and that nicotine is reduced in water pipe smoking," Krebs. "Not only does water pipe smoking include the same substances as cigarette smoke such as carbon monoxide and tar, tobacco used for water pipe smoking contains two to four percent nicotine verses one to three percent for cigarettes."

Researchers found increased levels of nicotine and cotinine in plasma, saliva and urine, supporting that water pipe smoking affects the periodontal tissues in the same way as cigarette smoking. "This study provides convincing evidence supporting the role of tobacco smoking as a risk factor for periodontal disease," said Krebs.

"Although the precise mechanisms of action of tobacco smoke are not well understood, it seems highly likely that the periodontal bone is one of the most susceptible tissues," said Krebs. "This hypothesis will be further tested by investigating the periodontal bone height levels of various tobacco smokers in the presently studied population."


The American Academy of Periodontology is an 8,000-member association of dental professionals specializing in the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth and in the placement and maintenance of dental implants. Periodontics is one of nine dental specialties recognized by the American Dental Association.

EDITOR'S NOTE: A copy of the study "Tobacco Smoking and Periodontal Health in a Saudi Arabian Population" is available to the media by contacting the AAP Public Affairs Department at 312/573-3244. The public and/or non-AAP members can view a study abstract online, and the full-text of the study may be accessed online for $20.00 at

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