Oral mucosal lesions and their association with tobacco use and qat chewing among Yemeni dental patients

Oral cancer knowledge, attitudes, and practices among senior dental students in Yemen: a multi-institution study

BACKGROUND

The "Knowledge, attitude, and practice (KAP)" approach is crucial in health system. Appreciating the current KAP status will reveal the extent of the efficiency of applied health strategies, and subsequently help to determine the appropriate health policy to be employed for improving the health indicators of a given disease/condition, including Oral Cancer (OC). This large-scale cross-sectional study aimed to assess knowledge, attitude, and practice on OC among senior dental students in Yemen.

METHODS

A pre-validated online questionnaire was used for data collection. It consisted of a series of close-ended questions on knowledge, attitudes and practices related to OC. Yemeni dental students in clinical levels (4th and 5th years) from nine dental schools based in four major cities were invited to complete the survey. The SPSS Version 28.0 was used for data analysis. Differences by different grouping factors were assessed by Chi-squared and Mann Whitney-U tests, as appropriate.

RESULTS

A total of 927 students completed the questionnaire: a response rate of 43%. While the majority identified smoking (93.8%), and smokeless tobacco (92.1%) as potential risk factors of OC, only 76.2% recognized sun exposure as a risk factor for lip cancer and only 50% were aware of old age as a risk factor of OC. Regarding clinical signs of OC, 84.1% reported that OC can present as non-healing ulcer, but only two thirds of the participants recognized that OC can present as a white and/or red lesion. With respect to practices, although 92.1% reported asking their patients regarding oral habits, only 78% reported they regularly carry out a soft tissue examination. Only 54.5% of the participants considered themselves to be well-trained to provide smoking cessation advice, and 21% were confident regarding their knowledge on OC. The 5th year students showed significantly better knowledge and practices than the 4th year students did (p < 0.01).

CONCLUSION

The study suggests significant gaps in knowledge, attitudes, and practices of senior dental students in Yemen regarding OC. The findings also underscore the urgent need to improve OC teaching and training of undergraduate dental students, and to provide periodic well-structured continuing professional development activities for dental professionals.

Habitual khat chewing and oral melanoacanthoma: A case report

BACKGROUND

Habitual khat (Catha edulis) chewing has been proven to cause numerous oral tissue changes. However, oral melanoacanthoma triggered by chronic khat chewing is rare. Oral melanoacanthoma is an uncommon, sudden, asymptomatic, benign pigmentation of the oral cavity. Under the microscope, the epithelial layer of the oral mucosa showed dendritic melanocyte proliferation and acanthosis. The study aimed to highlight chronic khat chewing as a trigger for oral melanoacanthoma.

CASE SUMMARY

In the current study, we report a case of a 26-year-old male patient with a rare presentation of oral melanoacanthoma triggered by regular khat chewing. Many intrinsic and extrinsic factors can cause oral pigmentation. Chewing khat is an extrinsic factor that can cause several diseases, including oral pigmentation. In this case, the definitive diagnosis was oral melanoacanthoma. This diagnosis was made based on the patient’s history, clinical lesion presentation, and microscopic biopsy results.

CONCLUSION

Habitual khat (Catha edulis) chewing causes many oral tissue changes including oral melanoacanthoma. The study aimed to highlight chronic khat chewing as a trigger for oral melanoacanthoma.

Global prevalence of oral pigmentation and its related factors: a systematic review and meta-analysis

BACKGROUND

Oral pigmentation is due to the accumulation of one or more pigments in tissues, causing changes in the color of the oral mucosal surfaces. Understanding the exact global prevalence of oral pigmentation and its associated factors helps researchers make the proper interventions at the right time; in this respect, the objective of the present systematic review and meta-analysis was to determine the global prevalence of oral pigmentation and its related factors.

