Development of field cancerization in the clinically normal oral mucosa of shisha smokers.

OBJECTIVES: This study aimed to investigate the changes that occur in the oral mucosa of shisha smokers and compare them to cigarette smokers, nonsmokers and smokers of both shisha and cigarettes and to detect whether these changes could be detected biochemically in saliva. METHODS: Four groups of subjects were included in our study (16 in each group); cigarette smokers, shisha smokers, nonsmokers and smokers of both. A salivary sample and a mucosal biopsy were obtained from each subject. Salivary detection of CYFRA 21-1 was performed on each salivary sample. The mucosal biopsy was examined by routine H&E techniques. Furthermore, immunohistochemical expression of p53 was studied in all cases. RESULTS: A statistically significant difference in p53 expression was present between nonsmokers and the three smoker groups. However, no statistically significant variation was present between the 3 smoker groups. Furthermore, no statistically significant changes were found in the CYFRA 21-1 levels among the four groups. CONCLUSION: Shisha smoking has the same damaging effect on the oral mucosa as cigarette smoking. Furthermore, no correlation was detected between the histological findings and the salivary biomarker used (CYFRA 21-1).