Gutka is a smokeless tobacco product that can cause a number of problems in long-term users. It is seen primarily in India and Pakistan but it is also used by immigrants from these countries in other parts of the world. Complications tend to appear earlier in a chronic gutka user compared to a betel nut or oral tobacco user.


Gutka is a mixture of:

(1) powdered tobacco

(2) areca nut (see betel chewing, above)

(3) aqueous calcium hydroxide (slaked lime)

(4) spices or perfumes (sandalwood, musk ketones, etc)


It is marketed in small pouches (sachet) which is initially chewed then placed it between the cheek and gum for hours at a time.


A chronic user is defined who uses 1 or more pouches per day for 6 months or longer. Although most users are men, women may be regular users.


Complications seen in chronic users:

(1) periodontitis with gingival recession and/or bleeding

(2) submucosal fibrosis

(3) leukoplakia followed by dysplasia followed by squamous cell carcinoma

(4) extension of the submucous fibrosis into the hypopharynx and esophagus

(5) reduced saliva


The submucosal fibrosis results in impairment due to a rigidity to the lips, tongue and oral mucosa.


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