Smoking a sheesha (also known as a hookah or water-pipe) is becoming increasingly trendy in Middle Eastern restaurants and bars, but, according to research in the November issue of the Journal of Periodontology, it could have serious consequences for your teeth. The researchers found that the prevalence of periodontal diseases was 30% in water pipe smokers, 24% in cigarette smokers and 8% in non-smokers. The relative risk for periodontal disease increased 5-fold in water pipe and 3.8-fold in cigarette smokers compared to non-smokers.

Many people believe that the smoke from a sheesha is less tainted than the smoke from a cigarette because it is filtered through water, but Kenneth A. Krebs, president of the American Academy of Periodontology, says that this study shows that it is not the case. “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 2-4% nicotine versus 1-3% for cigarettes,” he says. The 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. “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,” says Krebs. “This hypothesis will be further tested by investigating the periodontal bone height levels of various tobacco smokers in the presently studied population.”