Role of beetal quid and areca nut in oral cancer

[Anonymous]

Much of the tobacco in the world is consumed without combustion, by being placed into contact with mucous membranes through which the nicotine is absorbed to provide the pharmacological “benefit”. From the early days itself, beetal quid is mainly used for chewing. It usually consists of four main ingredients: betel leaf (Piper betel), areca nut (Areca catechu), slaked lime [Ca (OH)2] , and catechu (Acacia catechu). Since the introduction of pan, tobacco has become an important ingredient of it and most of the habitual pan-chewers include tobacco along with pan. Tobacco is also prepared in blocks and flakes for chewing, where North Americans use the term smokeless tobacco for thes products.
The use of betel quid, containing both areca nut and tobacco, is associated with a much higher relative risk of oral cancer, between 8-15 times as compared to that of 1-4 times, associated with using the quid, without tobacco. Betel quid chewing produces reactive oxygen species (ROS) that is detrimental to oral mucosa and can be directly involved in tumor initiation process, by inducing mutation, or by making the mucosa susceptible to betel quid ingredients and environmental toxicants. Betel quid chewing produces reactive oxygen species (ROS), that have multiple detrimental effects upon the oral mucosa. The production and release of ROS occurs under alkaline conditions during the autooxidation of areca nut (AN) polyphenols, in the betel quid chewer’s saliva. The ROS can be directly involved in the tumour initiation process, by inducing genotoxicity and gene mutation, or by attacking the salivary proteins and oral mucosa, leading to structural change in the oral mucosa, that may facilitate the penetration by other Betel quid ingredients and environmental toxicants. The nitrosation of areca alkaloids to AN-specific nitrosamines occurs in the saliva of betel quid chewers. These AN-specific nitrosamines are mutagenic, genotoxic and capable of inducing tumours in animal models. Studies have shown that beetal quid chewing without tobacco can also cause precancerous conditions in the oral cavity in the form of erythroplakia and OSF.
Areca nut contains potent cholinergic muscurinic alkaloids, notably arecoline and guavacaline, with a wide range of parasymphatheticomimetic effects. They promote salivation and the passage of wind through the gut; they rise blood pressure and pulse rate; and they elicit a degree of euphoria by virtue of their GABA receptor inhibitory properties which contribute to dependence and habituation. There are also bronchoconstrictor effects, and evidence for a role in precipitating and exacerbating asthama and diabetes. Areca nut is certainly the main etilogical agent in OSMF.

        

[Anonymous]

The most common disease that is caused by betel nut chewing is OSMF
Oral submucous fibrosis is a chronic debilitating disease of the oral cavity characterized by inflammation and progressive fibrosis of the submucosal tissues (lamina propria and deeper connective tissues). Oral submucous fibrosis results in marked rigidity and an eventual inability to open the mouth.The buccal mucosa is the most commonly involved site, but any part of the oral cavity can be involved, even the pharynx

The condition is well recognized for its malignant potential and is particularly associated with areca nut chewing, the main component of betel quid. Betel quid chewing is a habit practiced predominately in Southeast Asia and India that dates back for thousands of years. It is similar to tobacco chewing in westernized societies. The mixture of this quid, or chew, is a combination of the areca nut (fruit of the Areca catechu palm tree, erroneously termed betel nut) and betel leaf (from the Piper betel, a pepper shrub), tobacco, slaked lime (calcium hydroxide), and catechu (extract of the Acacia catechu tree).Lime acts to keep the active ingredient in its freebase or alkaline form, enabling it to enter the bloodstream via sublingual absorption. Arecoline, an alkaloid found in the areca nut, promotes salivation, stains saliva red, and is a stimulant.

The ingredients and nomenclature of betel quid vary by region as detailed below:

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Pan: This is freshly prepared betel quid (with or without tobacco).
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Gutka (gutkha, guttkha, or guthka): This is a manufactured version of betel quid with tobacco sold as a single-use sachet. It is primarily used on the Indian subcontinent (ie, India, Pakistan, Bangladesh). Betel quid without tobacco is mostly used in Southeast Asian countries (ie, Taiwan, Myanmar, Thailand, China, Papua New Guinea, Guam).
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Pan masala: This is a commercially manufactured powdered version of betel quid without tobacco used in the Indian subcontinent.
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Pan Parag: It is a brand name of pan masala and gutka used in India.
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Mawa (kharra): This is a crude combination of areca, tobacco, and lime.
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Mainpuri tobacco: Popular in parts of northern India, Mainpuri tobacco is a mixture of areca nut, tobacco, lime, and various condiments. Depending on local preferences, sweeteners or spices (ie, cardamom, saffron, clove, anise seed, turmeric, mustard) are also added as flavorings.

In most patients with oral submucous fibrosis, areca nut was chewed alone more frequently than it was chewed in combination with pan (ie, betel leaf plus lime plus betel catechu, with or without tobacco)or had a higher areca nut content.

        

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