**4.6 Shisha (water pipe) smoking**

Shisha is commonly available in restaurants, cafes, and other eatery shops in many countries and it contains a high concentration of nicotine, tar, and carbon monoxide [44].

Smoking with water (WPS) is a type of smoking that has traditionally been used for many years in Asia and the eastern Mediterranean. However, in the 1990s, it became global with increasing popularity in other parts of the world, including Western countries [45].

A recent study found a strong link between water pipe smoking and head and neck cancers [45]. In a study from Syria and Lebanon, Zaid et al. Reported that mutations in the p53 gene are smoking in the water tube at OSCC63 [46].

Al-Amad conducted a study in Jordan that found that 36% of those with oral cancer had a habit of smoking in a water pipe [47].