METHOD

A systematic review and meta- analysis were conducted using the following databases: Magiran, SID, Scopus, Embase, PubMed, Web of Science (WoS), and Google Scholar. The search was run to retrieve articles published from inception until July 2021, and the following keywords were applied in the search strategy: "Epidemiolo*", "Prevalen*", "Factor*", "Pigment*", "Mouth", and "Oral". The I² index was used to assess the heterogeneity of the studies, and Egger's test was used to examine the publication bias.

RESULTS

Sixty-nine articles, with a sample size of 70,668 people, meeting the inclusion criteria were included in the study. The pooled of prevalence of oral pigmentation was estimated to be 20.8% (95% confidence interval: 17.1-1.25%). The prevalence of oral pigmentation raised significantly towards the end of the timespan covered by the study (P˂ 0.001). The majority of the examined studies reported that the prevalence of oral pigmentation is significantly higher in men, smokers or those exposed to secondhand smoke, people with fair skin, and who were affected by Yusho patients.

CONCLUSION

The results of the present study show that the prevalence of oral pigmentation is high, with higher prevalence in men, smokers or those exposed to cigarette smoke, people with fair skin, and Yusho patients compared to other groups. It is recommended that. these findings be used in policy makers' decisions to deliver better health care.

Reliability and validity of the 15-item Chronic Oral Mucosal Disease Questionnaire in China: A short-form instrument to measure quality of life

BACKGROUND

Chronic oral mucosal diseases have been a common problem, which affected individuals' health and social functions seriously. Although there has been a rigorous Chinese version of the Chronic Mucosal Diseases Questionnaire (COMDQ-26) to measure the quality of life of patients with chronic oral mucosal diseases, 26 items were so redundant to be a burden for patients. It was necessary to make a brief, practical, and easy-to-use tool in China. This study aimed to test the validity and reliability of the Chinese version of the short-form Chronic Mucosal Diseases Questionnaire (COMDQ-15).

METHODS

A total of 165 respondents from a tertiary stomatological hospital were recruited in this study from July to December, 2020. Internal consistency, test-retest reliability, criterion validity, confirmatory factor analysis, and exploratory factor analysis were used to evaluate the reliability and validity of the Chinese version of Chronic Mucosal Diseases Questionnaire-15.

RESULTS

The total Cronbach's α of 0.841 and subscale ranging from 0.736 to 0.965 revealed good internal consistency of the reliability. The intraclass correlation coefficients exceeded 0.80 indicated excellent test-retest reliability. Compared with the Oral Health Impact Profile-14, the criterion validity was 0.549. The confirmatory factor analysis results supported acceptable validity of the Chinese version of Chronic Mucosal Diseases Questionnaire-15, and the exploratory factor analysis demonstrated that the 15 items were classified into four domains, with a cumulative proportion of 71.52%.

CONCLUSION

The Chinese version of Chronic Mucosal Diseases Questionnaire-15 is a brief and low-burden tool, and has been proved reliable and valid to assess the quality of life of patients with chronic oral mucosal diseases in China (the Chinese Clinical Trial Registry (no. ChiCTR2000031607).

The Prevalence and Correlates of Fissured Tongue Among Outpatients in Andkhoy City, Afghanistan: A Cross-Sectional Study

BACKGROUND

Fissured tongue is a common manifestation of the tongue, marked by the presence of multiple prominent grooves or fissures on the dorsal surface of the tongue. However, there is a lack of studies focusing on the prevalence and factors associated with fissured tongue among patients attending an outpatient clinic in Afghanistan.

AIM

The purpose of the current study was to determine the prevalence and factors associated with fissured tongue and its effects on the general health of adult outpatients in Afghanistan.

PATIENTS AND METHODS

The cross-sectional survey was conducted among outpatient populations in Andkhoy City, Afghanistan, between September 2019 and December 2019. A convenience technique was applied by including 1182 patient aged 18-80 years. Socio-economic status, smoking, nass use (smokeless tobacco use) and medical data were collected using face-to-face interviews. We used logistic regression analysis to identify factors associated with fissured tongue. A convenience technique was applied by including patient aged 18-80 years.

