Table 2.
Study designs and characteristics of included subjects in published studies aiming to evaluate the effects of narghile use on oral mucosa (clinical and histological studies)
| First author | El-Hakim (8) | Al-Belasy (9) | Ali (10) | El-Setouhy (11) | Dangi (12) | Al-Attas (13) | Seifi (14) | Al-Amrah (15) |
|---|---|---|---|---|---|---|---|---|
| Town (country) | Cairo (Egypt) Al Khobar (Saudi Arabia) | Mansoura (Egypt) | NR (Yemen) | Qalyubia (Egypt) | Haryana (India) | Jeddah (Saudi Arabia) | Babol (Iran) | Jeddah (Saudi Arabia) |
| Study design | Case-series | Longitudinal Comparative |
Cross-sectional Comparative |
Cross-sectional | Cross-sectional Descriptive |
Cross-sectional Descriptive | Cross-sectional Comparative |
Cross-sectional Comparative |
| Recruitment method | Patient consultants | Patient consultants | Patient consultants | Randomized sample of households | NR | Population clusters | Cafes Entertainment centers Dental students Medical sciences students |
Coffee shops Resting areas |
| Name of the smoking mode | Goza Shisha Hubble-bubble |
Shisha Water pipe Hookah |
Water-pipe Mada'a |
Waterpipe | Hookah | Shisha Moasel |
Waterpipe Hookah |
Waterpipe Gouza Shisha Hubble-bubble Narghile Hookah |
| Inclusion criteria | NR | Healthy No drugs Unilateral high mesioangular Impactions+exposed occlusal surfaces |
Using qat daily on only one side of the mouth for ≥10 Y | >18 Y Male Current NS (at least once per/week and smoked <100 cigarettes in their life) Never smokers |
NR | >18 Y | 20–40 Y | Healthy Male Adult |
| Non-inclusion criteria | NR | MS Former smokers Medication use Recent antibiotic use Need for antibiotic prophylaxis |
Unhealthy Systemic disease |
Female | Pregnancy Child Diagnosis of oral cancer prior to entry the study |
Non-S | Systemic disease Alcohol use Fixed or removable partial denture PS Oral mucosa lesion |
Alcohol use Medications use |
| Exclusive-NS | No Case 2 was an occasional CS |
Yes | No | No | No | No | Yes | Yes |
| Calculated sample size | No | No | No | No | No | Yes | No | No |
| Number | 3 | 100 | 11 | 128 | 163 | 228 | 40 | 20 |
| Age (Y) | 61 23 20 |
29a
22–39b |
45±9c
22–55b |
47±14c† | 45–95b | 34.9a | 30.15±6.02c
20–40b |
37.5a
28–65b |
| Number of years of smoking | Case 1:>20 Y Case 2: 3 Y |
NR | NR | 70 subjects≤14 Y 58 subjects >14 Y |
NR | NR | NR | NR |
| Type of tobacco | Moassel Tomback |
NR | NR | NR | NR | Moassel | NR | Moassel Jurak |
| Method of narghile use quantification | NR | ND | NR | HW HD | NR | NR | NW | ND |
| Quantity of used tobacco | Case 1: twice a day≥ 20 Y Case 2: twice a day for 3 Y Case 3: regular smoker 4 Y |
30%: 1–3 ND 37%: 4–6 ND 17%: 7–9 ND 16%: 10 to12 ND |
NR | 54%: ≤28 HW 46%: >28 HW 52%: ≤4 HD 48%: >4 HD |
NR | NR | 1–3 NW 20–80 min 3–5 Y |
1–4 ND .>15 min |
| Last narghile (h) | NR | NR | NR | NR | NR | NR | NR | NR |
| Explorations | Clinical examination Lesion biopsy |
Clinical examination | Clinical examination Histological study: two biopsies (chewing and contralateral sides) |
Clinical examination Genetic study |
Visual-tactile-examination | Clinical conventional oral examination | Clinical oral examination Histological study (cytological smear samples from three different areas) |
Histological study: collection of buccal cells The comet assay |
| Questionnaires | NR | Non-standardized | Non-standardized | Non-standardized | NR | Non-standardized | Non-standardized | NR |
| Comparison with active CS | No |
n=100 27a Y 20–38b Y |
n=11 38±12c Y 24–58b Y Heavy smokers (>20 CD) |
No | No | No |
n=40 30.32±5.69c Y 20–40b Y 3–30b CY |
No |
| Comparison with healthy-Non-S | No |
n=100 (100 M/0 F) 28a Y 20–37b Y |
n=11 32±10c Y 22–58b Y |
n=78 53±11c Y |
No | No |
n=40 30.30±5.83c Y 20–40b Y |
n=20 |
| Comparison with MS | No | No | No | No | No | No | No | No |
| Main results | Narghile use may predispose to OC. | NS have three times the risk of non-S for developing DS Increased frequency of smoking either cigarettes or narghile results in increased DS incidence Patients who smoke either cigarettes or narghile the day of surgery are at a significantly greater risk of developing DS than are the patients who do not smoke postoperatively or who smoke the second day after surgery DS in smokers appears to favor a systemic etiology rather than a direct effect of heat/smoke or suction on the extraction socket |
Histopathologic changes in the oral mucosa of both sides: no significant differences between the three groups Pathologic changes of the oral mucosa were related mainly to takhzeen al-qat |
TMN and CMN: higher in NS vs. non-S | Narghile use is associated with higher risk of SL | Narghile use is associated with SL while CT was positively associated with these lesions | Narghile use is effective in creating some quantitative cytometric alterations in oral mucosa | Narghile use causes DNA damage in buccal cells |
CD, cigarette/day; CMN, number of cells containing micronuclei; CT, chewing tobacco; CY, cigarette-years; DNA, deoxyribonucleic acid; DS, dry-socket; HD, hagar/day; HW, hagar (narghile tobacco unit)/week; MS, mixed smokers; ND, narghile/day; NS, narghile smokers; non-S, non-smokers; NR, not reported; NW, narghile/week; OC, oral cancer; PS, passive smoker defined as individuals who were exposed to cigarette smoke at home or work; SL, suspicious lesions; TMN, total number of micronuclei; Y, years.
a
Data are mean;
b
data are range (minimum–maximum);
c
data are mean±SD.
Significant differences:
†
NS vs. Non-S. No significant difference was found between NS vs. CS or NS vs.MS.