Correlation Between Smokeless Tobacco (Naswar) Use with Dental Caries and Halitosis Among Afghan Patients in 2024 a Case-Control Study

Authors

DOI:

https://doi.org/10.58342/ghalibMj.V.2.I.1.2.3

Keywords:

Naswar, Smokeless tobacco, Dental caries, Oral hygiene, Halitosis, Afghanistan, Public health

Abstract

Background: The consumption of smokeless tobacco (Naswar) is common in many contries including Afghanistan, and is associated with various oral and dental health issues. This study investigates the relationship between Naswar consumption, dental caries, and oral hygiene problems among patients visiting the dental clinic at the Ghalib University Hospital in Kabul.

Methods: Prospective case-control research conducted from March 2023 to September 2023, involving 121 participants, specifically males aged 16 to 65 years. The participants were divided into two groups: the case group (27 individuals) who consumed Naswar and the control group (94 individuals) who did not consume any tobacco products. Data were collected through a detailed questionnaire and clinical examination, and the analysis was performed using SPSS 26.

Results: The study found that 95.9% of participants had dental caries, with molars being the most commonly affected teeth. Furthermore, 43.8% of the participants reported Halitosis, and a significant association was observed between Naswar use and the presence of Halitosis (p < 0.05). However, no significant correlation was found between Naswar consumption and the severity or class of dental caries (p > 0.05).

Conclusion: Naswar consumption is associated with oral hygiene problems, particularly bad breath, but its effect on the severity of dental caries has not been conclusively proven. The high rate of dental caries in the study sample indicates the need for enhanced public awareness and preventive measures, especially among tobacco users.

Author Biographies

Munir Ahmad Ibrahimkhil, Clinical Stomatology Department, Medical Sciences Research Center, Ghalib University (Kabul), Afghanistan

Clinical Stomatology Department, Medical Sciences Research Center, Ghalib University (Kabul), Afghanistan

Abdul Wakil Ramakee, Clinical Stomatology Department, Medical Sciences Research Center, Ghalib University (Kabul), Afghanistan

Clinical Stomatology Department, Medical Sciences Research Center, Ghalib University (Kabul), Afghanistan

Hedayatullah Ehsan, Clinical Stomatology Department, Medical Sciences Research Center, Ghalib University (Kabul), Afghanistan

Clinical Stomatology Department, Medical Sciences Research Center, Ghalib University (Kabul), Afghanistan

Ali Sina Karimi, Clinical Stomatology Department, Medical Sciences Research Center, Ghalib University (Kabul), Afghanistan

Clinical Stomatology Department, Medical Sciences Research Center, Ghalib University (Kabul), Afghanistan

Marhabah Ahmadi, Clinical Stomatology Department, Medical Sciences Research Center, Ghalib University (Kabul), Afghanistan

Clinical Stomatology Department, Medical Sciences Research Center, Ghalib University (Kabul), Afghanistan

Faiz Mohammad Abdullah, Clinical Stomatology Department, Medical Sciences Research Center, Ghalib University (Kabul), Afghanistan

Clinical Stomatology Department, Medical Sciences Research Center, Ghalib University (Kabul), Afghanistan

References

Hecht, S. S., & Hatsukami, D. K. (2022). Smokeless tobacco and cigarette smoking: chemical mechanisms and cancer prevention. Nature reviews. Cancer, 22(3), 143–155. https://doi.org/10.1038/s41568-021-00423-4

Raj, A. T., Patil, S., Sarode, S. C., & Sarode, G. S. (2019). Systematic Reviews and Meta-Analyses on Smokeless Tobacco Products Should Include Shammah. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 21(8), 1147. https://doi.org/10.1093/ntr/nty144

