Oral Health Effects

Chewing areca nut products has harmful effects on oral and dental health. It can lead to tooth fractures, periodontal disease, leukoplakia, lichenoid lesions, oral submucous fibrosis (OSF), and oral cancer (NSW Health 2021). Therefore, it is advisable for public health initiatives to promote the discontinuation of areca nut consumption in order to control premalignant and malignant conditions such as OSF and oral cancer (NSW Health 2021).

EFFECTS ON SOFT TISSUE

Impact on Oral Mucosa

The Areca nut can be chewed whole or cut in half or as “quid”, a mixture containing crushed Areca nut combined with betel leaf, tobacco, slaked lime, alcohol, or other substances. Betel nut chewing is causally linked to cancers of the oral cavity when used alone or mixed with tobacco and/or alcohol. Regular chewing may induce chronic irritation and inflammation that damage epithelial cells of the oral cavity (Hernandez, Zhu, Goodman, Gatewood, Mendiola, Quinata and Paulino 2017). Some users of areca nut may experience a whitish-gray discoloration of the oral mucosa, while others might have a healthy mucosa without any discoloration or textural changes (NSW Health 2021).

Lichenoid Lesions and Oral Leukoplakia

There have been reports of lichenoid lesions developing in the oral cavity of areca nut chewers, particularly at the site of placement of areca nut products. These lesions may regress completely after stopping the habit. Oral leukoplakia typically presents as a white plaque or patch on the oral mucosa and is not pathologically or clinically classified as any other oral lesion. In some cases, it may be associated with tobacco use. Areca nut consumption is recognized as a significant risk factor for the development of oral leukoplakia and has been linked to an increased risk of oral squamous cell carcinoma (OSCC). Both areca nut and betel quid are independent risk factors for oral cancer (Shirzaiy and Neshat 2020).

Oral Submucous Fibrosis (OSF)

OSF is a precancerous condition with high malignant potential among oral mucosal lesions, primarily caused by the use of areca nuts. Areca nut stimulates fibroblasts, leading to excessive collagen production and deposition in the soft tissues of the oral mucosa. This results in decreased flexibility of the oral mucosa. OSF manifests as a significant reduction in mouth opening, rigidity, and blanching of the oral soft tissues, causing difficulty in speech, chewing, and swallowing (Shirzaiy and Neshat 2020). This condition is irreversible, and no effective treatment exists for this premalignant lesion.

If left untreated, OSF may transform into OSCC. Among oral precancerous lesions, OSF has the highest potential for malignant transformation. Oral cancers are attributed to a number of causal agents including tobacco, alcohol, human papillomavirus (HPV), and areca (betel) nut however, betel nut chewing has been established as an independent cause of oral cancer (Hernandez et. al 2017). Betel nut chewing is considered the fourth most commonly used addictive substance in the world after tobacco, alcohol, and caffeine (Hernandez et. al 2017).

EFFECTS ON TEETH

Tooth abrasion and fractured teeth

Chewing areca nut can lead to occlusal abrasion and fractured teeth due to its hard, fibrous nature. One complication of areca nut chewing is the shortening of the incisors. In regular users, the occlusal surfaces of the premolars and molars may become smooth, resulting in enamel abrasion and increased dentinal sensitivity (NSW Health 2021).

Betel nut Staining

Areca nut chewing produces copious amounts of red saliva. Additionally, polymers of ortho-quinones can discolour teeth, with the extent of staining varying based on the duration of use, resulting in colours ranging from red to black (NSW Health 2021).