Hookahs (Waterpipes)

Whether you call it a hookah, hubble-bubble, shisha or goza, a waterpipe by any name is hazardous to your health and has many of the same risks as smoking cigarettes. Here’s what you should know about hookah smoking and your dental health.

Among other serious health conditions like lung cancer and heart disease, research published in the October 2015 issue of the Journal of the American Dental Association (JADA) also finds that hookah smoking is associated with the following oral health issues:

• gum disease
• oral cancer
• esophageal cancer
• dry sockets

There is no safe form of tobacco use, and hookahs are no exception. Hookah smoking can be addictive like using cigarettes, because the tobacco also contains nicotine. The level of nicotine in hookah tobacco is not currently regulated.

Before research showed otherwise, many people believed hookahs were safer than cigarettes because the smoke passes through water before it’s inhaled. But hookah smoke contains many of the same irritants, toxins and carcinogens (chemicals known to cause cancer) as cigarette smoke.

Scientists estimate that people who smoke hookahs inhale about as much smoke as if they had consumed 100 cigarettes.

Hookah smoking was a popular trend in the 2010s, especially among young people due to the social aspect. As awareness of the health risks spread, opinions changed, and the use of traditional hookahs has decreased significantly since then. But that doesn’t mean all forms of hookah smoking have been left behind.

According to the 2024 National Youth Tobacco Survey, vaping is the dominant form of tobacco use among middle and high school students in the U.S. Vaping most commonly refers to the use of e-cigarettes, but also includes electronic hookahs (e-hookahs), or hookah pens.

Like e-cigarettes, e-hookahs are battery-powered and turn liquid containing nicotine, flavorings, and other harmful chemicals and substances into an aerosol (vapor mist), which is then breathed in. Even cartridges that claim to be nicotine-free have been shown to contain some nicotine, which is known to affect brain development in children, teens and young adults.

The amount of nicotine in vape pens has increased with vaping's popularity. A study shows that over five years, the average nicotine strength in an e-cigarette increased from 1.7% to 5%, which is double the amount of nicotine you inhale from a pack of cigarettes.

Because these electronic products are still new, there is limited information on their dental health risks. A study in JADA found a correlation between people who vape and people with untreated cavities, but more research must be done to determine whether those cavities are caused by vaping.

Quitting takes time and commitment, but there are plenty of free resources and support out there to help you succeed.

Visit smokefree.gov or call 1-800-QUIT-NOW to get started.

Be sure to ask your dentist for suggestions and support, too. Your dentist cares about your health and is there to offer guidance and motivation to help you succeed. In the meantime, make sure to store your tobacco products where children can’t reach them, as nicotine is a toxic substance that can cause illness — and in severe cases, coma or death — if swallowed.