A study of 342 oral keratotic white lesions induced by qat chewing among 2500 Yemeni

BACKGROUND: Qat chewing is a common habit in Yemen. Various studies demonstrated clear effects of this habit on the systemic organs of the human body. The lack of studies, however, on the effects of this habit on oral mucosa was the major motive of this study. METHODS: This cross-sectional study was made on 2500 Yemeni citizens (mean age 27 years, 1818 males and 682 females). Clinical protocol was made for all cases with a full intraoral examination. A new grading system was applied for each case with oral white lesion. RESULTS: Of our sample, 1528 cases (61.12%) were qat chewers; of them, 342 cases (22.4%) had oral keratotic white lesions at the site of qat chewing, while only 6 (0.6%) non-chewer cases had white lesions in their oral cavity (P < 0.000000, Odds ratio = 46.43, RR = 36.26). According to our grading system; 14, 5.9 and 2.4% were grade I, II and III. CONCLUSIONS: We conclude that qat chewing can provoke the development of oral keratotic white lesions at the site of chewing. The prevalence of these lesions and its severity increase as duration and frequency increase.     

Khat chewing habit produces a significant adverse effect on periodontal,oral health: A systematic review and meta‐analysis

Although there is a general agreement that a khat chewing habit produces clinicopathological changes in the oral mucosa. However there is no reliable evidence of the effects of a khat chewing habit on the periodontal tissues. Thus, authors aimed to investigate the influence of khat chewing habits on periodontal, oral health, by comparing khat chewers to non‐chewers in respect of gingival recession, periodontal pocketing depth and loss of attachment. A systematic review and meta‐analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. We searched PubMed, the Cochrane Library, Web of Science, Scopus and grey literature. The inclusion criteria were all studies with aims of comparing khat chewers and/or sides to non‐chewers and/or sides in respect of gingival recession, periodontal pocketing depth and loss of attachment. For continuous data, we computed weighted mean difference or standard mean difference analyses. An odds ratio using a random effect model was used if heterogeneity was detected; otherwise, a fixed effects model with a 95% confidence interval was used for continuous data. Two subgroups were analysed: khat chewers vs non‐chewers and khat chewer sides vs non‐chewer sides of the chewer's individuals. A total of 6373 participants were enrolled in 12 studies (khat chewers=3812, non‐chewers=2561). There were statistically significant differences between khat and non‐chewers in both subgroup analyses regarding gingival recession, periodontal pocketing depth and loss of attachment (P<.05). The odds ratios for khat chewers compared to non‐chewers, in respect of depth of periodontal pocket and gingival recession were 4.797 and 6.853 respectively. The results of this meta‐analysis have shown that the khat chewing habit produces a destructive and adverse effect on periodontal, oral health.     

Effect of khat chewing on 14 selected periodontal bacteria in sub‐ and supragingival plaque of a young male population

Background/aims: The habit of chewing khat (Catha edulis) for its amphetamine‐like effects is highly prevalent in Yemen and east Africa, and has expanded to Western countries. The purpose of this study was to estimate and compare the prevalence and levels of 14 periodontal bacteria in gingival plaque of khat chewers and khat nonchewers, as well as of khat chewing sides and khat nonchewing sides. Methods: A total of 408 sub‐ and supragingival plaque samples were collected from 51 young males (29 khat chewers and 22 khat nonchewers; age range 19–28 years) and analyzed using whole genomic DNA probes and checkerboard DNA–DNA hybridization. Clinical parameters were recorded for all teeth at six sites per tooth. Results: Streptococcus intermedius and Veillonella parvula were significantly more prevalent in the subgingival plaque of chewers, which also showed significantly higher levels of V. parvula and Eikenella corrodens. Similar results were found for the subgingival plaque of the chewing sides compared to the nonchewing sides. However, there was a significantly higher prevalence and higher levels of Tannerella forsythia in the subgingival plaque of the nonchewing sides. No significant differences were observed for the supragingival plaque between the two study groups. There was a significantly lower prevalence of Capnocytophaga gingivalis and Fusobacterium nucleatum in the khat chewing sides, and higher levels of V. parvula and Actinomyces israelii. Conclusion: The data suggest that khat chewing induces a microbial profile that is not incompatible with gingival health.     

