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J Periodontol. 2016 Feb;87(2):142-7. doi: 10.1902/jop.2015.150235. Epub 2015 Oct 2.

Comparison of Clinical and Radiographic Periodontal Status Between Habitual Water-Pipe Smokers and Cigarette Smokers.

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Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY.
Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
Department of Environmental Medicine, Toxicology Training and Lung Biology Disease Programs, School of Medicine and Dentistry, University of Rochester.
Department of Biostatistics and Computational Biology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY.
Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY.



There is a dearth of studies that have compared clinical and radiologic markers of periodontal inflammation between water-pipe smokers (WPs) and cigarette smokers (CSs). The aim of the present study is to compare the clinical and radiographic periodontal status between habitual WPs and CSs.


In total, 200 males (50 WPs, 50 CSs, and 100 controls) with comparable mean age and education were included. Demographic information was recorded using a questionnaire. Periodontal parameters (plaque index [PI], bleeding on probing [BOP], probing depth [PD], clinical attachment loss [AL], and marginal bone loss [MBL]) and numbers of missing teeth (MT) were recorded.


The duration of each smoking session for WPs and CSs was 50.2 ± 6.7 and 15.3 ± 0.4 minutes, respectively. Number of MT [P <0.0001], PI [P <0.0001], AL [P <0.0001], PD ≥4 mm [P <0.0001], and MBL [P <0.0001]) was significantly higher among WPs and CSs than controls. BOP was significantly higher among controls than WPs (P <0.0001) and CSs (P <0.0001). There was no statistically significant difference in the aforementioned parameters between WPs and CSs.


Males in a Saudi Arabian community who were CSs or WPs had more MT and poorer periodontal condition than never smokers. The periodontal condition of WPs was equally as poor as CSs. Additional clinical observational studies with emphasis on sex and sociodemographic characteristics are needed.


Alveolar bone loss; dental plaque; inflammation; periodontal index; smoking

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