Oral manifestations of habitual khat chewing: a case-control study

Individual and community-level factors associated with khat (Catha edulis) use among women of reproductive age in Halaba zone, South Ethiopia: a multilevel mixed effect analysis

Introduction

There is a paucity of data on factors associated with khat chewing among women of reproductive age using multilevel analysis. Furthermore, the effects of some potential factors like stressful life events, knowledge about and attitude toward the effects of khat have been given little attention and are not well understood. Therefore, this study aimed to examine the prevalence and multilevel factors associated with khat use among women of reproductive age in Halaba zone, South Ethiopia.

Methods

A community-based cross sectional study was conducted in Halaba zone from February to July, 2023. Systematic random sampling technique was used to include 1573 study participants. The dependent variable was current khat use, which is operationalized as using khat within 30 days preceding the study. An interviewer administered questionnaire was used for the data collection.

Results

The prevalence of current khat use among women of reproductive age was 65.9% [95%CI (63.5-68.2%)]. Factors significantly associated with khat use were; ages of women 35 and above years [Adjusted Odds Ratio (AOR) = 6.35, 95% CI: (3.62, 11.13)], ever married [AOR = 2.41, 95% CI: (1.10, 5.31)], secondary and above education [AOR = 0.28, 95% CI: (0.15, 0.49)], belong to richer household [AOR = 1.75, 95% CI: (1.12, 2.75)], mass media use [AOR = 3.12, 95% CI: (1.85, 4.81)], low knowledge about khat effects [AOR = 3.12, 95% CI: (1.85, 5.24)], positive attitude towards khat use [AOR = 11.55, 95% CI: (6.76, 19.71)], and strong social support [AOR = 0.43, 95% CI: (0.28, 0.64)] and non-user friend [AOR = 0.31, 95% CI: (0.20, 0.48)]. From the community level variables: rural residence [AOR = 5.06, 95% CI: (1.82, 14.09)] was significantly associated with khat use.

Conclusion

Khat use among women of reproductive age was found to be very high. From individual-level factors: advanced ages of women, secondary and above education, live in the richer wealth quintile, mass media exposure, low knowledge on khat effects, positive attitude towards khat use, strong social support, and from community-level variables: residing in rural area were significantly associated with khat use. Khat use screening for all women of childbearing age, as well as referral to substance use disorder centers for those women identified as having khat use disorder, should become a standard of care in all health facilities.

Effect of khat extract on color stability of digitally and manually fabricated provisional restorations: an in vitro comparative study

BACKGROUND

The aim of this in vitro study was to evaluate the effect of khat extract on the color stability of five different provisional restorative materials (PRMs).

METHODS

In this study, 50 specimens were fabricated from five different PRMs with different techniques. Twenty specimens were digitally fabricated of poly-methyl methacrylate (PMMA) CAD/CAM milling and 3D printing PRMs, while the other thirty specimens were manually fabricated of three different PRMs: PMMA self-cured (SC) acrylic resin, light-cured (LC) composite, and Bis-acrylic SC composite. Milling and 3D printing machines were used to fabricate the digital specimens, while the manual specimens were fabricated using a metallic mold. The material was placed in the mold, covered by a polyester stripe, and held between two glass slabs with a constant load for 30 s. After setting, the specimens were removed and checked. Ten disc-shaped specimens with 2 ± 0.3 mm thickness and 10 ± 0.3 mm diameter were prepared from each of the tested PRM. Then all the specimens were polished. Five specimens of each PRM were immersed in khat extract, while the other five were immersed in distilled water medium as a control group. The color measurements were recorded before and after 1 and 7 days of immersion using a spectrophotometer. The immersion media were renewed every 24 h and kept along with the specimens at 37 °C. The T test, paired T test, and ANOVA analysis of variance were used to analyze the results. The Bonferroni test was used for post-hoc multiple comparisons.

RESULTS

The interaction between the tested PRMs, the media, and the duration of immersion time was statistically significant (p < 0.05). PMMA CAD/CAM milling PRM was the most stable in color, and this was statistically significant (p < 0.05). The LC composite PRM composite was the least stable in color and was statistically insignificant (p > 0.05) when compared to the 3D printing and Bis-acrylic SC composite PRMs, respectively.

