Periodontal disease and intrinsic staining of teeth due to khat chewing

A male patient aged 28 years attended the SEGi Oral Health Centre to have his teeth cleaned. The patient was an immigrant worker from Yemen. An intra-oral examination revealed an abundance of plaque around the cervical areas of most of the teeth. A basic periodontal examination revealed a score of 2 in the maxillary sextants and 3 in the mandibular sextants. Gingival recession was seen around the mandibular left canine, first premolar and molars. There were dark black bands of staining around the cervical region of the teeth (Figure 1). Probing depths were around 3 mm throughout the mouth. A diffuse white patch was seen on the buccal mucosa (Figure 1). Reduced mouth opening and generalized attrition were also present. On questioning, the patient revealed a history of chewing khat (a green-leaved plant) since he was 15 years old. The patient had the habit of keeping partially chewed leaves in the buccal vestibule of the left posterior portion of his mouth. A diagnosis of chronic localized periodontitis in relation to the mandibular left posteriors was made. Oral prophylaxis was completed and the patient was counselled regarding the adverse effects of khat chewing and advised to quit the habit. The patient was re-called after 3 months for observation of the white lesion on the buccal mucosa.