Khat Teeth: Effects on Enamel, Gums, and Overall Oral Health

Khat, a plant commonly chewed for its stimulant effects, has significant implications for oral health. Regular use exposes teeth and gums to both chemical and mechanical stressors that can lead to long-term dental issues. While often discussed for its psychoactive properties, its impact on oral tissues deserves attention.

Understanding how khat affects enamel, gum tissue, and overall oral hygiene can help users and healthcare providers recognize early signs of damage and take preventive measures.

Chemical Components That Interact With Dental Tissues

The chemical composition of khat leaves plays a major role in their effects on dental tissues. Cathinone, the primary psychoactive alkaloid, is structurally similar to amphetamines and contributes to oral health deterioration. It induces vasoconstriction, reducing blood flow to the gums and impairing their ability to heal. This restricted circulation can delay the repair of microabrasions and increase susceptibility to periodontal disease. Additionally, cathinone is linked to xerostomia (dry mouth), which limits saliva’s protective effects and exacerbates enamel erosion.

Tannins in khat have an astringent effect, causing protein precipitation on enamel, leading to discoloration and a roughened texture that promotes plaque accumulation. A study in the Journal of Oral Pathology & Medicine found that habitual khat chewers exhibited more extrinsic staining and enamel surface irregularities than non-users. Tannins also lower salivary pH, creating an acidic environment that accelerates enamel demineralization. Combined with mechanical friction from chewing, this weakens teeth over time.

Flavonoids and alkaloids in khat further alter the microbial balance in the mouth. Research links khat use to an increased prevalence of Streptococcus mutans and Lactobacillus species, both associated with dental caries. This shift is likely due to reduced salivary flow and khat’s chemical properties, which create a favorable environment for acidogenic bacteria. A systematic review in BMC Oral Health found khat chewers had a significantly higher incidence of cavities, reinforcing the role of these chemical interactions in dental decay.

Mechanical Force And Chewing Patterns

Khat chewing exerts continuous mechanical stress on teeth and surrounding oral structures, influencing enamel wear and dental alignment. Habitual users chew for hours per session, subjecting dentition to repetitive occlusal forces. A study in the International Journal of Oral Science found chronic khat users exhibited significant occlusal surface flattening and enamel attrition, with severity correlating to frequency and duration of use.

The unilateral nature of khat chewing contributes to muscular imbalances. Persistent use of one side of the jaw can lead to masseter muscle hypertrophy, similar to effects seen in bruxism or habitual gum chewing. This muscular asymmetry may alter occlusion and predispose users to temporomandibular joint (TMJ) disorders. Clinical reports note increased TMJ pain, clicking, and restricted mandibular movement among long-term users, suggesting excessive mechanical strain contributes to joint dysfunction.

The fibrous nature of khat leaves also accelerates enamel wear. Unlike softer foods that distribute chewing forces evenly, khat’s coarse texture causes localized abrasion, particularly at cusp tips and incisal edges. Silica particles in khat further contribute to enamel erosion. A cross-sectional study in BMC Oral Health observed that habitual users exhibited greater enamel thinning and dentin exposure, increasing the risk of hypersensitivity and secondary caries.

Saliva Flow And pH Shifts

Khat chewing significantly affects salivary dynamics, altering both production and composition. While mastication typically stimulates saliva flow, khat’s alkaloids, particularly cathinone, initially increase secretion but later lead to prolonged dry mouth. A study in the Journal of Clinical and Experimental Dentistry found habitual users frequently reported persistent xerostomia, which compromises saliva’s buffering capacity and increases susceptibility to acid-related enamel erosion.

As salivary flow diminishes, the oral environment becomes more prone to acidity. Saliva neutralizes bacterial acids and supports remineralization, but when its buffering capacity is impaired, acidogenic bacteria thrive, accelerating enamel demineralization. Research in Archives of Oral Biology found khat users exhibited significantly lower salivary pH post-chewing, often below the critical threshold of 5.5 required for enamel demineralization. This sustained acidification weakens tooth structure, increasing the risk of cavities and hypersensitivity.

Khat use also disrupts saliva’s protective functions. Saliva contains calcium and phosphate ions essential for enamel repair, but studies indicate khat reduces their bioavailability, impairing remineralization. Additionally, tannins in khat contribute to protein precipitation in saliva, increasing viscosity and reducing its ability to coat and protect teeth. These biochemical shifts accelerate enamel erosion in frequent users.

Changes In Enamel Appearance

Prolonged khat chewing causes noticeable changes in enamel’s appearance and texture. One of the most visible effects is discoloration, ranging from yellowish to brownish staining. Tannins in khat bind to enamel’s protein matrix, creating persistent pigmentation that is resistant to routine brushing and whitening treatments.

Enamel also develops a rough, uneven texture due to mechanical abrasion and chemical erosion. The repetitive grinding action of chewing wears down enamel’s natural gloss, resulting in a dull, matte appearance. Over time, microscopic cracks and fissures form, increasing susceptibility to staining and bacterial adhesion. These structural changes contribute to greater plaque retention and enamel deterioration.

Observations In Gum Tissue

Khat chewing significantly impacts gum health, with habitual users frequently exhibiting signs of periodontal distress. One of the most common issues is gingival recession, caused by constant mechanical pressure on the gumline. The repetitive motion of chewing, often concentrated on one side, gradually pushes the gums away from the teeth, exposing the root surfaces. This exposure increases sensitivity and vulnerability to decay. A clinical study in the Journal of Periodontology reported that long-term users had a higher prevalence of gingival recession, with severity correlating to chewing habits.

Beyond mechanical irritation, khat’s chemical constituents contribute to inflammation in gum tissues. Cathinone-induced vasoconstriction reduces blood supply to the gingiva, impairing healing from minor injuries. Combined with reduced salivary flow, this promotes bacterial plaque accumulation, leading to gingivitis. If left untreated, prolonged inflammation can progress to periodontitis, a severe gum disease that destroys supporting bone structure. Studies have found khat use is associated with deeper periodontal pockets and increased tooth mobility, linking it to the progression of periodontal disease.