Khat chewing amongst UK resident male Yemeni adults: an exploratory study

AIM: This cross sectional study recruited adult male Yemeni residents in Sheffield and Birmingham, UK, to assess their use of khat. METHODS: Structured interviews were conducted in both areas during weekly khat chewing sessions. The data collected included socio-demographic characteristics, khat use, dependency on khat, psychological functioning of chewers (GHQ-12) and nicotine dependency. Patterns of khat use, dependency and psychological functioning were correlated with age and self-reported oral problems. RESULTS: 75 khat chewing volunteers (mean age 40.75 years) were interviewed. Average age of starting khat chewing was 17 years. The weekly amount chewed ranged from 0.25-3.0 khat bundles. Older respondents were more likely to be frequent chewers (p<0.025). 39% were assessed as dependent on khat, which correlated with frequency of use (p<0.041) and being in debt (p<0.046). Khat chewing correlated with nicotine dependence (p< 0.014). Self-reported oral problems correlated with both nicotine (p<0.04) and khat dependence (p<0.001). 93% reported that khat chewing promoted excessive smoking and 12% that this practice had initiated their tobacco use. CONCLUSIONS: Khat chewing creates dependency and correlates with tobacco smoking and nicotine dependence. Further research should investigate the correlations between khat and nicotine dependence. Development of a specific measure of khat dependence is recommended.     

Khmer dental and medical students' knowledge about the betel quid chewing habit in Cambodia

95 of 144 questionnaires submitted by volunteer Khmer medical and dental students on the betel quid chewing habit in Cambodia were evaluated (58 medical, 37 dental). Questions related to the composition of the betel quid, the physiological and oral effects as well as traditional and sociological aspects. Statistical tests showed that there were differences between dental and medical students, particularly relating to the knowledge about oral effects. While 81.1% of dental students knew that betel quid chewing causes oral cancer, only 31.0% of the medical students were adequately informed. Similarly, 51.4% of the dental students knew about the relation between betel quid chewing and submucous fibrosis compared to 8.6% of the medical students (P < 0.001). In contrast, only 18.9% of the dental students thought that betel quid chewing strengthens the gum, while 56.9% of the medical students believed that betel quid chewing would have this effect (P < 0.001). The answers also showed that students do not indulge in the betel quid habit. The decline of the betel quid chewing habit was also indicated by the fact that while 5.3% of students had parents chewing betel quid, in contrast 40% of students reported grandparents with this habit. There are deficiencies of knowledge about the most important effects of betel quid chewing, particularly in medical students. Since both medical and dental students will in their future professional life have an enormous impact on health and health education, it seems justified that the dental and medical curricula should focus on these traditional habits. Proper health education starting in the dental and medical school is warranted in Cambodia and probably also in other South and Southeast Asian countries where the betel quid chewing habit is prevalent so as ultimately to improve public knowledge on the oral and other effects of this habit.     

Comparing dose–response measurements of oral habits on oral leukoplakia and oral submucous fibrosis from a community screening program

J Oral Pathol Med (2010) 39 : 306–312 Background: Many studies have reported that the interaction and dose–response effects of betel quid chewing, tobacco smoking and alcohol drinking habits are important risk factors for oral cancer and precancerous lesions or conditions. These results are useful for comparing statistics, but may not be informative for personal disease‐related information. Methods: This study used data from a community screening program to evaluate the dose–response effects of daily frequency and duration from oral habits in Taiwan. The receiver operating characteristic (ROC) curves were further used to compare exposure measurements on indicating the occurrence of lesions/conditions. Results: Our results showed that the highest prevalence was found in leukoplakia (11.1%) and followed by oral submucous fibrosis (OSF, 4.4%). Betel quid chewing habit was found to have dose–response effects on leukoplakia and OSF, cigarette smoking habit only has the dose–response effect on leukoplakia, and alcohol drinking was not associated with both oral precancers. The daily frequency of chewing habit is a better indicator than other dose–response measurements for the occurrence of precancers. In addition, the cut‐off points of two to five counts per day have about 60–82% of sensitivities and 79–88% of specificities. Conclusions: The cut‐off points from ROC curves can provide an informative message to people with oral habits and their chances of developing diseases. High daily frequency of chewing can lead to excessive irritation to oral mucosa. Although the tobacco is never added to chewing quid in Taiwan, intensive irritation may play an important role in developing oral precancers in Taiwan.     

