Policy Statement 2.2.12 - Community Oral Health Promotion: Betel Nut Use

Position Summary

The use of betel quid (nut) containing areca nut should be avoided in order to prevent pre-cancerous and cancerous lesions of the mouth, which can have fatal consequences.

1. Background

1.1. Betel Nut’ is sometimes used interchangeably with ‘betel quid’.

1.2. Betel Quid or Paan contains Areca Nut, the fruit of the Areca Palm.

1.3. Areca Nut can be combined with other additives to create Paan or Betel Quid, which may also include tobacco. The most common method of using betel nut is to slice it into thin strips and rolled in a betel leaf with slaked lime powder or crushed seashells.(1)

1.4. Betel Quid chewing is common cultural practise in areas of Southern Asia and its use is increasing in Australia.

1.5. Some users rest Betel Quid in their buccal vestibules or under the tongue for long periods of time when not chewing it, increasing the potential of harm to these tissues.

1.6. Betel Quid or Paan chewing is considered to be the fourth most frequently used addictive substance in the world, following tobacco, alcohol and caffeine.(2)

1.7. Betel Quid use causes a psycho-stimulating effect, inducing euphoria and appetite suppression.(3)

1.8. Betel Quid use causes staining of the lips, intra-oral soft tissues and teeth.

1.9. Betel Quid use is a risk factor for the development of leukoplakia, erythroplakia, oral squamous cell carcinoma and oral submucous fibrosis which can have fatal consequences.(4)

1.10.  Betel Quid use can increase the risk of oral and oropharyngeal cancer, independent of tobacco and alcohol use.(5)

1.11. Betel Quid users may demonstrate poor oral hygiene, halitosis, attrition and/or poor periodontal health.(6)

1.12. Betel Quid is significantly associated with dependence.(7)

1.13. Betel Quid use is observed in both children and adults.

1.14. Areca Nut contains proven carcinogens such as tannins, polyphenols such as safrole, hydroxychavicol and catechins, and alkaloids.

1.15. Areca Nut products can be bought in Asian supermarkets in Australia. Products such as Paan Masala are not spit out leading to carcinogenic effects at sites beyond the oral cavity as well.

1.16. Areca Nut is grown in tropical areas such as northern Queensland.

1.17. The extent of use and consumption of Betel Quid in Australia is largely unknown.

Definitions

1.18. ARECA NUT is the seed of the fruit produced by the Areca Catechu tree.

1.19. PAAN is the chewing product created by combining areca nut with additives such as tobacco, slaked lime (calcium hydroxide) and various spices.

1.20. BETEL QUID is created by rolling Paan in the leaf from a betel vine.

1.21. PAAN MASALA is a dehydrated non-perishable preparation of areca nut, catechu, slaked lime, cardamom and many artificial perfuming and flavouring substances.

2. Position

2.1. Betel Quid use is not recommended.

2.2. Dentists should play a role in identifying and discouraging Betel Quid use.

2.3. Public education campaigns should discourage Betel Quid use.

2.4. Areca Nut must not be intentionally added to food or offered for sale as food.

2.5. Research is required into the extent of use and consumption of Betel Quid in Australia.

2.6. Accurate labelling of the Areca Nut products, especially with respect to admixture with tobacco, should be an important requirement and health warnings should be enacted.

2.7. The importation of Areca Catechu plants and the growing and sale of Areca Nut should be prohibited in Australia.

 

1 Yap et al 2008

2 Mirza et al 2011

3 Alcohol and Drug Foundation, 2019. Betel Nut https://adf.org.au/drug-facts/betel-nut/

4 WHO

5 Guha et al 2014

6 Raman Bedi, Crispian Scully, in Manson's Tropical Infectious Diseases (Twenty-third Edition), 2014

7 Mirza et al 2011

8 Garg et al 2015