title: Association between tobacco waterpipe smoking and head and neck conditions: A systematic review.
abstract: BACKGROUND
  With the growing popularity of waterpipe smoking (WPS), it is important to understand how WPS may impact health. The aim of this study was to systematically review the literature to identify potential health effects of WPS, specifically on the head and neck region.
  
  
  METHODS
  The authors systematically reviewed published articles that focused on WPS and head and neck conditions identified from the following databases: PubMed and MEDLINE, PsycInfo, and Google Scholar.
  
  
  RESULTS
  The authors included 20 articles in the review. Ten of the articles pertained to oral tissue outcomes, 7 to head and neck cancer, and 3 to the voice and middle ear. The authors found that WPS was associated with greater inflammation, Candida, periodontitis, dry socket, blood chromium and nickel levels, premalignant lesions, oral cancer, esophageal squamous cell carcinoma, attic retraction, edema in the vocal cords, and lower habitual vocal pitch and voice turbulence index.
  
  
  CONCLUSIONS
  WPS is associated with various head and neck conditions. Educational and policy approaches may be required to limit the spread of WPS and its potentially deleterious effects.
authors.forename: Teja
authors.initials: T
authors.lastname: Munshi
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Heckman
authors.forename: Susan
authors.initials: S
authors.lastname: Darlow
mesh_terms: D004427:Ear Diseases / Q000209:etiology; D006258:Head and Neck Neoplasms / Q000209:etiology*; D006801:Humans; D009059:Mouth Diseases / Q000209:etiology*; D012907:Smoking / Q000009:adverse effects*; D014832:Voice Disorders / Q000209:etiology*
keywords: Waterpipe smoking; cancer; craniofacial; flavored tobacco; head and neck health; periodontitis; precancerous lesions; systematic review; tobacco