RESULTS

The studied population consisted of 1182 participants, of whom 573 (48.5%) were males and 609 (51.5%) females. The prevalence of fissured tongue was 27.2% (95% CI: 24.7-29.9%) with males having significantly higher prevalence than females (47.5%, 95% CI: 43.3-51.6% versus 8.2%, 95% CI: 6.2-10.7%, p<0.001). Male participants (OR=7.1, 95% CI: 4.8-10.3), diabetes mellitus (OR=1.6, 95% CI: 1.1-2.3) and smokeless tobacco use (OR=12.0, 95% CI: 8.1-17.6) were the only variables independently associated with fissured tongue.

CONCLUSION

This study suggested that there was a high rate of fissured tongue among an outpatient clinic in Andkhoy, Afghanistan. Male gender, diabetes mellitus, and nass consumption were associated with fissured tongue. Therefore, these factors might usefully be targeted in local health promotion, prevention and early intervention programs.

Cone beam computed tomography findings in the temporomandibular joints of chronic qat chewers: Radiographic bone density and trabecular microstructural analyses

OBJECTIVES

This cross-sectional comparative study investigated the effects of qat chewing habit on the radiographic bone density (RBD) and trabecular microstructure of temporomandibular joint condyles using cone beam computed tomography (CBCT).

STUDY DESIGN

In total, 85 systemically healthy Yemeni males were included and divided into qat chewers (QCs; n = 41); and non-qat chewers (NQCs; n = 44). The participants responded to a structured questionnaire and underwent standardized clinical examination and CBCT scanning of the temporomandibular joint. Measurements of RBD and trabecular microstructure (trabecular thickness, trabecular separation, bone volume fraction, and fractal dimension) were performed. Statistical significance was established at P ≤ .05.

RESULTS

No statistically significant differences were found between QCs and NQCs in RBD or trabecular microstructure. The mean standard deviations and maximum values of trabecular separation on the nonchewing side for QCs were significantly lower compared to the corresponding values for NQCs (0.60 and 2.68 for QCs vs 0.72 and 3.05 for NQCs; P = .025 and .05, respectively). A comparison between chewing and nonchewing sides in QCs revealed no significant differences.

CONCLUSIONS

Qat chewing habit induces insignificant changes in condylar RBD and trabecular microstructure as detected by CBCT. Further studies using advanced radiographic techniques are warranted.

Cone beam computed tomography findings in temporomandibular joint of chronic qat chewers: Dimensional and osteoarthritic changes

The social habit of chewing qat (also known as khat) is widely practised in East Africa and the Arabian Peninsula. It has been linked with various oro-facial conditions, including temporomandibular joint disorders (TMD). This cross-sectional, comparative study sought to investigate the effects of qat chewing on temporomandibular joint (TMJ), using cone beam computed tomography (CBCT). A total of 85 Yemeni males were included. The participants were divided into two groups: Qat chewers (QC; n = 41) and non-qat chewers (NQC; n = 44). Relevant data were obtained using a structured questionnaire and standardised clinical examination. Additionally, CBCT images of the TMJs were obtained, and then, osteoarthritic changes and TMJ dimensions were analysed. SPSS 21 was used for statistical analyses, with a significant level was set at 0.05. Compared to NQC, a significantly higher proportion of QC presented with clinical signs of TMDs. The qualitative CBCT findings revealed significantly higher osteoarthritic changes in QC than in NQC: osteophyte (51.2% vs 22.7%; P = .008), subcortical sclerosis (48.8% vs 27.3%; P = .047), articular surface flattening (46.3% vs 6.8%; P = .009) and subcortical cysts (43.9% vs 4.5%; P < .001). However, CBCT quantitative findings (condylar dimensions) did not show significant differences between the two groups. The chewing side of the QC group showed slightly more changes compared to the non-chewing side. The results demonstrate that qat chewing has detrimental effects on TMJ manifested mainly as osteoarthritic changes. Further large-scale studies are recommended.

