The relationship of "shisha" (water pipe) smoking to postextraction dry socket

J Oral Maxillofac Surg. 2004 Jan;62(1):10-4. doi: 10.1016/j.joms.2002.11.001.


Purpose: This study was undertaken to determine whether "shisha" (water pipe) smokers (SS) were at a different risk of developing dry socket (DS) than were cigarette smokers (CS) or nonsmokers (NS) and to assess the effect of preoperative and postoperative smoking habits on the incidence of DS.

Materials and methods: One hundred NS, 100 CS, and 100 SS were enrolled. Surgery for removal of mandibular third molars was performed under local anesthesia with no incision or bone removal. At 1, 4, and 7 days after surgery, postoperative evaluation and postoperative smoking were recorded by the same examiner. The chi(2) test was used for statistical analysis of results. Statistical significance was defined as a value of P <.05.

Results: Smokers had 2 to 3 times the risk of NS for developing DS. Although SS had a greater incidence of DS than did CS, the difference was not significant (P =.083). The incidence of DS was not age dependent. Smokers who smoked the day of surgery had a significantly higher incidence of DS than did smokers who smoked the second day after surgery. Compared with NS, CS who smoked the day of surgery and SS who smoked the day of surgery or the first day after surgery had a significantly increased incidence of DS (CS/NS, day 0, P =.001; SS/NS, day 0, P =.001; day 1, P =.005).

Conclusion: SS had 3 times the risk of NS for developing DS, but there was no statistically significant difference between SS and CS. Increased frequency of smoking and smoking during the day of surgery significantly increased the incidence of DS.

MeSH terms

  • Adult
  • Dry Socket / etiology*
  • Female
  • Humans
  • Male
  • Mandible
  • Molar, Third / surgery*
  • Postoperative Period
  • Smoking / adverse effects*
  • Tooth Extraction / adverse effects*