Effect of khat chewing on 14 selected periodontal bacteria in sub- and supragingival plaque of a young male population

BACKGROUND/AIMS: The habit of chewing khat (Catha edulis) for its amphetamine-like effects is highly prevalent in Yemen and east Africa, and has expanded to Western countries. The purpose of this study was to estimate and compare the prevalence and levels of 14 periodontal bacteria in gingival plaque of khat chewers and khat nonchewers, as well as of khat chewing sides and khat nonchewing sides. METHODS: A total of 408 sub- and supragingival plaque samples were collected from 51 young males (29 khat chewers and 22 khat nonchewers; age range 19-28 years) and analyzed using whole genomic DNA probes and checkerboard DNA-DNA hybridization. Clinical parameters were recorded for all teeth at six sites per tooth. RESULTS: Streptococcus intermedius and Veillonella parvula were significantly more prevalent in the subgingival plaque of chewers, which also showed significantly higher levels of V. parvula and Eikenella corrodens. Similar results were found for the subgingival plaque of the chewing sides compared to the nonchewing sides. However, there was a significantly higher prevalence and higher levels of Tannerella forsythia in the subgingival plaque of the nonchewing sides. No significant differences were observed for the supragingival plaque between the two study groups. There was a significantly lower prevalence of Capnocytophaga gingivalis and Fusobacterium nucleatum in the khat chewing sides, and higher levels of V. parvula and Actinomyces israelii. CONCLUSION: The data suggest that khat chewing induces a microbial profile that is not incompatible with gingival health.     

Oral squamous cell carcinoma associated with khat chewing

The incidence of oral squamous cell carcinoma has been long associated with smoking, alcohol, and betel quid/areca nut chewing. This article presents a case of a 42-year-old female patient with squamous cell carcinoma of the floor of the mouth, associated with khat chewing. This relatively early presentation of oral squamous cell carcinoma may be linked to the synergistic effect of khat chewing and other known carcinogens such as polycyclic aromatic hydrocarbons and nitrosamines such as 4-(N-methyl-N-nitrosamino)-1-(3-pyridyl)-1-butanone, 4-(N-methyl-N-nitrosamino)-4-(3-pyridyl)-1-butanal. With the changing demographic structure and migration between countries, khat chewing is of increasing significance as it may contribute to the etiology of squamous cell carcinoma in developed countries.     

Periodontal status of a subject sample of Yemen

Abstract From August to October 1991, the periodontal status of 1001 Yemenis representing the age groups 12-14, 15-19, 20-24 and 35-44 years was recorded and evaluated with preference to the CPITN, the calculus index and clinical attachment levels. The impact of chewing khat, the leaves of a cultivated, alkaloid shrub, and of using the traditional miswak chewing stick for oral hygiene purposes were investigated. The results show that 6.9% of the juvenile probands (15-19 years) had healthy periodontal tissue (CPITN 0). whereas bleeding on probing and calculus (CPITN 1+2) were registered in 86.2%. In the 35-44 year age group. 1.7% were periodontally healthy, whereas 84.5% displayed plaque retention or shallow pocketing (CPITN 2-3) and 12.5% deep pocketing (CPITN 4). The treatment needs in all age groups are confined primarily to calculus removal and instruction in oral hygiene. The clinical attachment level and the calculus index revealed age-related attachment loss and calculus formation, primarily among male probands. The higher khat consumption among the male population is reflected in its detrimental effect on the periodontal tissue, especially among younger probands. Oral hygiene aids have also an influence on periodontal status, with a toothbrush proving more efficient than the miswak. WHO efforts directed towards prophylactic programs need to be intensified but can be staffed by dental hygienists.     

