Betel Nut & Teeth

Betel Nut & Teeth
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Betel Nut & TeethClinical Content Reviewed by Dr. Jay Khorsandi, DDS
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Table of Contents

  1. Culturally Ingrained Habit
  2. Betel Nut’s Popularity
  3. Oral Health Damage from Betel Nuts
  4. Dental Treatment for Betel Nut Chewers
  5. Steps Countries & Cultures are Taking to Curb Usage
  6. References

Stained teeth and cavities are results of betel nut addiction. Long term, people who chew betel nut have a higher risk of oral cancer.

Betel nut chewing is a common practice in Southeast Asia. It offers the shock of a stimulant drug and potentially some pain relief, even from toothaches.

Betel Nut: A Culturally Ingrained Habit That Damages Teeth

The betel nut, also called the areca nut, is a seed from the fruit of the areca palm tree, which is common throughout Southeast Asia. Chewing the betel nut releases a stimulant drug that gives a rush of euphoria, or happiness, and stamina, which wears off fairly quickly.

It is increasingly common among people who live in Southeast Asia, or who have immigrated from that region to other countries, to chew betel nut along with a plug of tobacco. While tobacco is a regulated substance in the United States, the betel nut is not, so it is freely imported.

While chewing the areca nut is not as common in the US as smoking tobacco or drinking alcohol, it is a common practice among migrant populations, so it is possible that the dental problems associated with betel nut addiction will become more prevalent. Dental problems are worsened when betel nut is combined with tobacco, which increases the risk of lesions and oral cancers.

The leading reason for chewing betel nuts is the energy boost it produces and is likely from the nut’s natural alkaloids, which release adrenaline.

Betel Nut’s Popularity

The most common sign of betel nut addiction is a stain on the teeth, ranging from reddish-brown to purple to black. Most of the staining comes from the betel nut itself, but adding spices, tobacco, and sweeteners increases potential tooth staining.

About 600 million people worldwide chew betel quids, or nuts, making this the fourth most used psychoactive substance. Tobacco, caffeine, and alcohol are the only three more popular substances.

There may be some pain-relieving effects with betel nut, which is sometimes used in parts of Southeast Asia as an herbal remedy for toothaches. Occasional use may not lead to oral health problems. However, since betel nut is addictive, people who use it are more likely to do so consistently, greatly increasing their risk of stained teeth and oral cancers.

What Oral Health Damage From Betel Nut Looks Like

Harm associated with chewing betel nut, with or without tobacco, includes:

  • Stained teeth, which damages overall appearance.
  • Damaged teeth, with more cavities, cracks, or chips.
  • Teeth coming loose and falling out.
  • Precancerous lesions or wounds in the mouth, which may look like red or white patches in the throat, cheeks, gums, or tongue.
  • Oral cancer of the lip, tongue, pharynx, or mouth.
  • Oral cancer of the esophagus (throat).
  • Stomach cancer.

A medical study published in 2008 surveyed 1,000 participants (994 people responded to surveys), ranging in age from 30 to 50 years old. About 32 percent of respondents had a higher risk of oral health problems, especially cavities and bleeding from the gums due to damage or gingivitis.

While the study found that brushing teeth at least once per day improved oral health and reduced the risk of cavities in betel nut chewers, their perception of their oral health was no different regardless of oral hygiene routine. About 80 percent of the survey respondents did not regularly visit a dentist. Everyone who participated reported that they knew betel nut chewing could damage their oral health, along with smoking and eating sweets.

Dental Treatment Is Important for Betel Nut Chewers

Health campaigns across Southeast Asian countries have attempted to stop or reduce betel nut chewing for decades, similar to the public health advertisements against smoking in the US. It is difficult to know whether these campaigns have an effect, as betel nut chewing is ingrained in many cultures in that area and has been for thousands of years.

As more health studies about the betel nut are published, and more health officials speak out against chewing this drug, rates of betel nut chewing may begin to decline. Improving access to dental care can also help to reduce the risk of harm from betel nut chewing.