CONCLUSIONS

This study demonstrated that khat extract medium has a high staining ability on the tested PRMs. CAD/CAM milling PRM was the most stable in color and could therefore be used as a long-term provisional. The increase in immersion time was a significant factor in the color change of the tested PRMs. The color of the 3D-printed PRM was the most affected over time.

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.

Determinants of dental caries among adolescent patients attending Hospitals in West Wollega Zone, Western Ethiopia: A case-control study

Background

Dental caries is a prevalent disease in both developed and developing countries and is a public health problem among adolescents. This study aimed to assess the determinants of dental caries among adolescent patients in the west Wollega Zone, Western Ethiopia.

Methods

A hospital-based unmatched case-control study design was conducted in West Wollega Zone, West Ethiopia. A total of 133 cases and 266 controls participated in this study. Data were collected using pre-tested questionnaires from three hospitals. Epi-info version 7 was used for data entry and was analyzed using SPSS version 20. Frequency, proportion, mean and standard deviation were computed to summarize the data. Statistics are presented using tables and bar graphs. Multivariable binary logistic regression analysis was used to identify the determinants of dental caries at P < 0.05. The adjusted odds ratio with 95% confidence interval (CI) was used to show the strength of association between the predictors and dental caries.

Results

A total of 399 adolescents were enrolled in this study, yielding a response rate of 100%. The study found that, daily consumption of sugared coffee (AOR = 2.91, 95% CI:1.62, 5.23), khat chewing (AOR = 2.90, 95%CI: 1.46, 3.15), daily consumption of bread (AOR = 2.65, 95%CI: 1.44, 4.89), daily consumption of sweet foods (AOR = 2.04, 95%CI:1.19, 3.48), living in urban areas (AOR = 1.86, 95%CI:1.09, 3.15), and daily tooth brushing using toothpaste or stick (AOR = 0.48;95%CI, 0.28, 0.81) were significantly associated with dental caries among adolescents.

Conclusions and recommendations

In this study, drinking sugared coffee, daily consumption of bread, khat chewing, sugary food consumption, living in urban areas, and daily tooth brushing using toothpaste were significantly associated with dental caries. Therefore, improving dietary and drinking habits and strengthening regular tooth brushing are important for reducing dental caries among adolescents.

Qualitative ultrastructural analysis of the submandibular salivary glands after administration of khat: in vivo study

Objective

Khat (Catha edulis Forssk) plant has been widely chewed for its psychostimulatory effects in the African and Arabian Peninsula, particularly in Yemen. Considering the khat leaves are gradually chewed without swallowing, while its active constituents are extracted into saliva, studying the effect of khat on salivary glands is necessary. This work is an extension of the previously published work that studied the effect of khat extract on the rats' submandibular salivary glands in terms of histological and immunohistochemical evaluations. The current research note aimed to better understand this effect on the ultrastructure of submandibular salivary gland cells by using transmission electron microscope.

Results

Oral administration of khat extract produced degenerative changes in the secretory and ductal cells of rats' submandibular salivary glands. These changes involved irregular boundaries of variable sized-nuclei, dilated RER, cytoplasmic vacuoles as well as swollen and degenerated mitochondria.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-021-05595-8.

Khat Chewing Induces a Floral Shift in Dental Material-Associated Microbiota: A Preliminary Study

Background

The habit of khat (Catha Edulis Forskal) chewing is widely practiced in the southern regions of Saudi Arabia, Yemen, and East Africa. This social habit has tremendous effects on oral and general health of khat chewers. Khat may affect bacterial species in plaque biofilms on oral rehabilitation materials. This preliminary case-controlled study aimed to assess and compare the effect of khat chewing on bacterial biodiversity between non-khat chewers (NKC) and khat chewers (KC) in oral biofilms on oral rehabilitation materials using polymerase chain reaction (PCR).

Material/Methods

Fifty participants were organized into 2 equal groups of NKC and KC, each containing 5 subgroups related to filling material type. Some participants had amalgam (A) or composite (C) restorations, while others had feldspathic porcelain (FP), nickel chromium (NC), and zirconia ceramic (ZC) crowns or bridges. Oral biofilm samples were collected from all participants, DNA was extracted, and samples were subjected to PCR. Bacterial species were then identified and counted. PCR products were sequenced to detect similarity. Partial 16S rRNA gene sequences of the current study samples were compared with 16S rRNA gene sequences from GenBank using BLAST on the National Center for Biotechnology Information website.

