Detection of cytological changes in oral mucosa among users of smokeless tobacco (shamma) in the KSA

Background and aim

Smokeless tobacco (ST) use is a major cause of cytological changes in the oral mucosa. ST products, such as shamma, which is prevalent in southern Saudi Arabia, raise concerns about the adverse health effects among its users. We evaluated the cytological changes in the oral mucosa of users and nonusers of shamma in the city of Najran, using Papanicolaou staining.

Materials and methods

We designed questionnaires and consent forms for this study that were administered to a total of 397 participants, comprising 250 nonusers of shamma (controls) and 147 shamma users (cases). Buccal cell smears were collected from all participants, fixed, and Papanicolaou stained. Photomicrographs were taken of all stained smears, and samples were subsequently diagnosed.

Results

Various cytological changes were detected among both cases and controls: atypia (2.0%, 1.2%, respectively), keratinisation (0.7%, 0%, respectively), inflammation (13.6%, 10.8%, respectively), and infection (4.1%, 3.6%, respectively).

Conclusion

The results showed higher percentages of cytological changes among shamma users compared with nonusers; however, the differences were not statistically significant. Habitual use of other substances in the control group could be a confounding factor given this geographic region and the cytological changes we detected in both cases and controls.

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