The use of manufactured cigarettes in Brazil has decreased since the mid-1980s [1], largely as a result of prevention policies, increase of the awareness of the harmful effects of cigarette use and the establishment of smoke-free environments [2]. Nonetheless, other types of tobacco consumption, such as electronic nicotine delivery systems (ENDS) and waterpipes (hookah, narghile and shisha) are popular practices among adolescents and young adults [3]. Waterpipe tobacco smoking (WTS) is responsible for a significant and growing portion of smokers in the world [4] and its use is increasingly popular, representing a potential public health concern [5], including in Brazil [6].

The introduction of flavoured tobacco, social acceptability and the lack of regulatory policies contributed to its spread [4], with signs of a growing global epidemic with serious prospects for morbidity and mortality [7]. There is a relationship between WTS and development of potentially malignant disorders and oral cancer [8, 9], even at a young age [10]. The deleterious effects are similar to cigarette smoking [11], or even more extensive [12], because of the exposure to various carcinogens and toxic substances, such as nitrosamines, polyaromatic hydrocarbons, aldehydes and heavy metals. Additionally, burning coal, a heat source, contributes to high levels of carbon monoxide [4].

Therefore, awareness programs on smoking and oral cancer must be targeted at young people, and WTS must be subjected to stricter control [10]. It is of great importance to educate the general public to dissipate the perception of its safe use [13], highlighting that oral health professionals should be prepared to provide effective tobacco-use prevention and cessation counselling because they will see more patients exposed to these products [14, 15].

Public health policy actions are needed to combat the emerging WTS epidemic [16]. Strategies aiming the new tobacco modalities should be implemented to prevent smoking habits in the new generation [3]. Brazil is internationally recognized for its leadership in tobacco control and is a signatory country of the World Health Organization Framework Convention on Tobacco Control (WHO/FCTC). Only Brazil and Turkey have adopted all MPOWER measures (monitor tobacco use and prevention policies, protect people from tobacco smoke, offer help to quit tobacco use, warn about the dangers of tobacco, enforce bans on tobacco advertising, promotion and sponsorship, and raise taxes on tobacco) at best-practice level [2]. A consistent prevention policy must comply with all articles of the WHO/FCTC, such as, banning all types of advertising, expanding the ban on product exposure and acting on indirect advertising of digital influencers on social networks, which are increasingly used to encourage smoking. When thinking about strengthening the National Policy on Tobacco Control (NTCP) in Brazil, the qualification of dental surgeons in chemical dependency would be an important strategy for the inclusion and expansion of these professionals as protagonists in primary health care [2].

We acknowledge São Paulo Research Foundation (FAPESP) for grant #2018/23248-1.

MGO Alves: substantial contributions to the conception, drafting the article, revising it critically for important intellectual content, final approval of the version to be published. BF do Carmo Carvalho: substantial contributions to the conception, drafting the article, final approval of the version to be published. SS Marques: substantial contributions to the conception, final approval of the version to be published. MA Lopes: substantial contributions to the conception of the letter, drafting the article, revising it critically for important intellectual content, final approval of the version to be published. JD Almeida: conception of the letter, drafting the article, revising it critically for important intellectual content, final approval of the version to be published.