Results

The Streptococcus sp. was the most common bacterial species among our participants (40; 80%), followed by Lactobacillus and Veillonella spp., accounting for 12% (6) and 8% (4), respectively. Streptococcus sp. was observed equally among NKC and KC, but Lactobacillus and Veillonella spp. were higher in KC and NKC, respectively. Lactobacillus was associated mainly with prosthetic materials, and Streptococcus was found among all examined dental restorative materials.

Conclusions

This research concluded that khat chewing significantly affects bacterial biodiversity in oral biofilms in the presence of different restorative and prosthetic dental materials.

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.

Khat and synthetic cathinones: Emerging drugs of abuse with dental implications

The rising global availability of the stimulant and euphoric substances, khat and synthetic cathinones, has become a cause for concern in many countries, including the United States. Both substances are illegal in United States, although this has not deterred their use. Besides central nervous system effects, these drugs also cause sympathomimetic and orodental adverse effects, similar to those of amphetamine. Although synthetic cathinones are stronger than khat in most cases, the latter additionally contains tannins, which have astringent effects on tissues components, including those in the oral cavity. Recognizing the use prevalence and reported orodental adverse effects of khat and synthetic cathinones, dental practitioners should be more familiar with these substances to optimally treat and educate their patients abusing them. This paper reviews the pharmacology and adverse effects of khat and synthetic cathinones, along with the extent of their use in United States, with particular emphasis on dental implications.

Radiographic Assessment of the Prevalence of Pulp Stones in a Yemeni Population Sample

Objective:

To determine the prevalence and distribution of pulp stones in the posterior teeth of a sample of adult Yemeni dental patients using digital panoramic radiographs.

Methods:

In total, 913 panoramic radiographs from patients attending the hospital dental clinics of at University of Sciences and Technology, Sana’a, Yemen, from January 2013 to December 2014 were examined. The occurrence of pulp stones in the posterior teeth of adult subjects was recorded. Associations between pulp stones and gender, age, arch, side and tooth type were studied.

Results:

The overall prevalence of pulp stones was 18.6% for individuals (170 out of 913 subjects) and 3.99% for examined teeth (351 out of 8802 teeth). The pulp stone occurrence was significantly higher in the maxilla than in the mandible for each tooth type and location (P<0.001). Pulp stones occurred more often on the right side (P<0.001). First molars represented 71% of the affected teeth with the maxillary right first molar showing the highest occurrence. Fifty-six percent of the affected subjects had pulp stones in more than one tooth. No significant difference in the occurrence of pulp stones was detected between genders or among age groups (P>0.05).

Conclusion:

The prevalence of pulp stones is different among populations. Pulp stones were found in approximately one-fifth of subjects in the Yemeni population, where up to 90% of the population have a Qat-chewing habit. This habit usually causes mechanical and chemical irritation and results in pulp calcification.

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.

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.

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.

Qat use and esophageal cancer in Ethiopia: A pilot case-control study

BACKGROUND

Qat (Catha edulis) chewing is reported to induce lesions in the buccal mucosa, irritation of the esophagus, and esophageal reflux. Case series suggest a possible etiological role in oral and esophageal cancers. This pilot study aimed to generate preliminary estimates of the magnitude and direction of the association between qat use and esophageal cancer (EC) risk and to inform the logistics required to conduct a multi-center case-control study.

METHODS

Between May 2012 and May 2013, 73 EC cases (including 12 gastro-esophageal junction cases) and 133 controls matched individually on sex, age, and residence were enrolled at two endoscopy clinics and a cancer treatment hospital in Addis Ababa. A face-to-face structured questionnaire was administered. Qat use was defined as ever having chewed qat once a week or more frequently for at least one year. Odds ratios were calculated using conditional logistic regression.

RESULTS

Only 8% of cases resided in Addis Ababa. Qat use was more frequent in cases (36%) than in controls (26%). A 2-fold elevation in EC risk was observed in ever qat chewers compared with never users in unadjusted conditional logistic regression (OR = 2.12; 95% CI = 0.94, 4.74), an association that disappeared after adjusting for differences in tobacco use, consumption of alcohol and green vegetables, education level, and religion (OR = 0.95; 0.22, 4.22). Among never tobacco users, however, a non-significant increase in EC risk was suggested in ever qat users also after adjustment. Increases in EC risk were observed with ever tobacco use, alcohol consumption, low consumption of green vegetables, a salty diet, illiteracy, and among Muslims; the four latter associations were significant.

