RESEARCH PAPER
Oral White Lesions Associated with Chewing Khat
Meir Gorsky 1
,  
Joel B. Epstein 2, 3  
,  
Harel Levi 4
,  
 
 
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1
Department of Oral Pathology and Oral Medicine, The Maurice and Gabriella Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
2
Medical-Dental Staff, British Columbia Cancer Agency, Vancouver, Canada
3
Department of Oral Medicine and Diagnostic Sciences, Chicago, USA
4
The Maurice and Gabriella Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
Publish date: 2004-09-15
 
Tobacco Induced Diseases 2004;2(September):145
KEYWORDS
ABSTRACT
Introduction:
Khat is a cultivated plant whose leaves when chewed elevate mood. Unlike the chewing of betel nut, no association between the white oral mucosal lesions in khat users and oral malignancies has been reported. Chewing of khat has been documented in many countries and has increased with worldwide migration. The impact of chewing khat upon the oral mucosa is essentially unknown.

Purpose:
The purpose of this study was to assess the occurrence of oral white changes in chronic khat chewers. Oral mucosal changes in a group of 47 Yemenite Israeli men over 30 years of age, who had chewed khat more than 3 years, were compared to those of 55 Yemenite men who did not chew.

Results:
White lesions were significantly more prevalent in the khat chewers (83%) compared to the non chewing individuals (16%) (P < 0.001). White oral lesions were identified primarily on the lower buccal attached gingival mucosa, the alveolar mucosa and the lower mucobuccal fold on the chewing side (p < 0.001). There was no significant association between the occurrence of the white lesions and smoking. Even though the majority of the white lesions (85.4%) were homogenous, 71.4% of the non homogenous lesions were identified in khat chewers. Vital staining with toluidine blue and exfoliative cytology was conducted on a subset of patients with homogenous and non-homogenous oral lesions, and there were no findings suspicious for pre-malignant or malignant changes.

Discussion:
This study demonstrated a relationship between khat chewing and oral white lesions, which we attribute to chronic local mechanical and chemical irritation of the mucosa. Our findings also suggest that mucosal changes associated with khat are benign, however, this initial study requires further studies including follow-up of khat users to confirm the current findings, including the likely benign changes associated with chronic use and histologic findings of clinical lesions.

 
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