Periodontal bone height of exclusive narghile smokers compared with exclusive cigarette smokers

Figures & data

Table 1 General characteristics of the study groups: exclusive narghile smokers (ENS, n=60) and exclusive cigarette smokers (ECS, n=60)

		ENS	ECS	p
Quantitative data: mean±SD [95% CI]
Age (years)		28.5±3.6 [27.5 to 29.4]	27.3±5.0 [26.1 to 28.6]	0.160
Quantity of tobacco used (NY or PY)		7.1±2.9 [6.3 to 7.8]	8.0±3.0 [7.2 to 8.8]	0.090
Visit to the dentist		0.0±0.0	0.1±0.3 [0.0 to 0.2]	0.011*
Daily tooth brushing frequency		0.9±0.60 [0.8 to 1.1]	1.1±0.85 [0.9 to 1.4]	0.135
Qualitative data: number (percentage)
Schooling level	Low	35 (58.3)	23 (38.3)	0.030^†
	High	25 (41.7)	37 (61.7)
Socioeconomic level	Low	0 (0.0)	8 (13.3)	0.003^†
	High	60 (100.0)	52 (86.7)
Quantity of tobacco used (NY or PY)	5–10	51 (85.0)	42 (70.0)	0.051
	10–15	9 (15.0)	18 (30.0)
Daily tooth brushing	Irregular brusher	12 (20.0)	16 (26.7)	0.436
	Regular brusher	48 (80.0)	44 (73.3)

NY: narghile-years; PY: pack-years. *p<0.05 (t-test): ENS versus ECS. ^† p<0.05 (Chi²): ENS versus ECS.

Fig. 1 Remaining teeth, plaque index, and periodontal bone height of the study groups: exclusive narghile smokers (ENS, n=60) and exclusive cigarettes smokers (ECS, n=60). (a) Remaining teeth. (b) Plaque index. (c) Periodontal bone height. Data are shown as box-and-whisker plots. Small rectangle: mean; large rectangle: 95% CI; error bars: standard deviation. p (Student's t-test): ENS versus ECS.

Table 2 Clinical and radiological data of the study groups: exclusive narghile smokers (ENS, n=60) and exclusive cigarette smokers (ECS, n=60)

		ENS	ECS	p
Plaque index classes	0–1	4 (6.7)	8 (13.3)	0.386
	1–2	26 (43.3)	37 (61.7)
	2–3	30 (50.0)	15 (25.0)
Bone loss	Yes	7 (11.7)	9 (15.0)	0.631
	No	53 (88.3)	51 (85.0)

Qualitative data: number (percentage). ^† p<0.05 (Chi²): ENS versus ECS.

Table 3 Study designs, characteristics, and results of studies aiming to evaluate the effects of narghile use on periodontal bone height

