Researchers looking into the causes of mouth cancer say booze and smokes are the major culprits, but have raised a flag about the use of water-pipes or "hookahs".
A study published in the New Zealand Medical Journal on Friday has found alcohol consumption, followed by tobacco are the most prevalent risk factors for oral cancer among Kiwis.
The researchers from the Dunedin Oral Pathology Department said current smokers were four times more likely to develop mouth cancer that non-smokers, while the risk for heavy smokers was 20 times greater.
They found that risk also synergised with alcohol, with those who were both heavy smokers and drinkers 48 times more likely to develop oral cancer.
"We're talking here about many drinks per week of beer, and particularly spirits, which are much more of a concern," says surgeon Leslie Snape.
But they flagged concerns over a popular belief smoking tobacco using the Middle-Eastern style water pipe known as shisha, nargileh or hookah was perceived to be healthier than cigarettes, despite evidence to the contrary.
"It has been shown that water-pipe use exposes smokers to substantially greater amounts of carcinogens than cigarettes.
"One 60-minute water-pipe smoking session is estimated to expose the user to carcinogens equivalent to as many as 10 cigarettes."
They said despite one study in Sydney showing a quarter of Arabic-speaking residents used water pipes there, and New Zealand's demographics changing, there had been no research into the use of the devices here.
"Research is required to estimate the actual prevalence of use of water-pipe smoking."
The study raised similar questions about the use of chewing-tobacco-style "oral preparations".
Between 2000 and 2010 there were 1916 reported cases of oral cancer in New Zealand.
"The quality of life for patients who have had a mouth cancer, if it's not picked up early, can cause them considerable difficulties," says Mr Snape.
The study has recommended dentists encourage "judicious" alcohol drinking and advise against smoking.
UV radiation was also flagged as an important risk factor for Kiwis.
NZN / Newshub.