Association between Shammah Use and Oral Leukoplakia-like Lesions among Adult Males in Dawan Valley, Yemen

Abstract

Background: Shammah is a traditional form of snuff dipping tobacco (a smokeless tobacco form) that is commonly used in Yemen. Oral mucosal changes due to the use of shammah can usually be observed in the mucosal surfaces that the product touches. The aim of this study was to determine the association between shammah use and oral leukoplakia-like lesions. Other associated factors were also determined. Materials and Methods: A cross sectional study was conducted on 346 randomly selected adult males. Multi-stage random sampling was used to select the study location.

The relationship of shammah (Arabian snuff) chewing to the risk of oral cancer and oral potentially malignant disorders

“…The odds of having OPMD/oral cancer in relation to shammah uses ranged from three to 39 times. One study reported that the odds of developing OPMD/oral cancer among current shammah users are 39‐fold (95% CI: 14‐105), while another study reported a 13‐fold increased risk among current shammah users (12.99; 95% CI: 6.34‐26.59) . The associated risk was relatively low among those that have quit shammah use and ranged from threefold (3.65; 95% CI: 1.40‐9.50) to 12‐fold (12.6; 95% CI: 3.3‐48.2).…”

“…The risk for shammah users to develop these lesions was 39 times (39; 95% CI: 14‐105) higher than non‐users. It was also noted that the associated risk of OPMD and/or oral cancer was higher among the current shammah users for current users (39; 95% CI: 14‐105 and 12.99; 95% CI: 6.34‐26.59) compared to those that have quit (12.6; 95% CI: 3.3‐48.2 and 3.65; 95% CI: 1.40‐9.50) …”

“…While assessing the quality of included studies using NOS score, only three were classified as good‐quality studies . These reported cancer cases that were confirmed either through histological analysis or hospital records and adjusted their risk estimates for other confounding factors including smoking.…”

“…16 Also, one study had a cohort-based study design. 12 The majority of studies reported OPMD and/or oral cancer sites, [12][13][14][15] and bucco-alvelolar mucosa, tongue, floor of mouth were the most common sites affected. In addition to shammah, studies also evaluated other tobacco-associated products including cigarettes, Qat and pipe.…”

“…The NOS score for the quality of the included studies ranged from 4 to 7 ( Table 2). Only three studies 15,17,20 had a NOS score of 7 to be considered a good-quality study. Four studies 12,14,18,19 recorded a NOS score of "5," while the remaining two studies 13,16 had a NOS score of "4."…”