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Global Oral Health and Inequalities
Published in Vincent La Placa, Julia Morgan, Social Science Perspectives on Global Public Health, 2023
Prevalence of severe periodontal disease also remains largely unchanged since 1990, although there has been a slight improvement. In 1990, prevalence was estimated at 11.2%, and by 2010, this had decreased to 10.8% of people, worldwide (Kassebaum et al., 2014). Epidemiological studies of periodontal disease are a challenge due to the various measurement tools used globally, and problems of coverage, and, as a result, figures are estimates. Incidence of cancer of the lip and oral cavity was 500,550 in 2018, with 177, 384 total deaths, of which 67% were males. The major risk factors for oral cancers are tobacco and alcohol consumption and areca nut (betal quid) chewing (Jethwa and Khariwala, 2017; Mehrtash et al., 2017). Oral cancer has the highest incidence of all cancers in Melanesia and South Asian males (Bray et al., 2018). It is the leading cause of cancer-related mortality for males in India and Sri Lanka. For males in LMICs, with a low HDI, oral cancer is the fourth highest of all cancers (Bray et al., 2018). In many HICs, the human papilloma virus infection is responsible for increasing oropharyngeal cancers (Mehanna et al., 2013) and prevalence is greater among men and older age groups from poorer backgrounds (Conway et al., 2015).
Premalignant Neoplasms
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
The prevalence of leukoplakia is estimated to be 1.49–4.9%. Unfortunately, most epidemiologic data are outdated and retrospective. Risk factors include tobacco use, alcohol use, areca nut use, UV exposure, age, family history of cancer, and immunosuppression. HPV has been implicated in epithelial dysplasia.
Experimental Oral Carcinogenesis
Published in Samuel Dreizen, Barnet M. Levy, Handbook of Experimental Stomatology, 2020
Samuel Dreizen, Barnet M. Levy
It has been shown that when tobacco tar is applied to the external skin of mice, it can initiate a neoplastic response. However, in most of the studies, tobacco tar that has been applied to the oral mucosa of mice and rats failed to initiate a neoplastic response. The question, of course, was whether this failure was due to some innate resistance of the oral mucosa of mice and rats to the mild carcinogens in tobacco or whether the saliva might have produced some kind of protection. As we shall see later, the saliva may play an important role in the carcinogenesis of the oral mucosa. In an interesting corollary study,39 uncured raw areca nuts, active shell lime, and chewing tobacco, mixed in almost the same proportions as the product used for chewing, were made into a soft paste by grinding, and placed in the vagina daily. Some 40 animals survived from 324 to 380 days after the beginning of the experiment. Raised papillomatous growths were present in three animals, in which the histologic examination revealed malignant changes. In four animals there was thickening of the mucous membrane with definite malignant changes in the vaginal epithelium. Metastases were present in four animals. Apparently the vaginal mucosa is highly susceptible to the carcinogenic activity of “pan”.
Metabolism of the areca alkaloids – toxic and psychoactive constituents of the areca (betel) nut
Published in Drug Metabolism Reviews, 2022
There are an estimated over 600 million people worldwide that chew the areca nut1 (AN) in some form, a practice that has existed since antiquity (Garg et al. 2014). Consumption is widely prevalent among citizens in many parts of the Asian continent, especially Southeast Asia (e.g. India, Pakistan, Taiwan, Malaysia, Sri Lanka, and Myanmar), and Tropical-Pacific regions. Chewing of AN is also common among Asian-migrant communities elsewhere in the world, including South Africa, France, Italy, Australia, UK, and Canada (Vilmer and Civatte 1986; Hardie 1987; Oliver and Radden 1992; Vora et al. 2000; Gupta and Ray 2004; Bissessur and Naidoo 2009; Furber et al. 2013; Petti and Warnakulasuriya 2018; Wood et al. 2019). A growing set of data suggest that AN consumption in the USA is frequent among immigrant and refugee populations, in which various unprocessed and commercialized products are poorly regulated and freely available for retail purchase (Oakley et al. 2005; Changrani et al. 2006; Pobutsky and Neri 2012; Milgrom et al. 2013; Do and Vu 2020; Tungare and Myers 2021).
Betel quid chewing and cessation in the sociocultural context of Paiwan people from Taiwan: a qualitative study
Published in Journal of Ethnicity in Substance Abuse, 2021
This study found that betel quid chewers did not show any significant characteristics in the preparation stage. Most of them entered the action stage directly after they decided to quit chewing betel quid. However, the duration of the action stage might vary. Some interviewees could get rid of the withdrawal symptoms within one to two weeks, while some had to use “quantity reduction” for two to three years before entering the maintenance stage. The main methods of quitting were to “stop chewing” or “chew less.” Chewing gum and other substitutes were not effective. Some interviewees had areca nut in their mouth without chewing to satisfy their cravings. The ability to decline the temptations from friends in social occasions significantly affected the success of quitting. From the descriptions of chewers who failed to quit in the action stage, this was mainly because of “stress,” “social interaction,” “cravings,” and the need for the psychoactive effects of betel quid. Moreover, when quitting betel quid, the chewers might experience a rebound effect on the amount of betel quid needed. Therefore, enhancing the self-efficacy of quitters is an important issue.
A Discourse Analysis on Betel Nut Chewing in Hunan Province, China
Published in Journal of Psychoactive Drugs, 2021
However, the betel nut is labeled as the fourth most consumed psychoactive drug after nicotine, alcohol, and caffeine (Cox, Mafaz, and Hans 2016). The World Health Organization (WHO, International Agency for Research on Cancer, 2004) regarded it as one of the most prevalent human carcinogens. Numerous studies have been conducted to identify the association between the use of the betel nut and the health risks. Thomas and Lennen (1992) discussed the potential cancer risk of betel eating habit. Wen et al. (2010) also found that the interaction of smoking with betel quid chewing may account for half of all cancer deaths in the group that used both. Binns, Wah, and Katie (2011) proposed that betel chewing has detrimental effects on health that are not restricted to the oral cavity, and that the products of betel nuts have the potential to become addictive. Cox, Mafaz, and Hans (2016) and Wei et al. (2017) reviewed the adverse health effects of the areca nut, including hepatocellular carcinoma, oral premalignant and malignant lesions, oral leukoplakia and erythroplakia, oral submucous fibrosis which is related with oral cancer, atrial fibrillation and death, the reproductive system, premature births and lower birth weight. Mehrtash et al. (2017) pointed out the side effects of betel quid and areca nut on oral and esophageal cancers. From the amount of usage, according to Nelson and Heischober (1999), novice betel nut users may have acute sensations of dizziness, vertigo, nausea, and diaphoresis while heavy betel nut users may have auditory hallucinations, delusions, and an acute reversible psychosis.