Dental Tribune International

Negative effects of betel quid chewing brought to the fore

By Dental Tribune International
February 26, 2020

SYDNEY, Australia: With a regular user base estimated to be in excess of 600 million, betel quid chewing is an extremely popular habit and cultural practice in the Asia Pacific region. However, its deleterious side effects, which can include mouth and oesophageal cancers, combined with a burgeoning black market, have prompted the Australian Dental Association (ADA) to release a warning regarding the potential dangers of using the stimulant.

Though the areca nut can be chewed by itself when in a fresh or dried condition, it is most commonly wrapped in a betel leaf with slaked lime and possibly other substances, such as cinnamon, cardamom and tobacco—a preparation commonly known as a betel quid. It is used for a multitude of purposes, including as a stimulant, a breath freshener and an appetite suppressant, and possesses historical significance for a number of cultures. In Vietnam, for example, the betel quid is a symbol often associated with love and marriage, while royalty in India reportedly used to have an assistant solely dedicated to constructing betel quids for them to nibble on.

There are a number of proven negative health consequences that can arise from habitual betel quid chewing, however. In 2003, the World Health Organization categorised chewing betel quid, both with and without tobacco, to be a carcinogenic activity, and it has been linked by numerous studies to tooth wear, gingival recession, periodontal disease and oral cancer. As reported by Dental Tribune International, a 2017 study of mouth cancer patients in Myanmar found that nearly all of them chewed the substance.

In Australia and New Zealand, the areca nut is currently prohibited from being imported under the Australia New Zealand Food Standards Code. In addition, its active ingredient, arecoline, is a Schedule 4 poison, which, according to the Alcohol and Drug Foundation, means that it is “illegal to possess or sell without proper authority”. However, a recent investigation conducted by the Australian Broadcasting Corporation has found that dozens of orally compromised patients may be associated with a substantial betel quid black market.

“More and more dentists are reporting to the Australian Dental Association that they’re seeing patients with the devastating consequences of betel quid chewing,” said Prof. Michael McCullough, the ADA’s oral medicine specialist, in a press release concerning the issue.

“At this point, the extent of its use across the nation is largely unknown although anecdotally dentists in practices around Australia are collectively seeing around 60–100 people a year presenting with damage to their mouths related to betel quid use,” he continued.

“Due to its devastating effects on the mouth and throat, the Australian Dental Association strongly recommends that Australians don’t chew betel nut or its derivatives to decrease their risk of developing precancerous or cancerous lesions within the mouth or throat,” McCullough concluded.

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