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A recent systematic review reported a strong association between the use of tobacco-containing betel quid and oral cancer incidence, with an odds ratio of 7.74 (95% CI: 5.3811.13) (35)

When the researchers focused on patients from the three groups who were age 60 on average (30 marijuana smokers, 33 tobacco-only smokers and 29 nonsmokers) they found that 57% of the marijuana smokers had paraseptal emphysema, compared with 24% of the tobacco-only smokers

Additionally, many municipalities, local school boards and boards of health have enacted by-laws and policies to limit vaping in their jurisdictions

In particular, cigarette smoking is a cause of oral dysbiosis, affecting microbial diversity and its functional potential 5,7