Abstract
Objective: The aim of this study was to detect cytological changes and Ki-67 protein expression in oral mucosa among water pipe users. Methodology: A case control study was study was carried out in Saudi Arabia from January to October 2022, two cytological oral smear samples were taken from 500 volunteers 300 were water pipe users (case) and 200 were normal individuals (control) and were stained using the Papanicolaou staining procedure and immunocytochemical method to show the expression of Ki-67. Result: Inflammation, infection, atypia and keratinization were interpreted from Papanicolaou stains. The prevalence of cytological inflammation was higher among water pipe smokers (77/300, 25.6%) than among non water pipe users (12/200, 6%). Reverse cytological infection and atypical were higher in water pipe smokers than in control, 9% versus 4.5% and 4.3% versus 0.5%, respectively, while keratinization was only identified in water pipe users (3.6%) versus control groups. The Ki-67 protein is expressed at a higher level in water pipe users compared to non users. Conclusion: The study results concluded that water pipe users had more atypical cells and more KI-67 protein expression in the oral mucosa as compared to their non water pipe users' counter parts.