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Betel Quid
Nadia Barak
Due: December 2, 2013
Betel nut (Areca nut) is the fruit of the Areca catechu tree, which grows in Asia,
the tropical Pacific region, and parts of east Africa. It is a major ingredient of betel quid,
(BQ) , which generally consists of dried areca nut, catechu, slaked lime, flavoring
ingredients, wrapped in betel leaf, and sometimes with tobacco. In Hindi it is called
Paan. It is chewed, then finally spat out or swallowed. Approximately 700 million
individuals, 10% of the worlds population, regularly chew betel nut (or betel quid)
worldwide. (2)
Betel quid is a mild stimulant, sometimes used with or without tobacco. It is an
established cause of oral and esophageal cancers, and when mixed with smokeless
tobacco, can cause pharyngeal cancer. There is evidence for the effect of betel quid on
the cardiovascular system. After chewing the betel quid, it causes the immediate effects
of vasoconstriction, an elevated pulse rate, and blood pressure increase. Betel quid also
contains four arecal alkoids, primarily arecoline which is shown to cause short term
hypoglycemia, and has a potential diabetogenic and carcinogenic effect. Betel quid
chewing can also induce periodontal disease, a known risk factor for cardiovascular
disease (1).
Betel quid stains the lips and teeth red. If chewed over a prolonged period of time
without cleaning the teeth, can turn the enamel and dentin black. Gingivitis and
periodontal disease is common in betel quid chewers. One of the reasons for gum disease
in betel quid chewers is because of the irritating effect of lime. Chewing betel quid for a
prolonged period can also wear down the teeth and make them mobile (2).
Betel quid chewing is common in Central Asia, South Asia, and South-east Asian
countries including Bangladesh, China, India, Pakistan, Philippines, Sri Lanka, Taiwan,
and Vietnam. It is thought to be the fourth most commonly used psychoactive substance
in the world. There is a slight higher prevalence of men betel quid chewers than women
and is associated with adults over the age of 30. There was much higher use of betel quid
among those with a lower socio-economic status, low level of education, no land
ownership, and unemployment. The use of chewing betel quid with tobacco was higher in
rural areas in comparison with urban areas (2).
It is important to take a full mouth series of x-rays on a patient that chews betel
quid because, betel quid can induce periodontal disease. The radiographs will be a
diagnostic tool in the assessments of periodontal disease. As professional hygienists, it is
important to perform a thorough intra oral exam to identify any abnormal oral lesions,
since betel quid is a known cause of oral and esophageal cancer. If any abnormal lesions
are noted, then a lab test or biopsy should be performed.
Our job as health professionals, is to speak to our patients about cessation. It is
important to let our patients know about the health risks associated with betel quid
chewing to the body and the oral cavity. If the patient has periodontal disease, oral
hygiene home care should be reviewed and patient should return every 3-4 months for
maintenance. At each visit, cessation should be reinforced. Without treatment,
periodontal disease can progress into a more severe form; Periodontal disease is a risk
factor for cardiovascular disease. If an intra oral malignant lesion is undetected it can be
fatal to the patient. The ingredients in betel quid can also cause hypertension in users.
As Dental hygienists, betel quid is relevant to our profession because an estimated
700 million individuals chew it regularly and it can induce periodontal disease. It is
important for us hygienists to know the clinical presentation, age, sex, race, and etiology
of betel quid users so we know how to treat the patient and speak to them about cessation.
Works Cited
1. Heck, Julia E., Erin L. Marcotte, Maria Argos, Faruque Pervez, Alauddin Ahmed,
Tariqul Islam, Golam Sarwar, Rabiul Hasan, Habibul Ahsan, and Yu Chen. "Betel
Quid Chewing in Rural Bangladesh: Prevalence, Predictors and Relationship to
Blood Pressure." International Journal of Epidemiology (2012): 462-70. Web. 26
Nov. 2013. <http://ije.oxfordjournals.org/>.
2. Yamada, Tomohide, Kazuo Hara, Takashi Kadowaki. "Chewing Betel Quid and the
Risk of Metabolic disease, and All-CAuse Mortality: A Meta-Anaysis." PLOS
ONE (2013): 1-9. Web. 26 Nov. 2013. www.plosone.org.