Leukoplakia, lichen planus, and other oral keratoses in 23,616 white Americans over the age of 35 years

This investigation provides the first detailed population-based reporting of white keratotic lesions of the oral mucosa in a United States population. More than 21% of 3,783 oral mucosal and connective tissue lesions reported from 23,616 white Americans, usually over 35 years of age, were keratotic lesions, representing 3.4% of the entire group of examinees. Leukoplakia was the most common of all lesions diagnosed and was the most common of the keratotic lesions (85.5% of the latter). The prevalence rate for leukoplakia was 28.9/1,000 white Americans over 35 years of age and was twice as high for males as for females (43.2/1,000 males versus 20.9/1,000 females). Age-specific leukoplakia prevalence rates demonstrated a tenfold increase for males from the third to the eighth decade of life, and twofold increase for females from the fourth to the seventh decade. Sites of leukoplakia involvement, in decreasing order of frequency, were lip vermillion, buccal mucosa, mandibular gingiva, tongue, oral floor, hard palate, maxillary gingiva, lip mucosa, and soft palate. Almost 7% of leukoplakias demonstrated carcinoma or severe dysplasia microscopically. Prevalence rates for other white oral mucosal lesions were tobacco/snuff pouch keratosis, 1.6/1,000; chronic cheek bite, 1.2/1,000; lichen planus, 1.1/1,000; palatitis nicotina, 0.7/1,000; and leukoedema, 0.3/1,000.     

Increasing popularity of waterpipe tobacco smoking and electronic cigarette use: Implications for oral healthcare

Cigarette smoking increases the risk of developing several systemic conditions including cancer, cardiovascular and pulmonary diseases. Cigarette smoking is also detrimental to oral health as it increases the incidence and severity of oral cancer, periodontal diseases and peri‐implantitis, as well as impacting negatively on the dental patients' response to therapy. Therefore, consideration of smoking behavior and recommendation of smoking cessation are important parts of dental treatment planning. However, cigarettes are no longer the most popular form of tobacco use among adolescents in the United States and globally. In recent years, tobacco smoking using a waterpipe (“hookah,” “shisha”) and use of electronic cigarettes (ECIGs) has increased significantly. Thus, dental clinicians likely will treat more patients who are waterpipe and/or ECIG users. Yet, the literature on the health effects of waterpipe and ECIGs use is sparse. Both waterpipe and ECIGs deliver the dependence‐producing drug nicotine. Waterpipe tobacco smoking has been associated with periodontitis, dry socket, premalignant lesions, and oral and esophageal cancer. The health effects of long‐term ECIG use are unknown. The purpose of this review is to inform healthcare professionals about waterpipes and ECIGs, highlight emerging evidence on the biological effects of these increasingly popular tobacco products, and introduce perspectives for dental patient management and future research.     

Khat induces G1-phase arrest and increased expression of stress-sensitive p53 and p16 proteins in normal human oral keratinocytes and fibroblasts

Khat is a psychostimulant plant used by over 10 million people daily, mainly in eastern Africa and the Middle East. Previous studies have suggested an association between khat use and oral lesions such as hyperkeratosis and oral cancer. This study investigated the effects of an extract of khat on primary normal human oral keratinocytes (NOK) and normal human oral fibroblasts (NOF). Low (sublethal) concentrations of khat inhibited the proliferation of both cell types in a dose-dependent and time-dependent manner. Both NOK and NOF treated with khat accumulated in the G1-phase of the cell cycle and showed increased expression of the stress-sensitive p53 protein after 24 h. Normal human oral keratinocytes showed a profound increase in p16^INK4A (p16) after 24 h and showed morphological changes suggesting cell differentiation. Normal human oral fibroblasts showed growth inhibition and increased expression of p21^WAF1/CIP1 (p21) within 24 h. The concentrations of khat tested in this study were within the range of those found in the oral cavity of khat chewers. The results show that stress induced by khat modulates the cell cycle in oral keratinocytes and fibroblasts. It is further speculated whether khat could have similar effects in vivo , especially in keratinocytes.     