CONCLUSIONS

This pilot study generated EC risk estimates in association with a habit practiced by millions of people and never before studied in a case-control design. Results must be interpreted cautiously in light of possible selection bias, with some demographics such as education level and religion differing between cases and controls. A large case-control study with enrolment of EC cases and carefully matched controls at health facilities from high-risk areas in the countryside, where the majority of cases occur, is needed to further investigate the association between qat use and EC.

Patterns of Partial Edentulism and its Relation to Khat Chewing in Jazan Population - A Survey Study

INTRODUCTION

Partial edentulism is a prime indicator of overall oral health in a given country. Khat chewing habit in the south region of Saudi Arabia is widely practiced by a majority of the population.

AIM

To determine the frequency of Kennedy's classes in each arch among different age groups, gender and to find out the relationship between khat chewing and the pattern of partial edentulism.

MATERIALS AND METHODS

The data was collected from 780 subjects reporting to the College of Dentistry, Jazan University, who required removable partial dentures. Clinical intra-oral and radiographic examinations were done. The study subjects were divided into five age groups, 20-29, 30-39, 40-49, 50-59 and ≥ 60 years respectively. Khat chewing hours/day and type of Kennedy's classes were recorded. The data were entered into a Statistical Package for Social Sciences program and analysed accordingly using Fisher-Exact test.

RESULTS

Class III was the highest in all middle age groups followed by Class I. Class III was the highest in males, while in females, Class I was the highest in both arches. Class IV was the lowest in all age groups, both arches, and genders. Among khat chewers Class III was the highest followed by class I in both arches. Class IV was the highest in >12 hours duration in maxilla but in the mandible, Class I and II were the highest in 1-6 hours duration. The obtained p-values were statistically significant (p<0.001) in all tested variables and age groups.

CONCLUSION

Kennedy's Class III was the highest followed by Class I, while Kennedy's Class IV was the lowest in all age groups and both arches regardless of khat chewing durations. In males Class III, was the highest, while in females Class I was the highest in both arches.

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.

Abuse and Misuse of Prescription and Nonprescription Drugs from Community Pharmacies in Aden City-Yemen

BACKGROUND

The abuse and misuse of prescription and nonprescription or the so-called Over-The-Counter (OTC) drugs is a serious and growing public health problem worldwide. The increased availability of these drugs has contributed to a dramatic rise of inappropriate use.

OBJECTIVES

The aim of this study was to investigate abuse/misuse of prescription and non-prescription drugs in community pharmacies in Aden city-Yemen and to gather information about suspected drug abusers in the community.

METHODS

A cross-sectional survey using a structured questionnaire randomly distributed to 200 community pharmacies (June-September 2013). Data were coded and analyzed using SPSS Results: A total of 170 pharmacists completed the questionnaire (85.0% response rate), more than half of which (57.7%) suspected drug abuse/misuse in their pharmacies. The top four suspected medications of abuse were Alprazolam, Ketoprofen, Tramadol, and antibiotics. Most participating pharmacists in this study (83.3%) noticed an increasing pattern of abuse/misuse. The majority of suspects of prescription and non-prescription drug abuse (64.1%) were either chewing Khat or carrying it while buying the drug from the pharmacists.

CONCLUSION

Abuse/misuse of prescription and nonprescription drugs is present in community pharmacies in Aden and it is linked to the recreational use of Khat. Current methods for controlling the problem are ineffective, and better methods should be developed.

Oral Lesions Induced by Chronic Khat Use Consist Essentially of Thickened Hyperkeratinized Epithelium

Objectives. The habit of khat chewing is prevalent in many Middle Eastern and African cultures and has been associated with various adverse conditions in humans. This study aimed to describe histological changes induced by chronic khat chewing on the buccal mucosa. Methods. Biopsies of the buccal mucosa from 14 chronic khat chewers, 20 chronic khat chewers who also smoked tobacco, and 8 nonchewers were compared for epithelial thickness, degree and type of keratinization, and connective tissue changes. Results. Tissues from khat chewers depicted abnormal keratinization of the superficial cell layer and showed increased epithelial thickness affecting all layers. Epithelial thickness in control samples was 205 ± 26 μm whereas thickness in khat chewers and khat chewers who smoked tobacco was significantly higher measuring 330 ± 35 μm and 335 ± 19 μm, respectively. Tissues from khat chewers also showed increased intracellular edema, increased melanin pigment deposits, and increased number of rete pegs most of which were thin and deep. Conclusions. These results show that oral lesions induced by chronic chewing of khat in the buccal mucosa present with white and brown discoloration due to increased epithelial thickness, increased keratinization, and melanin deposition.

