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Behavioral and Socioeconomic Determinants of Tooth Loss in Yemeni Adults: A Cross-Sectional Analysis
Basem H Al-Huthaifi1,2,3, Abdullmalik N Al-Hamati4, Ehab M Abdu3,5
1Faculty of Dentistry, Ibn Al-Nafis University for Medical Sciences, Sana'a, Yemen.
Purpose:
Tooth loss is a major public health problem in low- and middle-income countries, particularly where traditional habits such as khat chewing coexist with limited dental care. This study aimed to assess the behavioral and socioeconomic factors associated with oral hygiene, gingival health, and tooth loss among adults in Sana'a, Yemen.
Methods:
A clinic-based cross-sectional study was conducted among 513 adult patients attending four dental centers in Sana'a Governorate, Yemen, between January and April 2026. Data were collected through clinical examination and structured interviews covering sociodemographic characteristics, oral hygiene practices, khat chewing, and cigarette smoking. Multivariable logistic regression was used to identify independent associations with tooth loss. A two-sided p-value <0.05 was considered significant.
Results:
The mean age was 41.2 years (SD 14.7); 55.2% were female. Daily toothbrushing was reported by only 32.4% of participants, 76.6% never used dental floss. Mean OHI-S was 2.85 (SD 1.22), with 33.1% having poor oral hygiene; the mean Gingival Index was 1.72 (SD 0.69), with 55.0% exhibiting moderate to severe gingivitis. Daily khat chewing was reported by 30.6%, and 13.1% smoked cigarettes daily. After adjustment, khat chewing (adjusted OR 2.34; 95% CI 1.32-4.15; p=0.003) and cigarette smoking (adjusted OR 3.07; 95% CI 1.68-5.61; p<0.001) were independently associated with increased tooth loss, whereas daily toothbrushing (OR 0.54; 95% CI 0.32-0.91; p=0.021) and regular flossing (OR 0.42; 95% CI 0.21-0.84; p=0.013) provided protective benefits.
Conclusion:
Khat chewing, cigarette smoking, low socioeconomic status, low education, and infrequent toothbrushing are independently associated with tooth loss among adults attending dental centers in Sana'a, Yemen. Public health interventions should target these modifiable factors, particularly in conflict-affected settings where access to dental care is severely restricted.
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