Effect of Khat Chewing on the Salivary pH before and after Using Mouthwashes

BACKGROUND

Saliva is a biological fluid that has multiple protective functions. These functions can be attained only if the saliva keeps certain physo-chemical properties such as pH. The main purpose of the current study was to compare the salivary pH among khat chewers and non-khat chewers before and after specific intervals (15, 30, and 60 minutes) of using three commercially available mouthwashes (MWs).

METHODS

In this cross sectional study, thirty pharmacy student volunteers were divided into three groups of 10 for the three MWs. Each group was then subdivided into 5 volunteers as khat chewer and non-khat chewer. The statistical evaluation was carried out by using paired t-test and analysis of variance (ANOVA) for in vivo study of salivary pH.

FINDINGS

Low salivary pH in all khat-user volunteers before and after using MWs was indicated. There was an increase in the salivary pH after 15 minutes of rinsing with the three selected MWs for both groups of volunteers, after that there was a gradual decrease to the initial pH. The difference between the three groups was not significant at baseline and after 15 minutes, but there was a significant difference after 30 and 60 minutes for the non-khat-chewing and khat-chewing volunteers.

CONCLUSION

It can be concluded that using MWs results in altering salivary pH and continuous khat chewing lowers the baseline pH of saliva and ability to compensate the change of salivary pH.

Tobacco Cessation Counseling: Attitudes and Practices among Yemeni Dental Professionals

Tobacco use is a significant health problem in Yemen and worldwide. Dental practitioners can play a pivotal role in educating their patients on the risk of smoking and motivating them to quit. This study aimed to assess the attitudes towards and practices of tobacco cessation counseling (TCC) among Yemeni dental professionals and to evaluate whether such attitudes and practices are associated with gender, smoking status, and years since graduation. In this cross-sectional study, a self-administered questionnaire containing questions regarding the practice and attitudes towards TCC in dental clinic was used. SPSS version 20 was used for data analysis. For statistical analysis, Chi-square test was used with a significance level of P < 0.05. Of the 400 distributed questionnaires, 182 were completed and analyzed. 53.3% of the respondents were males and 46.7% were females. Around one fifth of the respondents were smokers. The majority reported that they routinely ask their patients about their tobacco habits (83.5%), and advise against tobacco use (85%). Around half of the respondents believed that tobacco cessation intervention may affect their clinical practice and their income negatively through decreasing number of attending patients and believed that provision of dental treatment is more important than TCC. The majority (92%) believe that health professionals should refrain from tobacco, and 83% agree that TCC should be included in dental school curricula. Recent graduates and non-smokers showed relatively better attitudes and practices. There is an urgent need for continuing educational programs in TCC. Also, inclusion of TCC to dental curriculum is highly required.

White oral mucosal lesions among the Yemeni population and their relation to local oral habits

AIMS

The aim of the present study was to assess the prevalence and risk factors of white oral mucosal lesions among Yemeni adults; in particular, those who chew khat and tobacco.

METHODS

The present cross-sectional study included 1052 dental patients aged 15 years and older. A detailed oral examination was performed by a single examiner in accordance with standard international criteria.

RESULTS

Overall, 25.2% of the study participants presented with one or more white lesions. The most prevalent lesions were khat-induced white lesion (8.8%), leukoedema (5.1%), and frictional keratosis (3.9%). Potentially malignant lesions, such as lichen planus, leukoplakia, and smokeless tobacco-induced lesions, were seen in 2.4%, 1.2%, and 1.7% of participants, respectively. Moreover, three cases of oral cancer were identified. The presence of white lesions was found to be significantly associated with advanced age (P = .004), male gender (P = .009), and khat/tobacco chewing habits (P < .001).