Clinical and cytological study of the oral mucosa of smoking and non-smoking qat chewers in Yemen

OBJECTIVE

The study was conducted to investigate the role of qat and smoking habits on the prevalence of visible and cytological abnormalities in the oral mucosa among Yemenites.

METHODS

We recruited 30 non-smoking and 30 smoking Yemenites chewing qat unilaterally for at least 5 years. We inspected oral cavities for the presence of lesions and took brush biopsies from the buccal mucosa/gingiva of the chewing/non-chewing region.

RESULTS

All visible oral lesions were flat and homogeneous, and cytological changes were detected frequently. Among both non-smokers and smokers, white lesions and cytological changes were detected in 77% of all cases. On the chewing area, the proportion with white lesions ranged--depending on anatomical area and smoking status--between 47 and 93% and was significantly more frequent than on the non-chewing side (range 3-47%). The proportion of regions with changes was similar in non-smokers and smokers. Kappa statistics for "interobserver" agreement between visual inspection and cytological specimens of brush biopsies was at best fair (≤0.25).

CONCLUSIONS

The high prevalence of visible lesions and cytological abnormalities among qat chewers was independent of smoking status.

CLINICAL RELEVANCE

The moderate level of agreement between visual inspection and exfoliative cytology demonstrates the still challenging clinical management of chronic qat chewers, though brush biopsies including adjuvant techniques like DNA cytometry may support the clinical decision-making process in future.

Qat Chewing and Risk of Potentially Malignant and Malignant Oral Disorders: A Systematic Review

BACKGROUND

Qat (also known as Khat, Kat and Miraa) is a green-leaved plant (Catha edulis). It is a shrub indigenous to Yemen and certain parts of eastern Africa. Chewing the leaves, which have sympathomimetic and euphoric effects, has been documented in many countries and increased with worldwide migration. The effect of long-term chewing Qat on the oral cavity is unknown.

OBJECTIVE

A systematic review was performed to identify any associations between Qat chewing and the occurrence of potentially malignant and malignant oral disorders.

METHODS

Medline and the Web of Science were searched for articles published before May 2014 without limits with regard to publication date and language.

RESULTS

From a total of 890 papers identified, 17 English papers reported potentially malignant or malignant oral disorders and Qat chewing. One additional paper in Arabic language was identified from reviewing the list of references of eligible papers. It was found that exposure to Qat may be associated with potentially malignant and malignant oral disorders, but methodological issues, such as inadequate study design, sample size, selection of study subjects, clinical evaluations of outcome and limited adjustment for confounders, limit the strength of the evidence base in this area.

CONCLUSION

The association between Qat chewing and potentially malignant and malignant oral disorders remains debatable and requires further investigations.

Oral symptoms significantly higher among long-term khat (Catha edulis) users in Ethiopia

OBJECTIVES:

Associations between khat (Catha edulis) chewing and different adverse oral-dental health conditions have been reported, yet evidence is still lacking. This study was designed to investigate the association between long-term regular khat chewing and self-reported oral symptoms.

METHODS:

A cross-sectional study was conducted on a sample of 1,255 university students in southern Ethiopia. Data on khat chewing status, a range of oral symptoms and other pertinent variables were collected using self-administered questionnaires. The association between long-term regular khat chewing and oral symptom count was investigated using negative binomial regression.

RESULTS:

The mean oral symptom count among long-term regular khat chewers was 1.75 (standard deviation [SD], 2.18; standard error [SE], 0.31), whereas that among those who were not long-term regular khat chewers was 1.18 (SD, 1.68; SE, 0.10). After adjustment for other variables, long-term regular khat chewers had approximately 50% more oral symptoms than those who were not long-term chewers did (adjusted count ratio, 1.53; 95% confidence interval, 1.12 to 2.10).

CONCLUSIONS:

Long-term khat chewing negatively affects the oral health of young university students.

