Areca nut (or betel nut) chewing is a habit practiced by millions of people in Asia and India for thousands of years. A number of additives are mixed and wrapped in a betel leaf, which is then chewed for an extended period of time. The practice has a number of potentially serious side effects.


Main elements for an areca nut quid:

(1) areca nut (from the palm, Areca catechu), typically sliced into small pieces

(2) betel leaf (which has a peppery taste)


Variable additives:

(1) slaked lime (which raises the intra-oral pH and increases absorption of alkaloids)

(2) plug tobacco

(3) spices (cardamom, coconut, saffron, nutmeg)


Commercially prepared products may be referred to as pan (or paan, which is a term for the quid) massala.


The active ingredient is believed to be arecoline, which acts as a stimulant and imparts a sense of well-being. However, a variety of other alkaloids are also present that could contribute to the effect.


Systemic adverse effects:

(1) dependency syndrome

(2) cardiovascular disease

(3) psychiatric disorders


Adverse effects on the oral mucosa and teeth:

(1) staining the oral mucosa and teeth a deep red color

(2) dental abrasion

(3) root fractures

(4) lichenoid lesions on the buccal mucosa or tongue (wavy keratotic lines that radiate from a central erythematous area)

(5) oral submucous fibrosis (affecting the oral cavity, hypopharynx and upper portion of the esophagus)

(6) betel chewer's mucosa (reddish brown area associated with epithelial hyperplasia)

(7) leukoplakia (with hyperkeratosis and epithelial hyperplasia, often with dysplasia)

(8) squamous cell carcinoma (may also arise in esophagus)


Other effects seen in chronic users which may or may not be causally related:

(1) The practice may protect against development of dental caries.

(2) It is uncertain if the habit contributes to development of periodontitis, since areas where it is practiced tend to have poor oral hygiene.

(3) Abnormalities in temporomandibular joint function.


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