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
Submission date: 2015-07-15
Acceptance date: 2015-10-22
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
Interventions to prevent periodontal disease in tobacco‐, alcohol‐, and drug‐dependent individuals
Purnima Kumar
Periodontology 2000
Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019
Parkes Kendrick, Marissa Reitsma, Mohsen Abbasi-Kangevari, Amir Abdoli, Mohammad Abdollahi, Aidin Abedi, E Abhilash, Victor Aboyans, Oladimeji Adebayo, Shailesh Advani, Bright Ahinkorah, Sohail Ahmad, Keivan Ahmadi, Haroon Ahmed, Budi Aji, Yonas Akalu, Chisom Akunna, Fares Alahdab, Ziyad Al-Aly, Fahad Alanezi, Turki Alanzi, Khalid Alhabib, Tilahun Ali, Sheikh Alif, Vahid Alipour, Syed Aljunid, Mahmoud Alomari, Tarek Amin, Saeed Amini, Hubert Amu, Robert Ancuceanu, Jason Anderson, Catalina Andrei, Tudorel Andrei, Alireza Ansari-Moghaddam, Benny Antony, Davood Anvari, Jalal Arabloo, Nicholas Arian, Monika Arora, Kurnia Artanti, Wondwossen Asmare, Desta Atnafu, Marcel Ausloos, Asma Awan, Getinet Ayano, Getie Aynalem, Samad Azari, Darshan B, Ashish Badiye, Atif Baig, Maciej Banach, Srikanta Banerjee, Suzanne Barker-Collo, Till Bärnighausen, Hiba Barqawi, Sanjay Basu, Mohsen Bayati, Shahrzad Bazargan-Hejazi, Tariku Bekuma, Derrick Bennett, Isabela Bensenor, Habib Benzian, Catherine Benziger, Adam Berman, Akshaya Bhagavathula, Neeraj Bhala, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Sadia Bibi, Ali Bijani, Antonio Biondi, Dejana Braithwaite, Hermann Brenner, Andre Brunoni, Katrin Burkart, Nagaraja Burugina, Zahid Butt, dos Caetano, Josip Car, Giulia Carreras, Joao Castaldelli-Maia, Maria Cattaruzza, Jung-Chen Chang, Pankaj Chaturvedi, Simiao Chen, Onyema Chido-Amajuoyi, Dinh-Toi Chu, Sheng-Chia Chung, Liliana Ciobanu, Vera Costa, Rosa Couto, Baye Dagnew, Xiaochen Dai, Albertino Damasceno, Giovanni Damiani, Lalit Dandona, Rakhi Dandona, Parnaz Daneshpajouhnejad, Gela Darega, Molla Derbew, Abebaw Desta, Samath Dharmaratne, Meghnath Dhimal, Arielle Eagan, Kalan Ebrahimi, Kristina Edvardsson, Andem Effiong, Tantawi El, Iffat Elbarazi, Saman Esmaeilnejad, Ibtihal Fadhil, Emerito Faraon, Medhat Farwati, Farshad Farzadfar, Mehdi Fazlzadeh, Valery Feigin, Rachel Feldman, Irina Filip, Filippos Filippidis, Florian Fischer, Luisa Flor, Nataliya Foigt, Morenike Folayan, Masoud Foroutan, Mohamed Gad, Silvano Gallus, Biniyam Geberemariyam, Birhan Gebregiorgis, Lemma Getacher, Obsa Getachew, Mansour Ghafourifard, Gheshlagh Ghanei, Ahmad Ghashghaee, Nermin Ghith, Gabriela Gil, Paramjit Gill, Ibrahim Ginawi, Salime Goharinezhad, Mahaveer Golechha, Sameer Gopalani, Giuseppe Gorini, Michal Grivna, Avirup Guha, Rafael Guimarães, Yuming Guo, Rajat Gupta, Rajeev Gupta, Tarun Gupta, Vin Gupta, Nima Hafezi-Nejad, Mohammad Haider, Randah Hamadeh, Graeme Hankey, Arief Hargono, Simon Hay, Golnaz Heidari, Claudiu Herteliu, Kamal Hezam, Thomas Hird, Ramesh Holla, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mowafa Househ, Thomas Hsiao, Junjie Huang, Charles Ibeneme, Segun Ibitoye, Irena Ilic, Milena Ilic, Leeberk Inbaraj, Seyed Irvani, Jessica Islam, Rakibul Islam, Sheikh Islam, Farhad Islami, Hiroyasu Iso, Ramaiah Itumalla, Jalil Jaafari, Vardhmaan Jain, Mihajlo Jakovljevic, Sung-In Jang, Shubha Jayaram, Panniyammakal Jeemon, Ravi Jha, Jost Jonas, Mikk Jürisson, Ali Kabir, Zubair Kabir, Leila Kalankesh, Tanuj Kanchan, Himal Kandel, Neeti Kapoor, André Karch, Salah Karimi, Kindie Kebede, Bayew Kelkay, Ryan Kennedy, Yousef Khader, Ejaz Khan, Maryam Khayamzadeh, Gyu Kim, Ruth Kimokoti, Mika Kivimäki, Soewarta Kosen, Laxminarayana Koulmane, Ai Koyanagi, Kewal Krishan, Nuworza Kugbey, G Kumar, Nithin Kumar, Om Kurmi, Dian Kusuma, Ben Lacey, Iván Landires, Savita Lasrado, Paolo Lauriola, Doo Lee, Yo