Khat use and appetite: an overview and comparison of amphetamine, khat and cathinone

ETHNOPHARMACOLOGICAL RELEVANCE

To understand the role of khat (Catha edulis) use on the aberrations in appetite and weight which are common comorbidities for khat and other amphetamine users.

MATERIALS AND METHODS

We provide a comprehensive overview and conceptual summary of the historical cultural use of khat as a natural stimulant and describe the similarities and differences between cathinone (the main psychoactive constituent of khat) and amphetamine highlighting the limited literature on the neurophysiology of appetite and subsequent weight effects of khat.

RESULTS

Animal and some human studies indicate that khat produces appetite suppression, although little is known about mechanisms of this effect. Both direct and indirect effects of khat stem from multiple factors including behavioral, chemical and neurophysiological effects on appetite and metabolism. Classic and newly identified appetite hormones have not been explored sufficiently in the study of appetite and khat use. Unique methodological challenges and opportunities are encountered when examining effects of khat and cathinone including khat-specific medical comorbidities, unique route of administration, differential patterns of behavioral effects relative to amphetamines and the nascent state of our understanding of the neurobiology of this drug.

CONCLUSION

A considerable amount of work remains in the study of the appetite effects of khat chewing and outline a program of research that could inform our understanding of this natural amphetamine׳s appetite effects and help prepare health care workers for the unique health effects of this drug.

Oromandibular dystonia in yemeni patients with khat chewing: a response to botulinum toxin treatment

Khat-(Catha edulis)related oromandibular dystonia is a difficult-to-treat subset of movement disorders that involve masticatory muscles with diverse and incapacitating manifestations. The aim of this study was to evaluate the efficacy of Botulinum toxin-type A therapy in khat chewer Yemeni patients with oromandibular dystonia. This prospective study included 18 khat-chewers Yemeni patients with refractory oromandibular dystonia, who were subjected to Botulinum toxin-A injection and followed up for 3 months thereafter. Primary efficacy outcome was the global impression scale, and secondary outcome measure was the Unified Dystonia Rating Scale. Patients showed improvement of both efficacy measures, maximum satisfactory responses were detected at the forth week after injection. No major adverse events were detected. Botulinum toxin-A is considered an effective and safe treatment option for refractory oromandibular dystonia in khat-chewers

The likelihood of khat chewing serving as a neglected and reverse 'gateway' to tobacco use among UK adult male khat chewers: a cross sectional study

BACKGROUND

Chewing khat leaves is often accompanied by tobacco use. We assessed aspects of tobacco use and explored factors associated with tobacco use patterns (frequency of use per week) among khat chewers who used tobacco only when chewing khat ("simultaneous tobacco and khat users", STKU).

METHODS

A sample of 204 male khat chewers was recruited during random visits to khat outlets. Data collected included socio-demographic items, tobacco use and khat chewing behaviours. Both psychological and physical dependence on khat were assessed using the Severity of Psychological Dependence on Khat (SDS-Khat) Scale, the Diagnostic Statistical Manual IV (DSM-IV) and adapted items from the Fagerström Test for Nicotine Dependence (chewing even when ill, and difficulty in abstaining from khat chewing for an entire week). Descriptive statistics and non-parametric analyses were conducted.

RESULTS

Of the 204 khat chewers, 35% were khat chewers only, 20% were STKU, and the remainder were daily cigarette smokers. The mean age of STKU was 38.12 (±14.05) years. Fifty seven percent of STKU smoked tobacco and chewed khat for two days per week and 43% smoked and chewed more frequently (three to six days: 33%, daily: 10%). Three quarters (74%) were former daily tobacco users. Khat chewing initiated tobacco smoking among 45% of STKU and 71% reported attempts to quit tobacco smoking during khat chew. Among STKU, smoking tobacco for more than two days per week was significantly associated (p < 0.05) with psychological dependence (increased levels of SDS-Khat), physical dependence (increased levels of DSM-IV symptoms, chewing even when ill, difficulty in abstaining from chewing for an entire week and self-reported health conditions) and behavioural factors (e.g. amount of khat chewed in typical khat session).

