Oral Staining and Malodor Secondary to Tobacco Abuse in Southwestern Saudi: A Case Report

Case Report

Austin J Dent. 2014;1(2): 1006.

Oral Staining and Malodor Secondary to Tobacco Abuse in Southwestern Saudi: A Case Report

Hossam A Eid1* and Manea Musa Musleh2

1Department of Oral medicine & Periodontology, Suez Canal University, Egypt

2Department of Periodontology, Ministry of Health, Saudi Arabia

*Corresponding author: Hossam A Eid, Department of Oral medicine & Periodontology, Suez Canal University, Ismailia, Egypt

Received: July 02, 2014; Accepted: July 28, 2014; Published: July 30, 2014


Smokeless tobacco (ST) chewing has detrimental effects on oral tissues including hard and soft tissues; it is often associated with gingivitis/periodontitis, impaired healing, dental caries, and oral mucosal lesions. This case report describes a 25 year-old male patient, who presented to King Khalid University, College of Dentistry (KKUCOD) dental clinic, with a chief complaint of oral malodor and staining. The clinical examination revealed heavy brown stains of the lower lip vermilion border and the facial aspect of the mandibular anterior dentition and localized gingival recession and areas of fenestrations at the attached gingiva of the mandibular central incisors. The patient admitted to an eight year history of cigarette smoking and smokeless tobacco. The heavy staining was noted by the patient to be observable two years ago. The staining was a social embarrassment and the most important issue for the patient.

Keywords: Smokeless tobacco; Gingival recession; Gingival fenestration; Pigmentation


Smokeless tobacco (ST) effects on the prevalence and severity of periodontal disease have been established with several systemic hazards. In the past 20 years, the use of smokeless tobacco has almost tripled. Considering the widespread use of ST products globally, the effects of such products on the periodontal tissues may be important [1]. Smokeless tobacco (ST) is an extremely addictive substance with a high rate of use in certain demographic groups, specially adolescents and young adults; it is available in two forms [2]. Snuff is a finely ground tobacco which is either dry (inhaled or sometimes placed in the mouth) or moist (placed in the mouth). Smokeless tobacco comes in three forms: loose, leaf, plug or twist. All forms of chewing tobacco are held or chewed in the mouth. There are 2,550 known compounds in processed tobacco in addition to nicotine [3]. Smokeless tobacco contains at least 30 metals including nickel and a radioactive compound called polonium-210. Formaldehyde and nitrosamines are also found in smokeless tobacco. All of these compounds have been known to cause cancer [4,5]. Snuff and chewing tobacco contain high concentrations of sodium (salt), swallowing tobacco juice containing sodium salt may contribute to the risk of high blood pressure. High blood pressure has been found to be a problem for a number of smokeless tobacco users [6,7]. This increase may give you a feeling of preparedness. However, the elevated blood pressure and heart rate actually decreases your heart's performance and thereby reduces your overall stamina [8]. Several kinds of sugar are found in unprocessed chewing tobacco and added during its processing which may cause dental cavities specially root caries frequently associated with gingival recession [7]. Cessation of smokeless tobacco use associated with withdrawal symptoms, including: irritability, impatience, anxiety, tension, poor concentration, sleep problems, changes in appetite, and craving [8]. The A seer region of southwestern Saudi Arabia is known for both a high rate of Khat chewing and tobacco use. The purpose of this paper was to report a case of 25 year old Saudi male who presented with oral malodor, gingival pigmentation and unaesthetic appearance due to unique intensifying pigmentation on lower lip mucosa and vermillion border (Figure 1&2).