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Oral health implications for hookah and bidi cigarette smokers focus of presentation

July 8, 2011
Toni-Ann Restivo, a senior and honors scholar from New York City College of Technology, earned third place for her presentation, “Alternative Smoking Using a Hookah or Bidi Cigarette: Implications on Oral Health” at ADHA student competition.
BROOKLYN, New York--New York City College of Technology’s first participation in the annual American Dental Hygienists’ Association student competition in June 2011 brought home a prize. Toni-Ann Restivo, a senior and honors scholar, took third place for her presentation, “Alternative Smoking Using a Hookah or Bidi Cigarette: Implications on Oral Health.” At one of the convention’s 50 student table clinics and poster session in Nashville, Tenn, Restivo displayed a poster and brochure and spoke about the growing fad of smoking tobacco through a hookah, or water pipe. It has become a popular social activity for young Americans, including college students. Hookah cafés and bars have proliferated in the past decade, several of which operate in Brooklyn. “I felt it was very important to present this at the exhibition,” saidRestivo, a Bensonhurst resident. “It’s a topic that’s surfacing right now in the dental health field.” She also has personal experience with the subject, having tried both hookah and Bidi smoking in her early 20s. ”I wanted this chance to enlighten all those at the convention about a topic that pertains to them and their patients, to help increase awareness and to aid in prevention,” she said.Education is important in understanding hookah fadHookah smoking originated in India roughly 400 years ago, as did the smoking of “bidi” cigarettes, made by rolling tobacco in the leaves of the tendu tree and sometimes flavoring them for sweetness. As anti-smoking legislation continues to build, bidi cigarettes have become scarce in the New York metropolitan area, while hookah smoking opportunities, even for those of high school age, have become easier to find at lounges, bars, or restaurants offering DJs, dancing, table service, and occasionally an outdoor patio. In 2003, New York Magazine even named the top five hookah bars. Restivo’s presentation pointed out that many young people mistakenly assume that smoking tobacco through a water pipe filters out harmful ingredients and is much less of a health hazard than cigarette or cigar smoking. Since the tobacco is often fruit-flavored, smokers think it is safer than ordinary tobacco, and don’t believe that it can cause cancer. But, according to Restivo, “A single cigarette lasts only a few minutes while smoking a hookah can last up to an hour. This increases exposure time to harmful toxins in the smoke.” Because hookah smokers take long, deep breaths, according to a 2005 study by the World Health Organization, they may inhale the equivalent of 100 or more cigarettes’ worth of smoke. Since charcoal is used to keep the tobacco burning, they also are inhaling polyaromatic hydrocarbons and carbon monoxide, which both have carcinogenic properties. Smokers also perceive bidis as being more “natural” than other cigarettes, but in fact they contain natural carcinogens. Bidis do not stay lit consistently, so smokers draw deeply on the cigarettes to keep them burning. Both hookah and bidi smoking also generate second hand smoke, which can affect nonsmokers in the vicinity. Among the effects of hookah and bidi smoking, Restivo listed oral, lung and bladder cancer, periodontal disease, lung edema, hypertension, coronary heart disease and other cardiovascular diseases, as well as nicotine dependence. Since hookah mouthpieces and hoses often are shared with others, smokers also have a higher risk of communicable diseases such as tuberculosis, herpes, hepatitis, and influenza. To make her case, Restivo used research materials from the Centers for Disease Control and Prevention, the Harvard Mental Health Letter, Cancer Science, Pharmacology Biochemistry and Behavior, Food and Chemical Toxicity, including the results of studies done in India, North Carolina, and Florida. Said Restivo’s mentor, Susan H. Davide, assistant professor of dental hygiene at City Tech, “Ms. Restivo's research is on a relevant topic and trend which she presented in an exemplary and professional manner, captivating her audience by sharing her knowledge with her peers and fellow ADHA members.” Third prize consists of a cash award of $300 to Restivo and a matching award for the college, which most likely will be used to purchase more Oraqix anesthetic for the college’s dental clinic. The clinic is open to the general public during the fall and spring semesters.Restivo, who holds a B.S. in biology with a minor in psychology and an associate degree in the sciences from the College of Staten Island, will graduate next year from City Tech with an associate degree in dental hygiene.Also presenting at the event was City Tech junior Ruth Marsiliani on the topic of “Differential Oral Indicators for HIV: COL Criteria.”For more information, go to comment on this topic, go to