Prevalence and association of smokeless tobacco use with the development of periodontal pocket among adult males in Dawan Valley, Yemen: a cross-sectional study
More details
Hide details
School of Dental Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
Department of Periodontology, Faculty of Dentistry, Jazan University, Jazan, Saudi Arabia
Mon Mon Tin-Oo   

School of Dental Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
Publication date: 2015-10-04
Tobacco Induced Diseases 2015;13(November):35
The traditional type of smokeless tobacco used in the Arabian Peninsula, particularly common in Yemen, is called shammah. This study aims to determine the prevalence of shammah use and its association with the development of periodontal pockets. Other associated factors with the development of periodontal pocket were also determined.

This cross-sectional study included 346 adult males aged 18 years old to 68 years old. Socio-demographic characteristics, oral hygiene practices, and shammah use history were surveyed by using a structured interview questionnaire. The clinical assessment for the presence or absence of periodontal pockets was assessed on the basis of community periodontal index. The chi-square test was used to assess significant differences in study groups in terms of the presence of periodontal pockets. Multivariable logistic regression was selected to assess potential associated factors with the development of periodontal pockets.

Among the 346 adult males, 248 (71.7 %), 30 (8.6 %), and 68 (19.7 %) males never used shammah, were former shammah users, and were current shammah users, respectively. The significant associated factors with the development of periodontal pocket were age group (30 years old and above) (Adjusted Odds Ratio (AOR) = 2.03, 95 % CI: 1.13, 3.65; P = 0.018), low family income category (AOR = 2.35, 95 % CI: 1.39, 3.99; P = 0.001), former shammah user (AOR = 2.66, 95 %: CI: 1.15, 6.15; P = 0.022), and current shammah user (AOR = 6.62, 95 %: CI: 3.59, 12.21; P = 0.001).

The results revealed that periodontal pockets were significantly associated with age group (30 years old and above), low family income category, former shammah use, and current shammah use. The findings of the current study highlighted the need to develop comprehensive shammah prevention programs and reduce periodontal disease and other shammah-associated diseases.

