Qat Chewing as an Independent Risk Factor for Periodontitis: A Cross-Sectional Study

This study assessed the effect of qat chewing on periodontal health, independent of other risk factors. Four hundred qat chewers and 100 nonchewers (20–50 years) were included. Demographic data and detailed information about chewing and smoking were obtained. Periodontal status was assessed using Community Periodontal Index (CPI) and clinical attachment loss (CAL). The qat chewers were older, included more males and smokers, and had worse oral hygiene but higher education levels; the majority were heavy chewers (mean duration of 14.45 years and frequency of 6.10 days/week). Regression analysis identified age, oral hygiene, education level, and cigarette smoking as independent predictors of periodontal destruction. Adjusted for these, qat chewing showed marginally significant association only with CAL (OR = 4.7; ). The chewing sides showed significantly higher scores than the nonchewing sides; however, equal scores on both sides or lower scores on the chewing sides (possibly no or beneficial effect) were still observed in 50% of the chewers. Heavy qat chewing is shown here as an independent risk factor for attachment loss. However, the possibility that the habit may have beneficial effects in a subset of the chewers cannot be excluded. A holistic model that resolves the existing contradiction is presented. 1. Introduction Qat, or khat (Catha edulis), is an evergreen plant belonging to the family Celastraceae which endemically grows in Ethiopia, Kenya, Yemen, Somalia, South Africa, and Madagascar. The fresh leaves and twigs of qat are habitually chewed by millions of local citizens of these as well as neighboring countries due to its stimulating effects attributed to the amphetamine- like stimulant cathinone. The qat chewing habit has spread with immigrants to Europe, North America, and Australia, becoming an international phenomenon [1]. Qat is usually chewed in social gatherings as a pastime activity or during special events such as wedding ceremonies. It is also used by drivers, labor, and even students for its reinforcing properties. Typically, 100–200？grams of the fresh leaves and twigs are chewed into a large quid that is retained against the cheek on one side of the mouth; the juice only is swallowed, while the quid is ejected at the end of the chewing session that lasts for 4–10 hours [1]. Although largely viewed as a social habit, long-term heavy chewing has been recently reported to induce a degree of dependence [2]. Qat chewing has been reported to be associated with adverse systemic health effects such as increased risk of cardiovascular