Reverse smoking is cultural. It tends to occur in tropical and subtropical countries, especially on islands and along the coasts. This is one way for fishermen and other people exposed to high amounts of water (monsoons, etc) to avoid having their smoke go out. In India this is considered more feminine than conventional smoking and avoids the chance of ashes falling on a nursing infant or into the cooking pot.
Items smoked in reverse:
(1) hand-rolled unfiltered cigarettes
(2) filtered cigarettes
(3) cheroots (called chutta in India)
(4) cigars
This is a particularly nasty way to smoke since the person is exposed to all elements of the smoke without filtration in combination with high heat.
Clinical features of reverse smoking:
(1) opportunity for frequent and widespread (cheek, lips, tongue, gingiva, palate) intra-oral burns
(2) mucosal erythema, including smoker's palate (see previous section)
(3) mucosal pigmentation including melanosis (which has to be distinguished from any pigmentation associated with race)
(4) mucosal thickening with leukoplakia
(5) fissuring and/or ulceration
(6) mucosal macules and/or papules
(7) submucosal fibrosis (with or without betel chewing, see above)
(8) oral dyskeratosis
(9) intra-oral neoplasia
(10) pulmonary complications of smoking, including COPD and lung cancer
Risk factors for complications:
(1) duration of smoking
(2) time spent smoking per day
(3) xerostomia
(4) additives to the tobacco
