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A mere 20 subjects used only siwaks. A study by Tubaishat et al.[14] reported that some toothbrush users believe that siwak chewing in addition to toothbrushing is the most effective way of reducing food debris. In the present study, statistically significant difference was observed between siwak use and educational level. This finding is in consensus with the study results of al-Otaibi,[3] who indicated that the siwak is preferred by less-educated Saudi Arabian people. Educational level was found to be significantly associated with cigarette smoking and khat chewing in the present study. Chewing of khat leaves,[7] and tobacco[7,15] and pipe smoking[16] are becoming a major public health problem worldwide. Khat is a well-known natural stimulant obtained from the plant Catha edulis and is widely used in certain Red Sea countries, including Yemen BKM120 in vivo GUCY1B3 and the province of Jizan in Saudi Arabia. Among the students of Jizan,[17] the percentage of khat chewing was found to be 20.5%. While among the Axum university (North Ethiopia) students,[7] the prevalence of khat chewing and cigarette smoking was 27.9% and 9.3%, respectively, and the commonest reasons for its use were to keep alert while reading (40.6%), for relaxation (65.5%), and to relieve stress (37.7%); also, having peer friends who were khat chewers was strongly and positively associated with khat use. Ageely[6] reported that in comparison to the other determinants like age, gender, and residence, the use of khat was significantly associated with school and college selleck inhibitor education (P