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.

Scientific literature exists regarding the oral and dental effects of khat (Catha edulis Forsk) chewing¹ and is divided regarding the effect of khat chewing on the periodontium.² Gingival recession, extrinsic staining of teeth and increased bleeding on probing has been reported.¹ A patient with a history of khat chewing for many years could have intrinsic staining of the teeth, as can be evidenced from this case.

Dental clinicians worldwide need to be aware of possible harmful oral effects of khat chewing.³ As people from war-torn nations (Yemen) migrate to other countries for education, work and shelter, they carry with them their innate cultural practices and traditions. Some of the practices (khat chewing) carry the danger of being transferred to the local population as well. It is also possible that migrant communities are not aware of the legal status of khat in the country where they are residing. The usage of khat is banned in Malaysia. The mere banning of the substance or inclusion of the substance in a banned list of substances has minimal benefits. Creating awareness regarding khat and the harmful effects of khat chewing is more likely to reduce its usage.