Lee, Janni Leung, Shanshan Li, Hualiang Lin, Wei Liu, Alessandra Lugo, Kunjathur Madhava, Azeem Majeed, Afshin Maleki, Reza Malekzadeh, Deborah Malta, Abdullah Mamun, Narayana Manjunatha, Borhan Mansouri, Mohammad Mansournia, Santi Martini, Manu Mathur, Prashant Mathur, Mohsen Mazidi, Martin McKee, Carlo Medina-Solís, Suresh Mehata, Walter Mendoza, Ritesh Menezes, Bartosz Miazgowski, Irmina Michalek, Ted Miller, GK Mini, Andreea Mirica, Erkin Mirrakhimov, Hamed Mirzaei, Sanjeev Misra, Yousef Mohammad, Abdollah Mohammadian-Hafshejani, Shafiu Mohammed, Ali Mokdad, Mariam Molokhia, Lorenzo Monasta, Mohammad Moni, Rahmatollah Moradzadeh, Shane Morrison, Tilahun Mossie, Sumaira Mubarik, Erin Mullany, Christopher Murray, Shankar Nagaraju, Mohsen Naghavi, Nitish Naik, Mahdi Nalini, Vinay Nangia, Atta Naqvi, Swamy Narasimha, Muhammad Naveed, Javad Nazari, Sabina Nduaguba, Ruxandra Negoi, Kandel Neupane, Huong Nguyen, Yeshambel Nigatu, Molly Nixon, Chukwudi Nnaji, Jean Noubiap, Christoph Nowak, Virginia Nuñez-Samudio, Felix Ogbo, Ayodipupo Oguntade, In-Hwan Oh, Andrew Olagunju, Mayowa Owolabi, A P, Keyvan Pakshir, Adrian Pana, Demosthenes Panagiotakos, Songhomitra Panda-Jonas, Ashok Pandey, Utsav Parekh, Eun-Cheol Park, Eun-Kee Park, Kan Pashazadeh, Mona Pathak, Shrikant Pawar, Richard Pestell, Hai Pham, Marina Pinheiro, Khem Pokhrel, Akram Pourshams, Akila Prashant, Amir Radfar, Vafa Rahimi-Movaghar, Mohammad Rahman, Muhammad Rahman, Amir Rahmani, Pradhum Ram, Juwel Rana, Chhabi Ranabhat, Priya Rathi, David Rawaf, Salman Rawaf, Reza Rawassizadeh, Andre Renzaho, Aziz Rezapour, Mavra Riaz, Leonardo Roever, Luca Ronfani, Gholamreza Roshandel, Ambuj Roy, Bedanta Roy, Basema Saddik, Amirhossein Sahebkar, Sana Salehi, Hamideh Salimzadeh, Abdallah Samy, Juan Sanabria, Milena Santric-Milicevic, Jose Sao, Brijesh Sathian, Monika Sawhney, Ganesh Saya, Falk Schwendicke, Abdul-Aziz Seidu, Kumar Senthil, Sadaf Sepanlou, Omid Shafaat, Syed Shah, Masood Shaikh, Mohammed Shannawaz, Kiomars Sharafi, Aziz Sheikh, Sara Sheikhbahaei, Mika Shigematsu, Rahman Shiri, Kawkab Shishani, K Shivakumar, Siddharudha Shivalli, Roman Shrestha, Soraya Siabani, Negussie Sidemo, Inga Sigfusdottir, Rannveig Sigurvinsdottir, João Silva, Ambrish Singh, Jasvinder Singh, Virendra Singh, Dhirendra Sinha, Valentin Skryabin, Anna Skryabina, Ali Soroush, Ireneous Soyiri, Chandrashekhar Sreeramareddy, Dan Stein, Paschalis Steiropoulos, Stefan Stortecky, Kurt Straif, Abdulkader Suliankatchi, Gerhard Sulo, Johan Sundström, Takahiro Tabuchi, Eyayou Tadesse, Animut Tamiru, Minale Tareke, Md Tareque, Ingan Tarigan, Bhaskar Thakur, Kavumpurathu Thankappan, Rekha Thapar, Musliu Tolani, Marcos Tovani-Palone, Bach Tran, Jaya Tripathy, Gebiyaw Tsegaye, Hayley Tymeson, Saif Ullah, Brigid Unim, Rachel Updike, Olalekan Uthman, Marco Vacante, Constantine Vardavas, Narayanaswamy Venketasubramanian, Madhur Verma, Simone Vidale, Bay Vo, Giang Vu, Yasir Waheed, Yanzhong Wang, Kevin Welding, Andrea Werdecker, Joanna Whisnant, Nuwan Wickramasinghe, Befikadu Wubishet, Kazumasa Yamagishi, Yuichiro Yano, Vahid Yazdi-Feyzabadi, Yigizie Yeshaw, Mohammed Yimmer, Naohiro Yonemoto, Zabihollah Yousefi, Chuanhua Yu, Ismaeel Yunusa, Hasan Yusefzadeh, Muhammed Zaman, Mohammad Zamani, Maryam Zamanian, Mikhail Zastrozhin, Anasthasia Zastrozhina, Jianrong Zhang, Zhi-Jiang Zhang, Chenwen Zhong, Yves Zuniga, Emmanuela Gakidou
The Lancet Public Health
Oral melanosis and severe periodontitis in toombak users: a case report
Badr Al-Tayar, Mon Tin-Oo, Mohd Sinor, Mohamed Abdikarim, Mohammed Al-ak'hali
European Journal of Medical Case Reports
Patterns of Periodontal Destruction among Smokeless Tobacco Users in a Central Indian Population
Pradeep Anand, Supriya Mishra, Deepti Nagle, Namitha Kamath, Kavitha Kamath, Sukumaran Anil