CONCLUSIONS

Khat chewing may promote different patterns of tobacco smoking, initiate and sustain tobacco smoking, and trigger tobacco cessation relapses among STKU. Increased frequency of tobacco smoking among STKU was linked to psycho-physical and behavioural factors. Further investigation within large and representative samples of both sexes of STKU in different contexts should be considered for health research and policy development. Khat chewing should be considered when designing tobacco prevention uptake, cessation interventions and relapse prevention programmes.

Khat (Catha edulis): A systematic review of evidence and literature pertaining to its harms to UK users and society

The use of khat ( Catha edulis) has been associated with a large number of physiological and societal harms, leading to calls for it to be controlled in the UK. The evidence of these harms is often equivocal, limited by confounding factors, or entirely anecdotal: high-powered, quality-controlled studies are lacking. Regardless, the body of relevant literature indicates that the once socially-regulated use of khat has been eroded. Some individuals have developed excessive consumption patterns, either using khat daily or in binge-sessions, though daily consumption is not necessarily problematic per se. The majority of users seem to use khat in moderation, where the associated harms appear low. For excessive users, harms associated with khat are greater, particularly relating to mental health. Social harms also seem to be largely related to excessive khat use rather than khat use itself. Even in cases of excessive khat use, however, causal relationships between chewing and harms have not been described. More research is required to establish the role of khat in liver disease, coronary problems, cancers of the digestive tract and incidents of domestic violence. Studies should consider the likeliness that certain users are more vulnerable to developing patterns of excessive khat use due to an interwoven set of factors such as social health determinants and pre- and post-migration experiences.

Qat chewing as an independent risk factor for periodontitis: a cross-sectional study

This study assessed the effect of qat chewing on periodontal health, independent of other risk factors. Four hundred qat chewers and 100 nonchewers (20–50 years) were included. Demographic data and detailed information about chewing and smoking were obtained. Periodontal status was assessed using Community Periodontal Index (CPI) and clinical attachment loss (CAL). The qat chewers were older, included more males and smokers, and had worse oral hygiene but higher education levels; the majority were heavy chewers (mean duration of 14.45 years and frequency of 6.10 days/week). Regression analysis identified age, oral hygiene, education level, and cigarette smoking as independent predictors of periodontal destruction. Adjusted for these, qat chewing showed marginally significant association only with CAL (OR = 4.7; P = 0.049). The chewing sides showed significantly higher scores than the nonchewing sides; however, equal scores on both sides or lower scores on the chewing sides (possibly no or beneficial effect) were still observed in 50% of the chewers. Heavy qat chewing is shown here as an independent risk factor for attachment loss. However, the possibility that the habit may have beneficial effects in a subset of the chewers cannot be excluded. A holistic model that resolves the existing contradiction is presented.

Factors associated with dental and medical care attendance in UK resident Yemeni khat chewers: a cross sectional study

Background

The chewing of khat leaf with tobacco smoking amongst Yemenis, Somalis and Ethiopians is reported to impact oral and general health. The health status and particularly dental and medical care attendance of UK-khat chewers has not received attention. This study aimed to explore health status and dental and medical attendance and its associated factors in UK permanently resident Yemeni khat chewers.

Methods

A cross- sectional study with a purposively selected sample of 204 khat chewers was conducted. Data were collected through face to face interviews. Data analysis included descriptive, Chi-square tests and binary logistic regressions.

Results

The mean age for this study sample was 44.84 (SD = ±19.70) years and 35% were employed. Forty five percent reported symptomatic medical attendance for self reported health conditions in the last two weeks whilst 44% had symptomatic dental attendance. Higher khat chewing dependency levels associated positively with both symptomatic dental and medical attendance (p = 0.004, OR = 1.14, 95%CI = 1.04-1.25; p = 0.003; OR = 1.16, 95%CI = 1.05-1.29, respectively). Higher social participation levels associated negatively with symptomatic dental attendance (p = 0.034, OR = 0.98, 95%CI = 0.96-0.99) whilst increase in age and self-reported health conditions associated positively with symptomatic medical attendance (p = 0.030, OR = 1.03, 95%CI = 1.01-1.06; p = 0.001, OR = 4.51, 95%CI = 2.02-10.08, respectively).

Conclusions

In this study of khat chewers, a significant proportion reported symptomatic dental and medical attendance. Demographic, psychosocial and self reported general health conditions were associated significantly with dental and medical attendance. Strategies to improve the dental and medical care attendance amongst this group should focus on these and other unexplored underlying factors.