Steps Countries & Cultures are Taking to Curb Usage

The popularity and longevity of betel nut chewing in southeastern Asia complicates intervention methods. However, the sheer volume of health problems associated with this psychoactive substance has caused governments to step up and try to stop people from using it as frequently.

There are four main methods used to try and control betel nut usage:

Government Agencies Partnerships

In Taiwan, there is a fine if you spit betel nut juice in the capital of Taipei, and offenders are also required to attend withdrawal classes. In addition, local farmers are given an incentive to change out their crops from producing betel nuts to instead plant mango, citrus fruits, or tea, CNN reports.

In Papua New Guinea, police set up roadblocks and fine individuals caught chewing the betel nut. In Myanmar, the government has mandated that betel nut cannot be chewed during office hours by government employees. There is also a campaign in place to have betel nut vendors removed from public spaces.

Public Awareness and Educational Campaigns

These campaigns include warnings on betel nut packaging; betel nut and smoking cessation services in communities, workplaces, and hospitals; and educational materials in schools, communities, and accessible to high-risk groups.

A study on an educational program performed in primary and secondary schools in Papua New Guinea showing the dangers of betel nut use was highly effective in helping students to recognize its hazards and quit using it.

Organized Oral Cancer Screenings

In Taiwan, the government is providing screening programs to detect oral cancer and funding efforts to help people quit betel nut chewing, BBC News reports.

As betel nut chewing is such a large risk factor for oral cancers, screening programs can help to detect the disease early and support individuals to quit betel nut. Treating the cancer early makes for better long-term outcomes.

Betel Nut-free Support in High-risk Environments

Betel nut chewing is common in low-income neighborhoods. Setting up campaigns and support systems to educate on the risks, and supporting individuals to quit and remain free from betel quid in these environments directly, can impact the overall public health concern by lowering the number of people chewing betel nut. Organizations and communities that support a betel nut-free environment are vital for prevention and intervention.

Chewing betel nut is often an ingrained aspect of many cultures. It is a learned behavior, and it is socially viewed as a positive thing. Studies of ex-chewers show that they were unaware that betel nut chewing had negative health effects.

Changing public perception about betel nut use is essential. Public education efforts on the hazardous and potentially life-threatening risk factors associated with betel nut chewing can potentially help to reshape this cultural belief of positivity surrounding the betel nut.


Betel Nut. (June 2021). Alcohol and Drug Foundation. Date fetched: June 7, 2021.

Police Warn of Ohio Teens Getting High Off Exotic Nut. (March 2017). Cleveland 19 News. Date fetched: June 7, 2021.

The Facts About Betel Nut and Tobacco. (April 2014). Department of Health, Vermont. Date fetched: June 7, 2021.

Influence of Betel Nut Chewing, Dental Care Habits and Attitudes on Perceived Oral Health Among Adult Pakistanis. (2008). Oral Health and Preventative Dentistry.

Prioritizing Research and Policy Interventions to Prevent Oral Cancers: Targeting the Betel Quid and Areca Nut Users. (October 2018). World Cancer Congress.

Hard Times for ‘Betel Nut Beauties’ as Taiwan Tries to Kick Deadly Addiction. (September 2016). CNN.

The Effectiveness of School Educating Program for Betel Quid Chewing: A Pilot Study in Papua New Guinea. (April 2018). Journal of the Chinese Medical Association.

Asia’s Deadly Secret: The Scourge of the Betel Nut. (March 2015). BBC News.

Sociocultural Factors That Affect Chewing Behaviors Among Betel Nut Chewers and Ex-Chewers on Guam. (December 2015). Hawaii Journal of Medicine & Public Health: A Journal of Asia Pacific Medicine & Public Health.

Disclaimer: This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to serve as dental or other professional health advice and is not intended to be used for diagnosis or treatment of any condition or symptom. You should consult a dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.