Dentists issue warning on hazards of betel quid chewing

4 February 2020

More and more dentists across Australia are seeing cases of oral cancer in patients who have brought the practice of betel quid* chewing with them from their homeland, a practice which has the potential to affect thousands of migrants and new Australian populations.

For World Cancer Day tomorrow, dentists are asking many new and immigrant Australians to stop the highly addictive habit that could cost them their life.

Betel quid chewing is regularly practised by 600 million people worldwide as a breath freshener, appetite suppressant and to induce euphoria in users from a range of countries including India, Sri Lanka, Malaysia, Taiwan and Myanmar. Through immigration, the use of betel quid has spread globally including to Australia in the last two decades.

“In some of these countries its use is widespread with chewing rates as high as 30 to 40 per cent of adults,” said the Australian Dental Association’s oral medicine specialist Professor Michael McCullough.

“More and more dentists are reporting to the Australian Dental Association (ADA) that they’re seeing patients with the devastating consequences of betel quid chewing.

“At this point, the extent of its use across the nation is largely unknown although anecdotally dentists in practices around Australia are collectively seeing around 60 to 100 people a year presenting with damage to their mouths related to betel quid use.”

Betel quid use affects the mouth by staining mouth, lips, teeth and cheeks bright red. Regular users are more likely to have poor oral hygiene, bad breath, tooth wear, gum recession, periodontal pockets or gaps around the tooth associated with severe gum disease and bleeding gums.

But using areca nut - either with tobacco (to create betel quid) or without – also increases the risk of developing soft tissue lesions, including leukoplakia (white patches on soft tissue), eythroplakia (red patches) and oral submucous fibrosis (which is progressive fibrosis or thickening and scarring of the mouth’s deep tissues), which can all progress to oral cancer.

Warning signs of oral cancer include white patches on the soft tissue of the mouth that cannot be rubbed away with a finger or cloth, an ulcer that has not healed after two weeks, and a change in firmness or texture of the mouth’s soft tissue particularly on the tongue or cheeks.

“If any of these symptoms appear, then it’s advisable to see a dentist as soon as practicable. Dentists are alert to these signs and the need for referral for specialist investigation if any symptoms are detected,” said Professor McCullough.

“Dentists are trained to screen for abnormalities in the mouth, as well as the head and neck region as part of
a routine dental check-up. This is when some dentists are picking up these unfortunate signs of betel quid

While using both tobacco and alcohol together is widely recognised as increasing the risk of developing oral
cancer, observational studies in South-East Asian countries showed that the interaction of smoking, alcohol
and betel quid chewing could increase oral cancer risk by 23 to 34 times.

Further, the Australian Drug Foundation advises that “there is no safe level of use” for areca nut. Since 2004,
areca nut has been recognized as a group 1 carcinogen, independent of the effects of tobacco, according to a
World Health Organization (WHO) report.

“Due to its devastating effects on the mouth and throat, the Australian Dental Association strongly
recommends that Australians don’t chew betel nut or its derivatives to decrease their risk of developing precancerous or cancerous lesions within the mouth or throat,” said Professor McCullough.