Ancient tooth wear reveals earliest evidence of habitual drug use

Fraser Macdonald, Dental Tribune International

Fri. 2. October 2026

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BRISBANE, Australia: Betel nut is a stimulant widely used across South and Southeast Asia and the Pacific and has long been regarded as one of the oldest psychoactive plant drugs. Until now, the earliest reliable evidence of its consumption came from dental calculus from around 3,500–3,000 years ago. A new archaeological study of human remains from Sulawesi in Indonesia has identified a previously unrecognised form of dental pathology that the researchers linked to habitual betel nut use. The findings suggest that the practice has much deeper roots than previously documented and may have begun in a form very different from modern betel chewing.

The research centres on two pre-agricultural foragers whose teeth show severe circumferential wear patterns unlike the attrition expected from normal mastication. In one individual, the third molar was substantially more worn than the second, suggesting that a hard spherical object was repeatedly held towards the back of the mouth. The second individual had similar wear affecting molars, premolars, canines and a lateral incisor.

The researchers proposed that the object was a whole, dehusked betel nut and that the wear had been caused by holding it between the teeth and sucking or gently gnawing it while moving it around the mouth. To test this explanation, they conducted chemical analysis of dental samples from both individuals. The results supported their hypothesis: arecoline, an active compound in betel nut, was detected in both individuals. Their laboratory experiments also found that intact betel nuts can release arecoline in quantities sufficient to produce physiological effects.

Prolonged use had severe dental consequences. The younger individual had exposed roots and pulp cavities and periapical lesions, and the authors suggested that the severe wear had eventually resulted in chronic infection. Both individuals had periodontal disease and tooth loss.

The chronology is particularly significant. The older individual dates to 25,000–16,000 years ago and the other to 7,600–6,300 years ago. This places betel nut use well before previously known records. The authors therefore proposed that the modern practice of betel chewing may have developed from a much older practice of sucking whole nuts.

For dental anthropology and bioarchaeology, the findings demonstrate the value of combining analysis of dental wear with biomolecular evidence to reconstruct a non-dietary oral behaviour. Their methodology was also notably minimally invasive: unlike most previous studies of this kind, the researchers extracted compounds by soaking the teeth in solvents, requiring no cutting, grinding or acid etching.

Modern betel nut use is an important oral health issue. Prolonged exposure is associated with significant oral disease, particularly an increased risk of oral cancer, and habitual chewing has also been linked to severe attrition, fractures, periodontal disease and tooth loss.

The study, titled “Betel nut sucking is the earliest recorded evidence for the habitual use of a neuroactive plant drug”, was published online on 11 September 2026 in Science Advances.

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