Cytological Evaluation of Oral Epithelial Changes in Apparently Healthy Oral Mucosa Among Smokers and Spicy Food Consumers.

Background Tobacco use remains a leading cause of morbidity worldwide, with increasing use of alternative forms such as shisha and e-cigarettes. Concurrently, dietary habits such as frequent spicy food consumption are common in many cultures. While the systemic effects of smoking are well documented, the localized cytological impact of both smoking and repeated dietary irritation from spicy foods on apparently healthy oral tissues requires further comparative investigation. Hence, this study aimed to evaluate and compare cytological alterations in the oral mucosa among users of cigarettes, shisha, and e-cigarettes, as well as frequent spicy food consumers, in comparison with a healthy control group. Methodology A cross-sectional study was conducted among 400 Saudi adults (300 smokers, 50 frequent spicy food consumers, and 50 healthy controls) between January and May 2025. Smoking exposure was further characterized by duration, frequency, and pack-years. Buccal mucosal smears were collected from standardized sites and stained using the Papanicolaou technique. Cytological abnormalities, including inflammation, microbial infection, cellular atypia, and binucleation, were assessed using predefined criteria. Statistical analysis was performed using SPSS version 22 (IBM Corp., Armonk, NY, USA), with significance set at p-values <0.05. Results Cytological abnormalities were significantly more frequent among smokers (48%) and spicy food consumers (34%) compared with controls (20%) (p < 0.05). Among smoking subgroups, e-cigarette users demonstrated a higher prevalence of nuclear alterations, including cellular atypia (15%) and binucleation (8.8%); however, this finding should be interpreted with caution given the smaller subgroup size (n = 80). In contrast, inflammatory changes were most commonly observed among spicy food consumers (26%), followed by cigarette smokers (23.3%). Conclusions Both smoking and frequent spicy food consumption are associated with cytological alterations in the oral mucosa. Smoking, including e-cigarette use, appears to be associated with nuclear alterations, while spicy food consumption is primarily associated with inflammatory changes. These findings should be interpreted in light of the cross-sectional design and potential confounding factors. Further longitudinal studies are required to clarify the clinical significance of these observations.