Original Article https://doi.org/10.70084/mru/pmrcc/042.P42

Oral Epithelium Changes Associated with Chronic Toombak Dipping

Mohamed Mahgoub Hassan Khalifa¹, Migdad Mohammed Monawer Mohammed¹, Awad-Eljeed Abu-Jooda Al-Obaid ¹, Haitham Abdalla Ali Ismail ², Hassan Yousif Adam Regal ³, Hussain Gadelkarim Ahmed^4,5.

Affiliations

¹Department of Histopathology and Cytology, Faculty of Medical Laboratory Sciences, University of Kordofan, El-Obeid, NK, Sudan.

²Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, University of Kordofan, El-Obeid, NK, Sudan.

³Department of Parasitology, Faculty of Medical Laboratory Sciences, University of Kordofan, El-Obeid, NK, Sudan.

⁴Prof Medical Research Consultancy Center, El-Obeid, NK, Sudan.

⁵Department of Histopathology and Cytology, FMLS, University of Khartoum, Sudan.

Correspondence to: Mohamed Mahgoub Hassan Khalifa, Email: khalifa.mmh@kordofan.edu.sd

Cite: Khalifa et al. Oral Epithelium Changes Associated with Chronic Toombak Dipping. Medical Research Updates Journal 2026;4(2):43-52. https://doi.org/10.70084/mru/pmrcc/042.P42

ABSTRACT

Background: Oral cancer (OC) is a significant global health issue linked to modifiable risk factors, including tobacco consumption. Consequently, investigating the effects of long-term toombak use on oral epithelium is vital. Methodology: The study conducted in El-Obeid City, Sudan, involved male toombak users and included 120 buccal smears: 30 from a control group and 90 from long-term users. Data was collected using a structured Arabic questionnaire on demographics and toombak use patterns. Buccal smears were obtained after oral wash, then fixed in 95% ethanol, dried, and stained with Papanicolaou (PAP) stain for cytological analysis. Results: This study examined 120 male volunteers, aged 15 to 73 years, with a mean age of 33 years. Nuclear degenerative alterations revealed karyolysis in 89% of cases and were absent in controls; karyorrhexis was noted in 5.6% of patients versus 3.3% of controls. Multinucleation occurred in 4.4% of cases, with no instances observed in the controls. Cytoplasmic vacuolization was observed in 89% of the cases, with no instances in the controls. Keratinization was observed in 7.8% of the cases and 6.7% of the controls. Cytological evidence of fungal infection was detected in 5 patients, comprising 80% cases and 20% controls. Cytological evidence of bacterial infection was observed in 8 patients (88% of cases and 12% of controls). Conclusion: Toombak users exhibit a significantly higher incidence of degenerative cellular changes, particularly karyolysis (indicating severe nuclear degeneration) and cytoplasmic vacuolization (indicating cytoplasmic damage). Additionally, there are corroborative changes such as multinucleation. Cytological evidence linked to infection in both cases and some controls suggests that microbial factors may contribute to tissue damage.

Keywords: Oral, cytology, toombak, pyknosis, karyolysis, keratinization