The Areca (Betel) Nut: Clinical Implications for Dental Practice in the United States

Areca nut (AN), commonly known as betel nut, has been used for centuries in ceremonies and rituals, consumed for unproven therapeutic effects, and abused as a recreational psychostimulant. AN is the fourth-most commonly abused psychoactive substance globally–only behind caffeine, nicotine and alcohol–and consumption is strongly associated with developing adverse oral effects, most notably oral potentially malignant disorders (e.g.oral leukoplakia, oral submucous fibrosis) and oral malignancies. Examples of other areca-related oral adverse reactions include profound dark brownish-blackish extrinsic staining, dentin hypersensitivity, periodontal disease, and betel chewer's mucosa. AN use is becoming more prevalent in Western countries, such as the US, due to increasing immigration from regions where the habit is endemic—such as the Indian subcontinent and Southeast Asians. However, US dental practitioners are likely unfamiliar with the habit and its significant clinical implications to oral health. Informing these practitioners is essential for identification of users and communicating effectively with them, along with managing the oral complications. This narrative review synthesizes current evidence on AN use with emphasis on US regulations and policy considerations, oral health effects, and findings from US-based studies of AN users. Furthermore, we offer perspective about knowledge gaps (e.g.,increasing public awareness) and the ramifications to US dental practice.