Olmsted syndrome--a rare syndrome with oral manifestations

Olmsted syndrome is a rare, congenital condition characterized by severe palmo-planter keratosis, periorificial keratosis, and hypotrichosis. Though orofacial keratosis is one of the consistent findings of Olmsted syndrome, it has never been reported in the dental literature. We report a case of Olmsted syndrome in an eight-year-old boy who presented with massive and crippling palmoplanter keratosis and bilateral oral lesions in the form of keratotic plaques at the corners of the mouth, as well as on the dorsum of the tongue.     

Hardness and microstructure of Ti-15Mo-5Zr-3Al alloy for dental casting

The purpose of the study was to assess the outcome of school‐based oral health education (OHE) and a sugar‐free chewing gum program on the oral health status of children in terms of reduced caries increment and gingival bleeding over a period of 2 years. Nine primary schools randomly chosen from one district were divided into three groups: OHE group (Group E), sugar‐free chewing gum in addition to OHE group (Group G), and the control group (Group C). All children of grade 1 (aged 6–7 years) were recruited (n?=?1342). After 2 years, 1143 children remained in the study group at follow‐up. The overall drop‐out rate was about 15%. Data on dental caries and gingival bleeding were collected by clinical examination. The results showed that the mean increment of DMFS in Group G was 42% lower than in groups E and C (P?P?P?P?相似文献   

Dental status and self‐assessed chewing ability in 70‐ and 80‐year‐old subjects in Sweden

The objective was to compare two cohorts of elderly people, 70 and 80 years old, with respect to dental status and self‐assessed chewing ability. The hypotheses were as follows: (i) dental status is associated with self‐assessed chewing ability; (ii) chewing ability is poorer among the 80‐ than the 70‐year‐old subjects. Identical questionnaires were in 2012 sent to all subjects born in 1942 and 1932, living in two Swedish counties. The response rate was 70·1% resulting in samples of 5697 70‐ and 2922 80‐year‐old subjects. Answers to questions on self‐assessed chewing ability, dental status and some other factors have been analysed. Dental status varied but was in general good; 72% of the 70‐ and 60% of the 80‐year‐old subjects reported that they had all or only few missing teeth. Rate of edentulism was 3% and 7%, respectively. Removable partial dentures were reported by 6% and 10%, respectively, implant treatment by 13% in both cohorts. Self‐assessed chewing ability was mostly good and correlated with the number of teeth (Spearman rho = 0·46). A majority of the edentulous subjects assessed their chewing ability as very or fairly good. Logistic regression showed that self‐assessed chewing ability was significantly associated with a number of dental variables but also with general health. In conclusion, dental status was relatively good at both ages but somewhat poorer in the older cohort. Dental status, some other dental variables and being healthy were in both age groups significantly associated with self‐assessed chewing ability.     

Oral cancer adjacent to dental implants mimicking benign lesions: a case series study

Despite the long‐term survival rates of osseointegrated dental implants, several biological complications are known to affect the peri‐implant tissues, such as peri‐implant mucositis and peri‐implantitis. Occasionally, the clinical features of these more common benign lesions, or others nonrelated to implants, might be similar to oral malignancies, leading to misdiagnosis. The objective of this study was to present a case series of oral cancer located adjacent to dental implants, aimed to identify the reasons for initial misinterpretation of diagnosis. Thirteen patients, 10 females and 3 males, aged 59 to 90, were assessed. Among the differential diagnoses established, a malignant or premalignant lesion was not considered in 10 out of the 13 patients. Peri‐implantitis was the most common preliminary diagnosis, followed by fungal infection, viral infections, and traumatic ulcers. The meantime for the diagnosis of oral cancer was 21.5 months. The clinical presentation of peri‐implant malignancy, such as ulceration, white and red plaques, and exophytic lesions, might mimic benign diseases that are more common in the oral cavity. Suspicious lesions with treatment failure that persist for more than 2 weeks require biopsy and histopathological analysis to establish an early definitive diagnosis to improve the prognosis and quality of life of the patients.     

