Though water pipes are widely viewed as a “safer” way to smoke, they may be as damaging to the teeth and gums as cigarettes are, a new study suggests.

Water pipes, or hookahs, have long been used for smoking tobacco in the Middle East, North Africa and parts of Asia, and “hookah lounges” are increasingly popping up in the U.S. and other countries.

The pipes consist of a long tube attached to a glass or plastic container that holds water in its base.

The tobacco, which is flavored with fruits and sugar syrup, is burnt using charcoal.

Because the smoke passes through the water before the smoker inhales it, water pipes are believed by some to filter out the harmful substances in tobacco smoke.

However, water pipe smoke contains the same toxins as cigarette smoke, the authors of the new study point out in their report in the Journal of Periodontology. And past studies have suggested that hookah smoking increases heart rate and blood pressure and impairs lung function.

To see if water pipes are as tough on the teeth as cigarettes are, Suzan Natto and her colleagues at the Karolinska Institute in Stockholm, studied 262 adults in Saudi Arabia, where hookah smoking is widespread.

Overall, 31 percent smoked water pipes exclusively, while 19 percent smoked only cigarettes. Another 20 percent used both smoking methods, and the rest - 30 percent - were non-smokers.

The researchers found that about 20 percent of all study participants had signs of gum disease, which is marked by inflammation and redness in the gums in its earlier stages, and, later, destruction of the bones and soft tissue supporting the teeth, possibly leading to tooth loss.

But while only 8 percent of non-smokers had gum disease, 30 percent of water pipe smokers and 24 percent of cigarette smokers were affected.

When Natto and her colleagues weighed other factors, such as study participants’ ages, they found that water pipe smokers were five times more likely than non-smokers to show signs of gum disease. Cigarette smokers had a nearly four-times greater risk than non-smokers.

It’s not clear why tobacco smoking promotes gum disease, but it’s “highly likely,” Natto and her colleagues note, that it harms the bones that support the teeth. Whatever the reason, they say, the findings suggest that tobacco from a water pipe is as harmful to the teeth as that of cigarettes.

SOURCE: Journal of Periodontology, November 2005.