Alterations in oral microbial flora induced by waterpipe tobacco smoking

International Journal of General Medicine Dovepress open access to scientific and medical research ORIGINAL RESEARCH International Journal of General Medicine downloaded from https://www.dovepress.com/ by 37.59.46.207 on 12-Jul-2018 For personal use only. Open Access Full Text Article Alterations in oral microbial flora induced by waterpipe tobacco smoking This article was published in the following Dove Press journal: International Journal of General Medicine Muhamad Ali K Shakhatreh 1 Omar F Khabour 1 Karem H Alzoubi 2 Majed M Masadeh 3 Emad I Hussein 4 George N Bshara 1 1 Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Irbid, Jordan; 2Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan; 3 Department of Pharmaceutical Technology, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan; 4Department of Biological Sciences, Yarmouk University, Irbid, Jordan Introduction Correspondence: Muhamad Ali K Shakhatreh Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan Tel + 962 2 7201000 ext 23874 Email Waterpipe is a way of tobacco consumption in which the smoke passes through the water before it is inhaled.1 The use of waterpipes is increasing all over the world, especially among young people and women.2 A waterpipe machine has four major parts: a head, stem, vase, and hose (Figure 1). Smoking using this machine includes the use of flavored and hydrated, tobacco known as “moassel.” A charcoal is placed on top of the tobacco to provide the heat needed to burn the moassel.1 The bottom of the head has holes in it that passes the produced smoke to the stem, which is submerged in water that half-fills the vase. The hose is not submerged, exits from the bowl’s top, and ends with a mouthpiece, from which the user inhales.1 The health effects of cigarette smoking are well documented; however, knowledge regarding the impact of waterpipe smoking on body health is still lacking.3 Previous literature has shown that smoke produced by a waterpipe contains a similar toxicant profile to that produced by cigarettes with different magnitude. For example, the tar 47 submit your manuscript | www.dovepress.com International Journal of General Medicine 2018:11 47–54 Dovepress © 2018 Shakhatreh et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/IJGM.S150553 Powered by TCPDF (www.tcpdf.org) Background: Waterpipe smoking is a global health problem and a serious public concern. Little is known about the effects of waterpipe smoking on oral health. In the current study, we examined the alterations of oral microbial flora by waterpipe smoking. Methods: One hundred adult healthy subjects (59 waterpipe smokers and 41 non-smokers) were recruited into the study. Swabs were taken from the oral cavity and subgingival regions. Standard culturing techniques were used to identify types, frequency, and mean number of microorganisms in cultures obtained from the subjects. Results: It was notable that waterpipe smokers were significantly associated with a history of oral infections. In subgingiva, Acinetobacter and Moraxella species were present only in waterpipe smokers. In addition, the frequency of Candida albicans was higher in the subgingiva of waterpipe smokers (p = 0.023) while the frequency of Fusobacterium nucleatum was significantly lower in the subgingiva of waterpipe smokers (p = 0.036). However, no change was observed in other tested bacteria, such as Campylobacter species; Viridans group streptococci, Enterobacteriaceae, and Staphylococcus aureus. In oral cavity and when colony-forming units were considered, the only bacterial species that showed significant difference were the blackpigmented bacteria (p < 0.001). Conclusion: This study provides evidence indicating that some of the oral microflora is significantly altered by waterpipe smoking. Keywords: waterpipe, smoking, oral microflora, hookah, tobacco Dovepress Shakhatreh et al Head Tray Stem International Journal of General Medicine downloaded from https://www.dovepress.com/ by 37.59.46.207 on 12-Jul-2018 For personal use only. Hose Vase Mouth part Figure 1 A waterpipe machine. The major components of a waterpipe machine are labeled and include the head, stem, vase, and hose. produced by a single episode of waterpipe is about five times that produced by a single cigarette.4 Similarly, exposure to carbon monoxide is at least several folds higher during waterpipe smoking compared with that of cigarette s moking.5 Furthermore, the polycyclic aromatic hydrocarbons in waterpipe smoke are many times more than that of cigarette smoke.6 In addition, the style of waterpipe smoking results in a dramatically higher exposure volume to smoke, more tobacco consumption per smoking event, and longer smoke inhalation periods.7 Finally, tobacco in waterpipes is usually mixed with sugar, glycerol, and flavors, this mixture is burned by charcoal.1 Thus, it is expected that waterpipe smoking will have a distinct effect on oral microbial flora. The effects of cigarette smoking on oral health show that cigarette smoking is associated with oral cancer, periodontal disease, oral infections, and interference with the taste and modulation of normal flora.8,9 Several studies have also investigated the effect of smoking on oral microbiota and showed significant differences in the subgingival bacteria between smokers and non-smokers,10 For example, Zambon reported that smokers harbored significantly higher levels of Bacteroides forsythus subgingivally.11 In addition, the prevalence of several oral pathogens such as Prevotella nigrescens, Prevotella intermedia, Porphyromonas gingivalis, and Tannerella was significantly higher in smokers than in non-smokers.12 Regarding waterpipe smoking, few studies have examined effects of waterpipe smoking on oral health. A recent study has shown a strong association between waterpipe smoking and periodontal disease.13 In addition, waterpipe smoking has been shown to significantly increase potentially malignant oral mucosal lesions14 and lower lip squamous cell carcinoma and keratoacanthoma.15 Moreover, waterpipe smoking has been shown to induce DNA damage in buccal cells.16 48 Powered by TCPDF (...truncated)