Influence of posterior dental arch length on brain activity during chewing in patients with mandibular distal extension removable partial dentures

It is well known that shortened dental arch decreases masticatory function. However, its potential to change brain activity during mastication is unknown. The present study investigates the effect of a shortened posterior dental arch with mandibular removable partial dentures (RPDs) on brain activity during gum chewing. Eleven subjects with missing mandibular molars (mean age, 66·1 years) on both sides received experimental RPDs with interchangeable artificial molars in a crossover trial design. Brain activity during gum chewing with RPDs containing (full dental arch) and lacking artificial molars (shortened dental arch) was measured using functional magnetic resonance imaging. Additionally, masticatory function was evaluated for each dental arch type. Food comminuting and mixing ability and the perceived chewing ability were significantly lower in subjects with a shortened dental arch than those with a full dental arch (P < 0·05). Brain activation during gum chewing with the full dental arch occurred in the middle frontal gyrus, primary sensorimotor cortex extending to the pre‐central gyrus, supplementary motor area, putamen, insula and cerebellum. However, middle frontal gyrus activation was not observed during gum chewing with the shortened dental arch. These results suggest that shortened dental arch affects human brain activity in the middle frontal gyrus during gum chewing, and the decreased middle frontal gyrus activation may be associated with decreased masticatory function.     

Traumatization of teeth and gingiva related to habitual tooth cleaning procedures

Abstract . Traumatization of oral hard and soft tissues connected with mechanical oral hygiene procedures has been reported in the dental literature. Definitions, classifications and localization of such lesions are listed, and in vivo and in vitro experiments within the field are reviewed. Existing literature suggests that hard tissue lesions are mainly due to abrasives in dentifrices, whereas gingival lesions may be caused by toothbrushing per se. Factual knowledge about the prevalence, severity and critical significance, as well as relevant and reliable experiments, is scarce and further research on these topics seems to be indicated.     

Histochemical analysis of pathological alterations in oral lichen planus and oral lichenoid lesions

Lichen planus is a dermatologic disease of unknown etiology characterized by keratotic plaques on the skin. Many patients also harbor white lesions of the oral mucosa. The literature contains numerous reports of lichen planus-like lesions evolving in conjunction with the administration of a variety of pharmacologic agents. It is difficult, if not impossible, to distinguish such lesions from one another. The present study evaluated the epithelial and basement membrane thickness, mast cells (intact cells and degranulated cells subepithelially) and the presence or absence of blood vessels in oral lichen planus and oral lichenoid lesions. The evaluation was done using the periodic acid-schiff (PAS) and toluidine blue staining techniques on 20 cases each of oral lichen planus and oral lichenoid lesions and 5 control specimens of normal buccal mucosa. The results showed an increased number of degranulated mast cells in areas of basement membrane degeneration, increased vascularity and increased PAS-positive basement membrane thickness in oral lichen planus as compared with oral lichenoid lesions. Reduced epithelial thickness was found in oral lichen planus. The present study emphasizes the importance of these parameters in differentiating oral lichen planus from oral lichenoid lesions using special staining techniques.     

Fluoride content in khat (Catha edulis) chewing leaves

Khat (qat) leaves are chewed for their psychostimulative effects; there is an unconfirmed suggestion that they contain a high concentration of fluoride (F). Khat samples from Yemen were suspended in deionized water, spun, and the supernatants exposed to a chelator that decomplexes F, which was assayed with an F(-)-electrode coupled to an ion analyser. F released into whole saliva after chewing khat for 15 min and from khat suspended in stimulated whole saliva for 1.5 h in vitro was measured also. Total F in dried khat leaves and their ash was assayed by the acid-hexamethyldisiloxane microdiffusion method. All methods demonstrated negligible amounts of F in or from khat leaves (<0.02 microg F/ml leached into water or saliva; 0.06 microg F/ml in saliva after chewing; 0.93 microg total F/g in dried leaf, 2.07 microg total F/g in ash).