CONCLUSIONS

The present study demonstrates a high prevalence of oral benign and potentially malignant white lesions. Further, it highlights the urgent need to develop and implement new government policies to regulate the sale of these products to reduce the prevalence of these lesions and the overall incidence of oral cancers in the Yemeni population.

Is Khat (Catha edulis) chewing a risk factor for periodontal diseases? A systematic review

Background

Khat (Catha edulis) chewing is a highly prevalent habit in the Arabian Peninsula and East Africa, and has recently spread to Western countries. The association between khat chewing and oral mucosal lesions is well documented in the literature. However, there is no concrete evidence on the association between khat chewing and periodontal disease. The purpose of this systematic review was to analyze the influence of khat chewing on periodontal health.

Material and Methods

A literature search of PubMed, Scopus and Web of Sciences databases was carried out to identify relevant articles published from 1990 to May 2017. The inclusion criteria were all clinical studies that assessed the relationship between khat chewing and periodontal disease.

Results

The search yielded 122 articles, of which 10 were included in this systematic review. Most of the studies exhibited a positive correlation between khat chewing and periodontal disease.

Conclusions

Altogether, the analysis of the current evidence reveals that khat chewing is destructive to the periodontium and enhances the risk of periodontal disease progression. However, due to variability of studies, more longitudinal case-controlled studies are highly warranted to establish a causal relation between khat chewing and periodontal disease.

Key words:Khat chewing, periodontal health, periodontal disease, risk factor.

Effect of Frequency and Duration of Tobacco Use on Oral Mucosal Lesions – A Cross-Sectional Study among Tobacco Users in Hyderabad, India

Purpose: Tobacco use is one of the most important risk factors for the development of oral mucosal lesions including oral pre-cancer and cancer. The type and location of the lesion varies with the type of tobacco used, the way it is used, and the frequency and duration of use. Hence, the present study aimed to determine the effect of frequency and duration of tobacco use on oral mucosal lesions among tobacco users in Hyderabad city. Materials and Methods: A cross-sectional study was carried out among 280 tobacco users who were categorized into smokers, chewers and mixed groups according to the habit. One forty subjects diagnosed with Oral Mucosal Lesions, designated as cases and One forty lesion free controls, frequency matched for age, gender, habit and family income were assessed. The study protocol included a visual oral soft tissue examination and a questionnaire-based interview. Statistical analysis was done using Chi square test and t- test. Multiple logistic regression analysis was done to assess the association of the variables with lesions. Results: Oral submucous fibrosis (18%) was the most common oral mucosal lesion followed by Leukoplakia (14%) and Smoker’s palate (12%). Dose-response relationships were observed for both duration and frequency of habits on the risk of oral mucosal lesions. However, it was significant only for frequency of the habit. A significant positive correlation was observed between occurrence of lesion and those with no education (p=0.005). Conclusion: The study revealed that frequency and duration of tobacco use was associated with the risk of oral mucosal lesions.

Khat (Catha edulis) and its oral health effects: An updated review

Khat or qat (Catha edulis) is a plant that grows in East Africa and southern Arabia. The leaves and twigs of this small tree are chewed by several millions of people worldwide for their stimulating amphetamine-like effects. The reported prevalence of khat chewing in Europe and the USA is on the rise, especially with global migration. Long-term khat chewing has several detrimental general and oral health effects. The aim of the present study was to review the current literature regarding khat use and its association with oral and dental diseases, with particular emphasis on its link with oral keratotic white lesions and oral cancer. We searched the literature to identify all relevant articles. Studies showed that khat is associated with several oral and dental conditions, including keratotic white lesions, mucosal pigmentation, periodontal disease, tooth loss, plasma cell stomatitis, and xerostomia. There are limited data on the incidence of dental caries among khat chewers. The evidence that khat chewing is a risk factor for oral cancer is still weak, and is mainly based on anecdotal case reports and uncontrolled studies.

