BETEL QUID (PAAN) CHEWING AND ORAL EPITHELIAL DYSPLASIA IN LAHORE: AN ANALYTICAL STUDY

Abstract

<h3>Background</h3> Betel quid (locally–called "paan") is widely chewed habitually in Pakistan and South and Southeast Asia. It is hand-rolled at paan stalls by smearing a betel leaf (from Piper betel) with slaked lime, catech paste, chopped areca nut, and a variety of condiments and flavoring agents. Paan is considered a group 1 carcinogen for humans by the International Association for Research on Cancer. It is one of the major causes of oral cancer in these regions. The reactive oxygen species released during chewing can initiate carcinogenesis by inducing mutagenesis. <h3>Objective</h3> The present study was performed to determine the frequency of epithelial dysplasia among habitual paan chewers. It also calculated the association between the quantity and quality of paan chewing and the severity of oral epithelial dysplasia. <h3>Methods</h3> This was a cross-sectional analytical study. Cytological smears from 300 habitual paan chewers were collected. After fixation with alcohol, smears were then air dried and stained with hematoxylin, eosin, Giemsa, and Pap stains. The material was then examined under an optical microscope. Epithelial dysplasia was identified and graded using the method of Speight. <h3>Results</h3> Epithelial dysplasia was observed in 57.7% of the habitual paan chewers, which was significantly associated with the number of paans consumed per day as well as duration of paan consumption. These variables were positively correlated with grading of epithelial dysplasia. <h3>Conclusions</h3> The study concludes that epithelial dysplasia was present in the majority of habitual paan chewers in Lahore city. The correlation between the amount of betel quid chewing and the severity of epithelial dysplasia means the effect is dose-dependent.