Critical analysis of the published literature about the effects of narghile use on oral health

Critical analysis of the published literature about the effects of narghile use on oral health D uring the last decades, there has been an increased trend in narghile use globally (1, 2). It has been considered as a global threat and given the status of an epidemic by public health officials (3). Several reviews were written concerning the health effects of narghile use, especially cardiorespiratory (2Á7). As dentists are almost certain to encounter narghile smokers (NS) amongst their patients, it is important to inform the dental team of the significantly detrimental impacts of narghile use on oral health. However, to the best of the authors' knowledge, no review has raised its oral health effects. Nevertheless, data regarding its effects on oral health are few. We searched MEDLINE and SCOPUS on June 30, 2015, using the combination of the following keywords: ('narghile' or its different synonyms) and ('oral lesions' or 'oral cancer' or 'dry socket' or 'periodontium'). Only 16 studies (8Á23) were found. The studies of Ashril and Al-Sulamani (22) and Natto (23) were not retained since their full texts were not retrieved. Direct contact with authors (mail or postal addresses) failed to obtain a copy of their manuscripts. When looking into the abstract of Natto study (23), having the same title as a previous one by the same team (18), it seems like a synthesis of their previous studies (17Á20). Therefore, only 14 studies were retained (8Á21). Tables 1 and 2 display their designs and main results. There is a high risk that narghile use may have harmful effects on oral cavity. However, several methodo-logical limitations were noted in the 14 retained studies. The first limitation concerns the 'narghile' synonyms. Narghile is the generic name for any method of tobacco use featuring the passage of smoke through water before being inhaled (2, 6). In the literature, the name of this mode of smoking depends on the country of origin and includes several terms: goza, shisha, water pipe, water-pipe, waterpipe, hubble-bubble, mada'a, moassel, narghile, and hookah (Tables 1 and 2). One error, of a methodological nature, is to group under one universal entity ('waterpipe', particularly in one word) different types of pipes which are actually used with different smoking products in different contexts (24). This error is not only a scientific reduction-ism but also a nominalism that has fuelled world confusion (2, 6). Two examples of such confusion were highlighted by …