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Although the practice was frowned upon or forbidden in many places, women began smoking during World War I

However, possible predisposing factors may include poor oral hygiene and overgrowth of pigment-producing bacteria or fungi in the mouth, treatment with certain antibiotic medications, smoking, chewing tobacco, and/or mouthwash use.

In June 2023, just 27% of respondents to the survey believed e-cigarettes were less harmful than smoking, while 57% of respondents believed vaping was either more or equally bad than smoking