Xie, W., Mridha, M. K., Gupta, A., Kusuma, D., Butt, A. M., Hasan, M., Brage, S., Loh, M., Khawaja, K. I., Pradeepa, R., Jha, V., Kasturiratne, A., Katulanda, P., Anjana, R. M., & Chambers, J. C. (2023). Smokeless and combustible tobacco use among 148,944 South Asian adults: a cross-sectional study of South Asia Biobank. BMC public health, 23(1), 2465. https://doi.org/10.1186/s12889-023-17394-w

Hamrah, M. H., Hamrah, M. S., Hamrah, M. H., Dahi, T., Fotouhi, A., Sakamoto, J., & Hamrah, M. H. (2018). Nass use and associated factors among outpatients in northern Afghanistan: A cross-sectional study in Andkhoy City. Tobacco induced diseases, 16, 36. https://doi.org/10.18332/tid/93574

Ehsan H. (2025). The influence of smoking on periodontal health: A case-control study in Afghanistan. Journal of periodontology, 96(7), 817–825. https://doi.org/10.1002/JPER.24-0693

Tobacco. (2021, November 19). Summary results of the global youth tobacco survey in selected countries of the WHO European Region. https://www.who.int/europe/publications/i/item/WHO-EURO-2020-1513-41263-56157

Tobacco, N. (2023, July 31). WHO report on the global tobacco epidemic, 2023: protect people from tobacco smoke. https://www.who.int/publications/i/item/9789240077164

Larsson, S. C., & Burgess, S. (2022). Appraising the causal role of smoking in multiple diseases: A systematic review and meta-analysis of Mendelian randomization studies. EBioMedicine, 82, 104154. https://doi.org/10.1016/j.ebiom.2022.104154

Sinha, D., Agarwal, N., & Gupta, P. (2015). Prevalence of smokeless tobacco use and number of users in 121 countries. British Journal of Medicine and Medical Research, 9(6), 1–20. https://doi.org/10.9734/bjmmr/2015/16285

Siddiqi, K., Shah, S., Abbas, S. M., Vidyasagaran, A., Jawad, M., Dogar, O., & Sheikh, A. (2015). Global burden of disease due to smokeless tobacco consumption in adults: analysis of data from 113 countries. BMC medicine, 13, 194. https://doi.org/10.1186/s12916-015-0424-2

Siddiqi, K., Husain, S., Vidyasagaran, A., Readshaw, A., Mishu, M. P., & Sheikh, A. (2020). Global burden of disease due to smokeless tobacco consumption in adults: an updated analysis of data from 127 countries. BMC medicine, 18(1), 222. https://doi.org/10.1186/s12916-020-01677-9

Sinha, D. N., Suliankatchi, R. A., Gupta, P. C., Thamarangsi, T., Agarwal, N., Parascandola, M., & Mehrotra, R. (2018). Global burden of all-cause and cause-specific mortality due to smokeless tobacco use: systematic review and meta-analysis. Tobacco control, 27(1), 35–42. https://doi.org/10.1136/tobaccocontrol-2016-053302

Tinanoff, N., Baez, R. J., Diaz Guillory, C., Donly, K. J., Feldens, C. A., McGrath, C., Phantumvanit, P., Pitts, N. B., Seow, W. K., Sharkov, N., Songpaisan, Y., & Twetman, S. (2019). Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective. International journal of paediatric dentistry, 29(3), 238–248. https://doi.org/10.1111/ipd.12484

Mittal, N., Singh, N., & Naveen Kumar, P. G. (2020). Prevalence of Dental Caries among Smoking and Smokeless Tobacco Users Attending Dental Hospital in Eastern Region of Uttar Pradesh. Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine, 45(2), 209–214. https://doi.org/10.4103/ijcm.IJCM_245_19

Doddawad, V. G., Shivananda, S., Paul, N. J., & Chandrakala, J. (2022). Dental caries: Impact of tobacco product among tobacco chewers and tobacco smokers. Journal of oral biology and craniofacial research, 12(3), 401–404. https://doi.org/10.1016/j.jobcr.2022.05.004

