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 a commonly used inaccurate term to describe betel quid.

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

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

1.4. Betel Quid or Pan chewing is considered to be the fourth most frequently used addictive substance in the world, following tobacco, alcohol and caffeine.1

1.5. Betel Quid use causes a psycho-stimulating effect, inducing euphoria and appetite suppression.2

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

1.7. Areca Nut can be combined with other additives to create Pan 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.3

1.8. 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

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

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

1.11. Betel Quid is significantly associated with dependence.7

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

1.13. Areca Nut products can be bought in Asian supermarkets in Australia.

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

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

Definitions

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

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

1.18. BETEL QUID is created by rolling Pan in the leaf from a betel vine.

2. Position

2.1. No one should use Betel Quid.

2.2. No one should use products containing tobacco.

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

2.4. Public education campaigns should discourage Betel Quid use.

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

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

2.7. 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.

2.8. The importation of Areca Catechu plants and the growing and sale of Areca Nut should be banned 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