Cytomorphological Pattern of Oral Mucosal Cells Among Khat Plant Chewers in Yemen

Abstract

This is a descriptive analytical case control study was conducted in Yemen Amran city in the period between Jull 2010 and Jull 2013 to detect cytological atypical changes in buccal mucosa among khat users. A total of 599 individuals were investigated, of whom 499 were khat chewers (cases) and 100 were non-khat users (controls). The cytological smears were obtained from buccal mucosa using wooden tongue depressor, and participants underwent the Papanicolaou stain for cytological changes and AgNOR staining for evaluation of the mean number of AgNOR dots per nucleus. A significant correlation between khat use and oral cytological changes was found among cases compared to controls. Cytological atypia were verified among 25(5%) of the cases compared to 1(1%) of controls, (P= 0.02). Hence, keratinization was identified in 143(28.7%) of the cases compared to 11(11%) of controls, (P= 0.000). Acute inflammatory cells was identified in 55(11%) of the cases compared to 4(4%) of controls, (P= 0.03). Viral infection was observed in 53(10.6%) of the cases compared to 4(4%) of controls, (p= 0.02). Fungal infection ( Actinomyces israelii, Aspergillus and monilia) was observed in 16(3.2%) of the cases compared to 1(1%) of controls, (p= 0.05). Also a significant relation between oral epithelial atypia and duration, intensity of khat plant chewing. Statistical analyses revealed a greater mean number of AgNORs per nucleus in (cases) khat chewers (3.24) compared to (1.36) in non khat users (controls) (P= 0.000). This study concluded that the khat chewers a risk factor caused cytological changes in oral mucosa and this cytological changes particular oral epithelial atypia associated with duration and intensity of khat chewing. In addition to the mean AgNORs count is a useful indicator for cellular proliferation activity in oral epithelium and for prediction of the risk of exposure to certain carcinogenic elements that may induce oral cancer.