This resource has been developed for health professionals. It aims to improve their understanding of the health issues associated with betel nut use and provide guidance on how to conduct a brief intervention with patients using the substance.
Betel nut is the seed of the fruit of the areca palm. It is also known as areca nut.
The product or preparation depends on the customs in the country of origin. For example, betel nut products and preparations can be known as 'paan' or 'supari' (India and Pakistan), 'bin lang' (China), 'puwak' (Sri Lanka) and 'buai' or 'daka' (Papua New Guinea)2,3.
Around 10% of the world’s population (600 million people) chew betel nut in some form2. Betel nut is the 4th most widely used psychoactive substance in the world, after nicotine, alcohol and caffeine4 .
Betel nut plays an important role in social customs, religious practices and cultural rituals in the Asia-Pacific region1,2. Betel nut use is common in India, Sri Lanka, Maldives, Bangladesh, Myanmar, Taiwan and several islands in the South Pacific region, including Papua New Guinea. Betel nut is also used in Thailand, Indonesia, Malaysia, Cambodia, Vietnam, Philippines, Laos, China and in the migrant communities from these countries2.
In Australia, betel nut is mostly used amongst those born in the Indian subcontinent and South-East Asia, including refugees.
Betel nut is used for ceremonial and recreational reasons3,5, including social and cultural inclusiveness, improved mood, alertness, as a digestive aid after meals, mouth freshener, as well as for it's pleasant smell and taste6.
Betel nut can be used on its own or as a mixture of various ingredients, known as 'betel quid'. In its most basic form, betel quid consists of betel leaf, betel nut, slaked lime (calcium hydroxide), various spices and is often mixed with tobacco2.
Betel quid may be self-prepared with the ingredients wrapped in the betel leaf, or commercially made with the powdered ingredients packaged in tins or sachets2,7. The quid is placed in the mouth (usually between the gum and cheek) and may be chewed, or remain in contact with the oral mucosa8.
Betel nut has been declared as a group 1 carcinogen to humans8. The active ingredient in betel nut, arecoline, is a Schedule 4 poison9. The number of people presenting with health issues associated with betel nut use is increasing in Australia10.
People migrating from countries where betel nut is traditionally used will often continue this practice10. A high proportion of people migrating to NSW are from countries where the practice is common, including India, China, Philippines, Vietnam, Nepal and Pakistan11.
People who use betel nut products and preparations may be unaware of their harmful effects.5
Use of betel nut products and preparations are linked with a range of short- and long-term health issues.
Use of betel nut is known to cause:
Health professionals can conduct brief interventions with patients who use betel nut. It is recommended that health professionals advise patients:
If the patient also uses tobacco products, it is recommended they are referred to
For dental practitioners, it is also recommended that they screen for signs or symptoms of oral cancer and provide brief advice to patients who use betel nut.
This resource was collaboratively developed with: Australian Centre for Integration of Oral Health (ACIOH); Dental Health Services Victoria; Illawarra Shoalhaven LHD; La Trobe University; Northern Sydney LHD; University of Melbourne; University of Sydney; Western Sydney LHD; Western Sydney University; South Western Sydney LHD.