title: Prevalence and association of smokeless tobacco use with the development of periodontal pocket among adult males in Dawan Valley, Yemen: a cross-sectional study.
abstract: BACKGROUND
  The traditional type of smokeless tobacco used in the Arabian Peninsula, particularly common in Yemen, is called shammah. This study aims to determine the prevalence of shammah use and its association with the development of periodontal pockets. Other associated factors with the development of periodontal pocket were also determined.
  
  
  METHODS
  This cross-sectional study included 346 adult males aged 18 years old to 68 years old. Socio-demographic characteristics, oral hygiene practices, and shammah use history were surveyed by using a structured interview questionnaire. The clinical assessment for the presence or absence of periodontal pockets was assessed on the basis of community periodontal index. The chi-square test was used to assess significant differences in study groups in terms of the presence of periodontal pockets. Multivariable logistic regression was selected to assess potential associated factors with the development of periodontal pockets.
  
  
  RESULTS
  Among the 346 adult males, 248 (71.7 %), 30 (8.6 %), and 68 (19.7 %) males never used shammah, were former shammah users, and were current shammah users, respectively. The significant associated factors with the development of periodontal pocket were age group (30 years old and above) (Adjusted Odds Ratio (AOR) = 2.03, 95 % CI: 1.13, 3.65; P = 0.018), low family income category (AOR = 2.35, 95 % CI: 1.39, 3.99; P = 0.001), former shammah user (AOR = 2.66, 95 %: CI: 1.15, 6.15; P = 0.022), and current shammah user (AOR = 6.62, 95 %: CI: 3.59, 12.21; P = 0.001).
  
  
  CONCLUSIONS
  The results revealed that periodontal pockets were significantly associated with age group (30 years old and above), low family income category, former shammah use, and current shammah use. The findings of the current study highlighted the need to develop comprehensive shammah prevention programs and reduce periodontal disease and other shammah-associated diseases.
authors.affiliation: School of Dental Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan Malaysia.
authors.forename: Badr
authors.initials: B
authors.lastname: Al-Tayar
authors.affiliation: School of Dental Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan Malaysia.
authors.forename: Mon Mon
authors.initials: MM
authors.lastname: Tin-Oo
authors.affiliation: School of Dental Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan Malaysia.
authors.forename: Mohd Zulkarnian
authors.initials: MZ
authors.lastname: Sinor
authors.affiliation: Department of Periodontology, Faculty of Dentistry, Jazan University, Jazan, Saudi Arabia.
authors.forename: Mohammed Sultan
authors.initials: MS
authors.lastname: Alakhali
keywords: Community Periodontal Index; Males; Periodontal pocket; Shammah; Smokeless tobacco