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Al-Belasy FA J Oral Maxillofac Surg 2004; 62: 10–14

In this study in Egypt, a comparison was made of dry socket incidence in the week following removal of a lower 3rd molar tooth in 3 groups of 100 patients each: nonsmokers (NS), cigarette smokers (CS) and 'shisha' smokers (SS: hookah users). No surgical flaps were raised, and no bone removed.

Dry socket was diagnosed at follow-up as a constant radiating pain not relieved by analgesics and with denuded socket or necrotic clot and foetor. Rates were 7% for NS, 16% for CS and 26% for SS. The differences between NS and the two smoking groups were statistically significant (P = 0.046 for CS, P ≤ 0.001 for SS), but CS and SS did not differ significantly (P = 0.083).

However, when SS patients were grouped according to smoking 1-3 (n = 30), 4-6 (37), 7-9 (17) and 10-12 (16) pipes per day, there was a significant trend. Respective rates were 10%, 22%, 41% and 50% (P ≤ 0.001). Smoking either cigarettes or pipes on the day of the extraction was also associated with an increased incidence of dry socket.