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.

Prevalence of oral white lesions due to qat chewing among women in Yemen.

OBJECTIVES: To investigate oral mucosal white lesions due to qat chewing among Yemeni women and their possible confounders (tobacco, water-pipe). PATIENTS AND METHODS: In a cross-sectional hospital study, 162 healthy women were divided into 109 qat chewers and 53 non-qat chewers. Inclusion criteria were as follows: ≥20 years of age, chewing qat habitually ≥5 years on one side. Women were interviewed about tobacco/water-pipe use and examined for oral mucosal lesions. RESULTS: Among chewers, white lesions were recorded in 82/109 (75.2%) at the chewing site. Lesions on the opposite side were recorded among 6/109 (5.5%) and among 7/53 (13.2%) non-chewers. Lesions reported among chewers were correlated with the side of chewing and with longer duration of the habit. The difference in the prevalence of white lesions present between cases and controls was significant (P < 0.000). When white lesions were correlated with the durations of chewing and water-pipe and cigarette smoking, results in terms of chewing were highly significant (P = 0.000) and those in terms of water-pipe smoking and cigarette smoking were not significant. CONCLUSION: Habitual chewing of qat fibres by Yemeni women over decades caused mucosal white lesions recorded on the chewing side irrespective of additional noxae as tobacco and water-pipe smoking.