ADHA Access March 2012 : Page 10
risk factor for periodontal disease. Because hookah smoke is inhaled, the lung cells are directly exposed to carcinogens, where they bind to DNA, thus altering normal cell functions. In addition, since the harmful components of hookah are ¿ ltered out of the body via the urinary system, they have been found to impinge on cells found along this system, altering their ¿ ltration properties. With regards to oral cancers, “irritation from exposure to tobacco juices increases the risk of developing oral cancers e; the irritation by tobacco juice products is likely to be greater among hookah smokers than among pipe or cigar smokers because hookah smoking is typically practiced (with or with-out inhalation) more often and for longer periods of time.” 4 Smoking hookah is just as much a potential risk factor for peri-odontal disease as smoking conventional cigarettes. This has been demonstrated through a cross-sectional study in Saudi Arabia, where periodontal disease was measured using probing depths among 262 participants aged 17-60 years. “The prevalence of periodontal disease de ¿ ned as a minimum of 10 sites with a probing depth of 5 mm was 19.5 percent in the total population, 30 percent in water pipe smok-ers, 24 percent in cigarette smokers and 7 percent in non-smokers. The relative risk for periodontal disease was 5.1 and 3.8-fold higher for water-pipe and cigarette smokers respectively, compared to non-smokers.” This study indicates that smoking of either type, whether it was hookah or cigarettes, is a potent risk factor for periodontal disease. 2 It has been proven in a cohort study done on men using bidi cigarettes in Karunagappally, Kerala, India that “bidi smoking sig-ni ¿ cantly increased oral cancer risk.” 7 In addition, it has been shown “in location-speci ¿ c analysis, [that] bidi smoking was signi ¿ cantly associated with cancer of the gum and mouth.” 7 This study revealed a positive correlation between the duration and frequency of bidi use and the increased risk for oral cancers—especially of the À oor of the mouth and periodontal tissue—when compared to those who never consumed this product. When considering bidi smoking as a risk factor for lung cancer, it has been suggested that people who smoke this product take deeper puffs, which increases the amount of smoke available to become ab-sorbed by respiratory cells. Since the smoke has various carcinogenic chemicals, these chemicals interfere with the normal functioning of respiratory cells. This often leads to respiratory cell death and/or in-hibition of normal cell functioning. This in turn can cause uncontrolled proliferation of respiratory cells, thus leading to lung cancer, which is commonly seen as the frequency and duration of use increases. 6 Hazards Common to Both Types of Smoking Smoking either hookah or bidis is a risk factor for cardiovascular diseases, nicotine dependence, increased risk to spread communi-cable diseases and secondhand smoke. Smoking in general, whether using hookah or bidis, is a risk factor for cardiovascular disease. Because of the “numerous toxic substances known to cause clogged arteries” and increased concentrations of CO from smoking, both increase the chances for heart disease. 4 Smoking leaves plaques and increases fat deposits along arteries and vessels, which constricts the size of the vessel, thus decreasing blood À ow throughout the body. This increases stress on the heart to deliver the same quantity of blood via narrower vessels, which ultimately leads to hypertension. In addition, decreased oxygen À ow back to the heart due to the nar-rowing of its vessels can lead to coronary heart disease, as these cells become starved for cellular energy to carry out normal functioning. 4 Furthermore, as the concentration of CO in cells increases, the amount of oxygen decreases because both compete with one another. However, since CO has a stronger af ¿ nity for cells, it binds more read-ily than oxygen, leading to a decrease in the amount of oxygen avail-able for exchange via the cardiopulmonary system. This could lead to a heart attack, as heart cells are starved from oxygen and cannot produce the cellular energy needed to pump blood around the body. 4 Nicotine dependence is a concern when consuming hookah or bidi cigarettes. A single hookah session lasts approximately one hour and has been found to deliver “10-50 percent more nicotine” than a single cigarette. 2 In addition, smoking bidis delivers “concentrations of nicotine three times the amount found in a ¿ ltered, conventional cigarette.” 6 This indicates that both can be potentially more addictive than cigarette smoking because of the alarming increase in nicotine delivered during a single session. Smoking can spread communicable diseases. This idea is es-pecially true with hookah because it is typically smoked in groups sharing the same hose and mouthpiece. However, there also has been evidence of people sharing bidi cigarettes and thereby increasing the chances of spreading disease—tuberculosis, for example, which spreads from an infected person via aerosols created by coughing or sneezing or through direct saliva contact. Other communicable dis-eases that may be transmitted using both types of tobacco products in a group setting are herpes, hepatitis and other illnesses such as in À uenza or the common cold. 4 When smoking in a public area, secondhand smoke becomes an important risk factor for disease. According to the Centers for Disease Control and Prevention, “secondhand smoke from hookahs poses a serious risk for nonsmokers, particularly because it contains smoke not only from the tobacco but also from the heat source.” 4 Secondhand smoke from bidi cigarettes is equally damaging because it exposes everyone to the smoke even if they themselves are not consuming it. This allows everyone around the smoke to become Bidi Cigarette Components and Harmful Constituents “Bidi is a leaf-rolled cigarette made of coarse, uncured tobacco, tied with a string at one end.” 5 Its tobacco is rolled in the leaf of a tendu tree, and just like hookah tobacco it is available in a variety of À avors, which helps to increase its appeal. In addition, bidis are cheaper than conventional cigarettes and mimic the appearance of a marijuana cigarette, which are both believed to help increase its pop-ularity. 6 Just like hookah, “these cigarettes are perceived as a safer, more natural alternative to conventional cigarette smoking e; ” however, it has been determined that they are equally or more harmful than regular cigarettes. 6 As seen with hookah, there are carcinogenic additives such as phenol, hydrogen cyanide, benzo(a)pyrenes, and nitrosamines that are responsible for increased cancer risk associated with consuming this product. Phenols are believed to be carcino-genic because they cause lung edema. Lung edema disrupts normal respiratory cell functioning. Edema is de ¿ ned as swelling due to water retention. This occurs because phenols are alcohol compounds that, through osmosis, cause water to be retained within the lung. Hydro-gen cyanide is known to inhibit cellular respiration. It is a potent toxin that inhibits the enzymes associated with the electron transport chain found within mitochondria. This blocks cellular energy from being produced, and if inhibited long enough, these cells will die due to a lack of cellular energy needed to carry out normal functions. Benzo(a) pyrenes and nitrosamines are both chemical compounds that directly bind to DNA and inhibit its replication and repair systems. They bind to the side chains of DNA and inhibit its enzymatic activity as well as cause mutations along the chain. This creates a nonfunctioning or an exaggerated function of DNA, which can lead to uncontrolled prolif-eration of cells, as seen in cancer. 6 Harmful Effects from Smoking Bidis It has been proven that smoking bidi cigarettes leads to elevated CO levels, as well as “higher risks of hypertension, coronary heart disease, oral (speci ¿ cally tongue and À oor of mouth) cancer and lung cancers.” 6 As seen in hookah, smoking increases exposure to CO. CO is a potent antagonist of oxygen. It readily binds to iron thus blocking oxygen from binding e; however, unlike oxygen, CO cannot be used to produce cellular energy. Over time an increase in CO causes cells to die because they are starved from cellular energy and cannot carry out normal functioning. 10 MAR 2012 access
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