Oral hygiene and periodontal health status among khat chewers. A case-control study

Background

Habitual khat chewing is a widespread male habit in Southern Arabia and East Africa. The aim of this study was to assess the effect of Khat chewing on oral hygiene and periodontal health status among Yemeni male khat chewers.

Material and Methods

This case- control study included 310 khat chewers, aged 20-65 years, and 72 age- and gender- matched non-chewers as controls. Periodontal examination included recording of dental plaque index (PI), gingival index (GI), probing pocket depth (PPD), attachment level (AL) and gingival recession (GR). Demographic data, oral hygiene practices, and duration, frequency and site of khat chewing were obtained using questionnaires. SPSS was used for data analysis. ANOVA and t- tests were used to compare groups.

Results

Khat chewers had significantly higher mean PI, AL, GR scores than non-chewers (P < 0.05). However, no significant differences in the GI and PPD mean scores were observed between both groups (p > 0.05). Interestingly, the results showed that the chewing side had less PI, GI and PPD than non-chewing side. However, gingival recession was significantly higher in the chewing side. The duration of chewing showed a significant effect on PI, PPD, AL, and GR but had no effect on the gingival condition. Likewise, the frequency of chewing showed a significant effect on PPD, AL, and GR, but had no effect on other indices (PI and GI).

Conclusions

The results of this study indicate that khat chewing have a detrimental effect on the periodontium.

Key words:Khat chewing, periodontal health, oral hygiene.

Periodontal Health Condition and Associated Factors among University Students, Yemen

INTRODUCTION

Studies on oral health status among Yemeni population are scarce.

AIM

This study aimed to evaluate the periodontal health among advantaged section of Yemeni society, university students, in health and non-health fields.

MATERIALS AND METHODS

Periodontal health status of a sample of 360 students from dental, medical and literature faculties (120 each with equal gender distribution) at Sana'a University was evaluated by two calibrated examiners using CPI index. Data regarding tooth-brushing practices and smoking and khat chewing habits were obtained using a structured interview questionnaire.

RESULTS

Only 45 students (12.5%) had healthy periodontium, while 113 (31.4%), 186 (51.7%) and 16 (4.4%) had bleeding, calculus and shallow pocket, respectively, with no significant differences between faculties. Females revealed significantly better periodontal health compared to males, though their bleeding score was higher. Dental and medical students and female students in general were significantly more interested in tooth-brushing and significantly less interested in practicing the deleterious habits such as smoking and khat chewing.

CONCLUSION

The overall periodontal health of Sana'a University students is still unsatisfactory even among students in health field. Females and students in health field revealed better periodontal health and oral health practices (tooth-brushing) in comparison to male students and those in non-health field. The negative effects of the highly prevalent smoking and khat chewing habits deserve further reliable researches and proper educational programs at the national level.

Evaluation of Oral Changes Among Tobacco Users of Aljouf Province, Saudi Arabia

OBJECTIVE

To know the prevalence of tobacco associated changes among male population of Aljouf province of Saudi Arabia.

MATERIALS AND METHODS

This study included 536 male subjects with positive history of tobacco habits. All the participants were asked to fill a questionnaire regarding the habit details and were examined clinically for the oral changes.

RESULTS

Majority of the subjects used tobacco in smoked form (69.0%). Out of the 536 patients with tobacco smoking and chewing habits 72% showed changes in oral mucosa. Smokers melanosis (43.28%) was the most commonly observed oral change followed by leukoedema (27.05%) and smoker's palate (22.76%). Leukoplakia (3.17%) was the most commonly seen premalignant lesion.

CONCLUSION

The study confirms the fact that use of tobacco can be positively correlated to the occurrence of various benign, premalignant and malignant oral changes. This study aids in creating awareness among the public regarding the deleterious effects of tobacco and may motivate them for cessation of tobacco use.