Cytological Changes and Immunocytochemistry Expression of P53 in Oral Mucosa Among Waterpipe Users in the Kingdom of Saudi Arabia.

Objective In this study, we aimed to assess cytological changes and p53 expression in oral mucosa among waterpipe users in the Kingdom of Saudi Arabia (KSA). Methodology A case-control study was conducted in KSA from January to October 2022. Two cytologic oral smear samples each were taken from 500 volunteers; 300 were waterpipe users (case) while 200 did not use a waterpipe (control). They were then stained using the Papanicolaou staining procedure and immunocytochemical method to show the expression of P53. Results The interpretation of the Papanicolaou staining outcomes showed the presence of four results with different proportions: inflammation, infection, atypia, and keratinization. Cytological inflammation was identified among 77/300 (25.6%) waterpipe smokers, which was higher than that among non-users (12/200, 6%). The reverse cytological infection and atypia were also higher in waterpipe smokers compared with controls (9% vs. 4.5% and 4.3% vs. 0.5%, respectively), and keratinization was detected only in waterpipe users (3.6%) compared with controls. Waterpipe users had higher p53 protein expression than non-users. Conclusion Using a waterpipe is an effective way to change the oral mucosa. In atypia and keratinization, there was high p53 expression. These results could indicate that p53 is involved in both the change from normal to cancerous cells and the growth of new cells, but the presence or absence of p53 staining could not be used to predict the outcome of potentially cancerous oral mucosal lesions.