First author	Natto (17)		Javed (29)	Present study
Study design
Year of publication	2005		2016
Years of the study	NR		2013–2014	2013–2015
Town (country)	Jeddah (Saudi Arabia)		Riyadh (Saudi Arabia)	Sousse (Tunisia)
Study design	Cross-sectional Comparative		Cross-sectional Comparative	Cross-sectional Comparative
Recruitment method	Announcements/news paper		Visitors of a dental clinic for treatment	Flyers Acquaintances of people involved in the study
Name of the smoking device	Water pipe		Water pipe	Narghile
Inclusion criteria	>20 teeth		Healthy individuals Habitual ENS (>1 narghile/day for at least the past year) Habitual ECS (>1 cigarette/day for at least the past year) Non-S	Male Age: 20–35 years Tabamel smokers
Non-inclusion (or exclusion) criteria	Pregnancy Unhealthy		MS Systemic diseases Edentulous individuals Crowded teeth or occlusal trauma Alcohol consumers Tobacco chewers Lactating and/or pregnant females Medication use (antibiotics, non-steroidal anti-inflammatory drugs, steroids) ≤3 months Periodontal treatment ≤6 months	<20 teeth Tobacco use <5 PY or <5 NY Jurak and/or Tombac smokers Diabetes mellitus, Previous head or neck radiation therapy Medication use: antidepressants. anticonvulsants, cyclosporine A, calcium antagonists
ENS	Yes		Yes	Yes
Calculated sample size	No		Yes (no reference cited)	Yes (32)
Number of ENS (M/F)	117 (90/27)		50 (50/0)	60 (60/0)
Age of ENS (years)	17–60^a M: 39 [37–41]^b F: 38 [34–43]^b		485±62^e years	20–35^a 284±36 [275–294]^c
Starting narghile use age (years)	NR		NR	NR
Number of years of smoking	NR		20.5±2.8^e	NR
Type of tobacco	NR		NR	Tabamel
Method of narghile use quantification	RY		Times/daily Session duration	NY
Quantity of narghile tobacco used	57 [48–66]^b RY 44^d: <40 RY 56^d: ≥40 RY		Frequency of use: 4.7±1.1^e times/daily Session duration: 50.2±6.7^e min	7.1±2.9 [6.3–7.8]^e 85^d: 5 ≤ NY<10 15^d: ≥10 NY
Grams of tobacco/narghile session	NR		NR	20
Last narghile (h)	NR		NR	NR
Explorations	Clinical examination [4 sites (buccal, mesial, distal, lingual) for all teeth] Radiographic exam		Clinical examination [6 sites (mesiobuccal, mid-buccal, distobuccal, distolingual/palatal, mid-lingual/palatal, and mesiolingual/palatal) for all teeth] Radiographic examination	Clinical examination Radiographic examination
Questionnaires	Standardized without citing a reference		Non-standardized	Non-standardized
Used materials	Panoramic digital radiographs		Full mouth digital radiographs	Panoramic digital radiographs
Comparison with ECS	n=72 (58 M/14 F) M: 36 [34–38]^b years F: 38 [34–43]^b years 230 [193–268]^b CY 51^d: <170 CY 49^d: ≥170 CY		n=50 (50 M/0 F) 50.1±3.5^e years Duration of smoking: 22.3±6.5^e years Frequency of use: 15.4±3.6^e times/daily Session duration: 15.3±0.4^e min	n=60 (60 M/0 F) 27.3±5 [26.1–28.6]^c years 70^d: 5 ≤ PY <10 30^d: ≥10 PY
Comparison with Non-S	n=99 (56 M/43 F) M: 38 [35–41]^b years F: 35 [32–39]^b years		n=100 (100 M/0 F) 46.5±4.2^e years	NA
Comparison with MS	n=67 (51 M/16 F) M: 33 [31–35]^b years F: 32 [28–37]^b years 174 [141–207]^b CY 24 [18–30]^b RY		NA	NA
Results
	PBH	BL (%)	BL (mm)	PBH	BL (%)
ENS	0.76 [0.75–0.78]^b†‡	27^d†	5.1±0.8^e†	0.86±0.04 [0.84–0.87]^c	12^d
ECS	0.76 [0.74– 0.78]^b	24^d	5.6±1.2^e	0.85±0.03 [0.84–0.86]^c	15^d
MS	0.80 [0.79–0.82]^b	9^d	NA	NA	NA
Non-S	0.81 [0.79– 0.83]^b	6^d	2.2±0.9^e	NA	NA
Other results	PBH decreases with age. Relative risk of BL (after adjustment for age) associated with narghile use and cigarette smoking compared with Non-S.			The two groups had similar means of PBH and similar frequencies of BL.
Conclusions	Narghile use is associated with PBH reduction		The periodontal condition of ENS was equally as poor as ECS.	Both ENS and ECS exhibited the same PBH reduction suggesting that the two types of tobacco smoking are associated with BL.

BL: bone loss. ECS: exclusive cigarette smoker. ENS: exclusive narghile smoker. F: female. M: male. Min: minutes. MS: mixed smoker. NA: not applied. Non-S: non-smoker. NR: not reported. NY: narghile-year. PY: pack-years. RY: run-years. ^aData are range (minimum and maximum). ^bData are mean [95% CI]. ^cData are mean±SD [95% CI]. ^dData are percentages. ^eData are mean±SD. Significant differences: *ENS versus ECS; ^†ENS versus Non-S; ^‡ENS versus MS.