A year ago, a 13 year old boy from Mahottari came to my clinic with the complaint of restricted mouth opening and burning sensation in the inner cheeks. Hardly a single finger would go between his teeth. On history and examination we concluded that it was Oral Submucus fibrosis. This is a precancerous condition which might end up in cancer of the oral cavity one day if the habit would be continued. With proper advice, treatment and exercise he had improved mouth opening and the symptoms subsided slowly. The point that I am trying to make here is that he had chewed betel nut for 4 years already, i.e shockingly started at the age of 9 years or younger and also told me that most of his friends at school and home did this.

In Nepal, every now and then you will be offered this at social occasions. It is really hard and could be chewed for hours and still does not finish. Yes, I am talking about the so common supari, sweet supari or pan parag which is offered at various occasions to the guests and more so in the Terai belt of Nepal where it is so widely grown. It is actually referred to as Areca nut but more commonly as Betel nut as it is taken along with betel leaf in the form of the very famous “Paan”. Today, this betel nut is found in various forms in the market, namely parag, gutkha, sweet supari, paan etc.

I remember having this thing when we were kids. It came in small packets and only cost one rupee. It was sweet in taste and we did enjoy it as to buy it again and again. They were called Madhu, and the similar versions today are Pinky and so on wrapped in colorful wrappers enticing the children. The other versions like gutkha, parag, paan parag etc is also commonly used by the adults and today even youngsters are indulging in the habit.

It was not until a few years back that I discovered this was the fourth most widely used addictive substance in the world following tobacco, alcohol and coffee. The International Agency for Research in Cancer has categorized areca nut as a carcinogen as it contributes significantly to the incidence of oral and oro-pharyngeal cancers. Areca nut chewing is not only associated with development of oral and esophageal cancer, hepatocellular carcinoma, and liver cirrhosis but also to obesity, type 2 diabetes, hypertension,hyperlipidemia, metabolic syndrome, chronic kidney disease and a greater risk of cardiovascular diseases. Also, locally speaking this habit can cause a number of problems in the oral cavity such as stains, wearing of teeth, fracture of teeth and even problems of the temporomandibular joint in some cases. So, the implications of this habit are very serious.

The pattern of rise of the number of users of this nut worldwide is alarming as evidence suggests that almost 10% population of world is already using this. Likewise is the increase in the number of users in Nepal. If this continues, the present problems posed by the tobacco epidemic might be worsened by yet another substance added, i.e areca nut epidemic?

So, we should realize the potential of addiction posed by this and the various health risks it might make you prone to and act in the individual level by learning ourselves and teaching others about what we have learnt. Additionally, the policy makers should realize this potential problem of the future and act now to restrict this to what it is and also decrease the number of people taking this through restriction in its sale to children, advertisement, increased taxation for the products and similar strategies.