Khan, M. A., Vichayanrat, T., & Ngoenwiwatkul, Y. (2024). The association between smoking and smokeless tobacco use with dental caries among Pakistani patients. BMC oral health, 24(1), 723. https://doi.org/10.1186/s12903-024-04508-y

Zhang, J., Leung, K. C. M., Sardana, D., Wong, M. C. M., & Lo, E. C. M. (2019). Risk predictors of dental root caries: A systematic review. Journal of dentistry, 89, 103166. https://doi.org/10.1016/j.jdent.2019.07.004

Tomar, S. L., & Winn, D. M. (1999). Chewing tobacco use and dental caries among U.S. men. Journal of the American Dental Association (1939), 130(11), 1601–1610. https://doi.org/10.14219/jada.archive.1999.0099

Mittal, N., Singh, N., & Naveen Kumar, P. G. (2020). Prevalence of Dental Caries among Smoking and Smokeless Tobacco Users Attending Dental Hospital in Eastern Region of Uttar Pradesh. Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine, 45(2), 209–214. https://doi.org/10.4103/ijcm.IJCM_245_19

Sham, A. S., Cheung, L. K., Jin, L. J., & Corbet, E. F. (2003). The effects of tobacco use on oral health. Hong Kong medical journal = Xianggang yi xue za zhi, 9(4), 271–277.

Patil, V. R., & Sanjai, K. (2025). Impact of Smokeless Tobacco on Salivary Antioxidant Systems and Oral Health: A Comparative Study Among Individuals With and Without Tobacco Pouch Keratosis. Cureus, 17(6), e85229. https://doi.org/10.7759/cureus.85229

Osborne, S. R., Alston, L. V., Bolton, K. A., Whelan, J., Reeve, E., Wong Shee, A., Browne, J., Walker, T., Versace, V. L., Allender, S., Nichols, M., Backholer, K., Goodwin, N., Lewis, S., Dalton, H., Prael, G., Curtin, M., Brooks, R., Verdon, S., Crockett, J., … Holliday, S. (2020). Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia. The Medical journal of Australia, 213 Suppl 11, S3–S32.e1. https://doi.org/10.5694/mja2.50881

Hatsukami, D. K., Lemmonds, C., Zhang, Y., Murphy, S. E., Le, C., Carmella, S. G., & Hecht, S. S. (2004). Evaluation of carcinogen exposure in people who used "reduced exposure" tobacco products. Journal of the National Cancer Institute, 96(11), 844–852. https://doi.org/10.1093/jnci/djh163

Hecht, S. S., Stepanov, I., & Carmella, S. G. (2016). Exposure and Metabolic Activation Biomarkers of Carcinogenic Tobacco-Specific Nitrosamines. Accounts of chemical research, 49(1), 106–114. https://doi.org/10.1021/acs.accounts.5b00472

Gupta, P. C., Murti, P. R., & Bhonsle, R. B. (1996). Epidemiology of cancer by tobacco products and the significance of TSNA. Critical reviews in toxicology, 26(2), 183–198. https://doi.org/10.3109/10408449609017930

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Published

2025-09-22

How to Cite

1.
Ibrahimkhil MA, Ramakee AW, احسان ها, Karimi AS, Ahmadi M, Abdullah FM. Correlation Between Smokeless Tobacco (Naswar) Use with Dental Caries and Halitosis Among Afghan Patients in 2024 a Case-Control Study. مجلۀ علوم طبی غالب [Internet]. 2025 Sep. 22 [cited 2025 Oct. 3];2(2):31-40. Available from: https://www.mj.ghalib.edu.af/index.php/mj/article/view/41

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Vol. 2 No. 2 (1404): Volume 2, Issue 2, Autumn and Winter 2025

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Research Articles

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Copyright (c) 2025 منیر احمد ابراهیم خیل, عبدالوکیل رامکی, هدایت الله احسان, علی سینا کریمی, مرحبا احمدی, فیض محمد عبدالله

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