Layten Davis D, Nielsen MT. Tobacco: production, chemistry and technology. 1 ed. Oxford: Blackwell Science; 1999.
Gupta P, Ray C. Epidemiology of betel quid usage. Ann Acad Med Singapore. 2004;33 Suppl 4:31–6.
Axéll TE. Oral mucosal changes related to smokeless tobacco usage: research findings in Scandinavia. Eur J Cancer B Oral Oncol. 1993;29(4):299–302.
Zhang X, Schmitz W, Gelderblom H, Reichart P. Shammah—induced oral leukoplakia-like lesions. Oral Oncol. 2001;37(7):609–12.
Scheifele C, Nassar A, Reichart P. Prevalence of oral cancer and potentially malignant lesions among shammah users in Yemen. Oral Oncol. 2007;43(1):42–50.
Alsanosy RM. Smokeless tobacco (shammah) in saudi arabia: a review of its pattern of use, prevalence, and potential role in oral cancer. Asian Pac J Cancer Prev. 2013;15(16):6477–83.
Samman MA, Bowen ID, Taiba K, Antonius J, Hannan MA. Mint prevents shamma-induced carcinogenesis in hamster cheek pouch. Carcinogenesis. 1998;19(10):1795–801.
Al Agili DE, Park HK. The prevalence and determinants of tobacco use among adolescents in Saudi Arabia. J Sch Health. 2012;82(3):131–8.
Al Agili D, Park H. Oral health status of male adolescent smokeless tobacco users in Saudi Arabia. East Mediterr Health J. 2013;19(8):711–9.
Hajeb R. Prevalence of oral mucosal lesions and related risk habits in outpatient dental clinics in Malaysia and Yemen. 2010. Accessed 22 Feb 2015.
Zhou J, Michaud DS, Langevin SM, McClean MD, Eliot M, Kelsey KT. Smokeless tobacco and risk of head and neck cancer: Evidence from a case–control study in New England. Int J Cancer. 2013;132(8):1911–7.
Boffetta P, Aagnes B, Weiderpass E, Andersen A. Smokeless tobacco use and risk of cancer of the pancreas and other organs. Int J Cancer. 2005;114(6):992–5.
Singh G, Rizvi I, Gupta V, Bains VK. Influence of smokeless tobacco on periodontal health status in local population of north India: A cross-sectional study. Dent Res J. 2011; doi:10.4103/1735-3327.86045.
Lesan S, Nosratzehi T, Ousia M, Arbabikalati F, Pourmardan E. The Correlation between the Frequency of Oral Lesions and the Amount of Smokeless Tobacco Usage in Patients Referred to Oral Medicine Department of Zahedan Dental School. J Dent (Shiraz). 2014;15(2):81–5.
Mahmud SZ, Alif SM, Tarafder MA, Hossain SM. The Correlation between Periodontal Diseases and Chronological Age among Type 2 Diabetes Mellitus Patients attending at National Healthcare Network (NHN) Mirpur Centre, Dhaka, Bangladesh. Birdem Med J. 2013.
Kamath DG, Verma B, Kamath S. Effect Of Socioeconomic Status On Periodontal Health Of a Population in Mangalore. Natl J Integr Res Med. 2012;3(4):121–5.
Hopcraft MS, Morgan MV, Satur JG, Wright F, Darby IB. Oral hygiene and periodontal disease in Victorian nursing homes. Gerodontology. 2012; doi:10.1111/j.1741-2358.2010.00448.x.
Fisher M, Taylor G, Tilashalski K. Smokeless tobacco and severe active periodontal disease, NHANES III. J Dent Res. 2005;84(8):705–10.
Listgarten M. The role of dental plaque in gingivitis and periodontitis. J Clin Periodontol. 1988; doi:10.1111/j.1600-051X.1988.tb01019.x.
Gemmell E, Seymour GJ. Immunoregulatory control of Th1/Th2 cytokine profiles in periodontal disease. Periodontology 2000. 2004;35(1):21–41.
Taubman MA, Valverde P, Han X, Kawai T. Immune response: the key to bone resorption in periodontal disease. J Periodontol. 2005;76 Suppl 11:2033–41.
Palmer RM, Wilson RF, Hasan AS, Scott DA. Mechanisms of action of environmental factors–tobacco smoking. J Clin Periodontol. 2005;32 Suppl 6:180–95.
Montén U, Wennström JL, Ramberg P. Periodontal conditions in male adolescents using smokeless tobacco (moist snuff). J Clin Periodontol. 2006;33(12):863–8.
Wouters F, Salonen L, Frithiof L, Hellden L. Significance of some variables on interproximal alveolar bone height based on cross‐sectional epidemiologic data. J Clin Periodontol. 1993;20(3):199–206.
Kallischnigg G, Weitkunat R, Lee PN. Systematic review of the relation between smokeless tobacco and non-neoplastic oral diseases in Europe and the United States. BMC Oral Health. 2008;8(1):13.
World Health Organization. Oral health survey-basic method 4th edition. 1997. Accessed 22 May 2015.
Neufeld K, Peters D, Rani M, Bonu S, Brooner R. Regular use of alcohol and tobacco in India and its association with age, gender, and poverty. Drug Alcohol Depend. 2005;77(3):283–91.
Sreeramareddy CT, Ramakrishnareddy N, Kumar H, Sathian B, Arokiasamy J. Prevalence, distribution and correlates of tobacco smoking and chewing in Nepal: a secondary data analysis of Nepal Demographic and Health Survey-2006. Subst Abuse Treat Prev Policy. 2011; doi:10.1186/1747-597X-6-33.
Agbor M, Azodo C, Tefouet T. Smokeless tobacco use, tooth loss and oral health issues among adults in Cameroon. Afr Health Sci. 2013; doi:10.4314/ahs.v13i3.38.
Petersen PE, Ogawa H. The global burden of periodontal disease: towards integration with chronic disease prevention and control. Periodontol 2000. 2012; doi:10.1111/j.1600-0757.2011.00425.x.
Zhang Q, Li Z, Wang C, Shen T, Yang Y, Chotivichien S et al. Prevalence and predictors for periodontitis among adults in China, 2010. Glob Health Action. 2014. doi:10.3402/gha.v7.24503.
Peeran SW, Singh AR, Alagamuthu G, Kumar PN. Periodontal status and its risk factors among young adults of the Sebha city (Libya). Dent Res J (Isfahan). 2013;10(4):533–8.
Kumar S, Dagli RJ, Dhanni C, Duraiswamy P. Relationship of body mass index with periodontal health status of green marble mine laborers in Kesariyaji. India Braz Oral Res. 2009;23(4):365–9.
James JA, Sayers NM, Drucker DB, Hull PS. Effects of tobacco products on the attachment and growth of periodontal ligament fibroblasts. J Periodontol. 1999;70(5):518–25.
Mohamed S, Janakiram C. Periodontal status among tobacco users in Karnataka. India Indian J Public Health. 2013. doi:10.4103/0019-557X.115006.
Kumar S, Dagli RJ, Chandrakant D, Prabu D, Suhas K. Periodontal status of green marble mine labourers in Kesariyaji, Rajasthan. India Oral Health Prev Dent. 2008;6(3):217–21.
Yalcin F, Eskinazi E, Soydinc M, Basegmez C, Issever H, Isik G, et al. The effect of sociocultural status on periodontal conditions in pregnancy. J Periodontol. 2002;73(2):178–82.
Dhaliwal JS, Lehl G, Sodhi SK, Sachdeva S. Evaluation of socio-demographic variables affecting the periodontal health of pregnant women in Chandigarh, India. J Indian Soc Periodontol. 2013; doi:10.4103/0972-124X.107475.
Eke P, Dye B, Wei L, Thornton-Evans G, Genco R. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res. 2012;91(10):914–20.
Gundala R, Chava VK. Effect of lifestyle, education and socioeconomic status on periodontal health. Contemp Clin Dent. 2010; doi:10.4103/0976-237X.62516.
Possible role of nicotine and cotinine on nitroxidative stress and antioxidant content in saliva of smokeless tobacco consumers
Shaik Fareeda Begum, Gutam Nagajothi, Kodidela Swarna Latha, G. Sandeep, Bandi Sreekanth, Chitta Suresh Kumar, W. Rajendra, Narendra Maddu
Practical Laboratory Medicine
User Experiences of Prescription and Over-The-Counter Drug Abuse in Aden City, Yemen
Ebtesam Abood, Jenny Scott, Mayyada Wazaify
Link between perceived oral and general health status among Yemeni adult dental patients
Mohammed Alhajj, Esam Halboub, Abdullah Amran, Abdulaziz Alkheraif, Fuad Al-Sanabani, Bandar Al-Makramani, Abdulghani Al-Basmi, Fawaz Al-Ghabri
BMC Oral Health
Effectiveness of scaling and root planing with and without adjunct probiotic therapy in the treatment of chronic periodontitis among shamma users and non‐users: A randomized controlled trial
Fahim Vohra, Ishfaq Bukhari, Saeed Sheikh, Refal Albaijan, Mustafa Naseem, Mudassir Hussain
Journal of Periodontology