Areca Nut Chewing Habits Research Articles

Assessment of tissue copper level in oral submucous fibrosis patients

Background: Oral submucous fibrosis (OSMF) is a precancerous condition with a high risk (7.6%) of cancer development. It is caused by use of areca nut in various forms. Areca nut contains high level of copper as compared to other commonly eaten nuts. Copper acts as cofactor of lysyl oxidase (LOX) that controls maturation of collagen. Aims: The aim of the study is to estimate tissue copper level in OSMF patients with habit of areca nut chewing and to correlate any change in tissue copper level with histopathological grading of OSMF. Materials and Methods: A hospital based case-control study was done on 30 subjects visiting out-patient department (OPD) of Kothiwal Dental College Moradabad, of which 15 were clinically diagnosed OSMF cases with habit of areca nut chewing and 15 were taken as controls with no habit of areca nut chewing. Tissue copper levels were measured by Atomic Absorption Spectrophotometer (AAS). Results : The study showed highly significant difference in mean tissue copper level (P P Conclusions : The present study confirms the hypothesis that copper level in increased in areca nut chewers presenting OSMF. Moreover, copper level increased with increased in histopathological grade of OSMF.

Plasma fibrinogen degradation products in oral submucous fibrosis.

Context:Plasma fibrinogen degradation products (FDPs) and oral submucous fibrosis (OSMF).Background:OSMF is a chronic, progressive, scarring disease of multifactorial etiology. Areca nut is found to be the main cause of this disease. But it has been found in the routine clinical practice that some individuals with the habit of areca nut chewing may not show any clinical evidence of OSMF, while some individuals without the habit of areca nut chewing are found to have OSMF. So, there must be some other factors associated with OSMF. Recently, plasma FDPs have been identified as an early indicator of disease in OSMF patients. A systematic review of their role would help to elucidate whether there is an association of these FDPs in the pathogenesis of OSMF or not.Objective:To review studies reported in the literature elucidating the role of these plasma FDPs in OSMF.Materials and Methods:Articles were searched in PubMed; MEDLINE using appropriate key words like “plasma fibrinogen degradation products” and “oral submucous fibrosis.” Hand search of journals was also performed. Articles were reviewed and analyzed.Results:The search strategy revealed nine relevant articles which studied the role of these plasma FDPs in the etiopathogenesis of OSMF and further progression of this disease with the increased clinical grades and the risk of carcinoma, but the exact role of these factors is still obscure.Conclusion:The data validate the role of plasma FDPs in the etiopathogenesis of OSMF. Studies with a large sample size are still required to evaluate the definite association between these FDPs and OSMF. It has the advantage of being a noninvasive method to evaluate the stage of OSMF patients, instead of using the invasive techniques like biopsy.

A Comprehensive Review of Etiopathogenesis of Oral Submucous Fibrosis

ABSTRACTAccepted as an Indian disease, oral submucous fibrosis, is considered not only a chronic debilitating disease but a poten tially malignant condition of oral cavity, strongly associated with the habit of betel nut chewing, that has been sporadically detected in many other western countries and various conti nents, posing a reason for concern in order to create awareness for such debilitating disease. This article provides an overview of the recent concepts and exact role of areca nut alkaloids and other etiological factors in the pathogenesis of oral submucous fibrosis (OSMF).How to cite this articleKalra SK, Lathi AA, Lathi SA. A Com prehensive Review of Etiopathogenesis of Oral Submucous Fibrosis. Int J Head Neck Surg 2015;6(2):76-79.

Neoadjuvant chemotherapy: role in locoregionally advanced oral cancers

Background: Oral cancers are the most predominant cancers in our region due to the habit of betel nut chewing. The treatment protocols available have not given satisfactory results. Neoadjuvant chemotherapy has been tried out successfully in other cancers like cancer of larynx. Objectives: Our study aimed to assess the response of neoadjuvant chemotherapy in locally advanced oral cancer. Materials and Methods: A total of 40 patients were taken up for the study; 20 patients each in both study and the control groups. In the study group, patients were subjected to three cycles of neoadjuvant chemotherapy (cisplatin and 5-fluorouracil) after doing relevant investigations, later evaluated for resectability, and later taken up for surgery or radiotherapy depending on the response. In the control arm, all the patients were directly taken up for surgery. Results: The results showed that among the 20 patients who underwent neoadjuvant chemotherapy no one had complete response, 55% had partial response, 35% had stable disease, and 2 had progressive disease and were advised palliative radiotherapy only. Two patients in study arm were lost for follow-up. The remaining 16 patients in study arm and all 20 patients in control arm were taken up for surgery. The specimens were assessed histopathologically for positive margins. Almost equal incidence of positive margins was found in both arms. The patients were followed up for 2 years after surgery. The results showed marginally better disease-free survival in stage III disease patients who underwent neoadjuvant chemotherapy followed by surgery compared to those who had direct surgery; however, no major difference in patient with stage IVA disease was seen. Conclusion: Neoadjuvant chemotherapy in locally advanced oral cancers delays the progression of disease and gives partial response macroscopically. There was no significant improvement in locoregional control, disease-free survival, and overall survival of the patients.

Salivary estimation of copper, iron, zinc and manganese in oral submucous fibrosis patients: A case-control study

Background: Trace elements (TEs) are required for physiological functioning and alterations are noted in potentially malignant disorders and oral cancer. These TEs are used in early diagnosis, treatment and also as an indicator of disease progress and prognosis. Aims: To estimate the TEs such as copper (Cu), zinc (Zn), iron (Fe), manganese (Mn) and Cu/Zn ratio in the saliva of oral submucous fibrosis (OSF) patients and controls. Settings and Design: The hospital-based study was conducted to estimate salivary TEs using atomic absorption spectrometry (AAS) in 60 individuals. Methods and Material: 5 ml saliva was collected from OSF cases (n=30) and controls (n=30) and was centrifuged and prepared by using the Wet Ashing method. The TEs were estimated in parts per million (ppm) by using AAS. Statistical Analysis Used: The data obtained was statistically analyzed using non parametric tests such as Mann Whitney U and Kruskal Wallis tests. Results: Significant difference in the mean salivary Zn, Mn and Fe levels in OSF when compared to that of controls. Mean salivary Cu levels were increased and Cu/ Zn ratio was decreased in OSF when compared to the controls. Conclusions: To conclude TEs play a role in the pathogenesis and progression of OSF. Betel quid and areca nut chewing habits are frequently associated with OSF and alters the salivary TE levels. Concerted efforts would, therefore, help in early detection, management and monitoring the efficacy of treatment.

Areca Nut Chewing Habit in Preschoolers: Two Rare Case Reports and Literature Review

Areca Nut Chewing Habit in Preschoolers: Two Rare Case Reports and Literature Review

Sex-Differences of Low to Moderate Leisure-Time Physical Activity on Metabolic Risk Factors in Type 2 Diabetes Mellitus Patients

Background: Exercise is an integral part of the diabetes management and prevention. However, it is hard to maintain and to reach current recommendation due to the unavoidable aging process. This cross-sectional study investigates our type 2 diabetes patients participating in our DM education program from January to December 2011 to find out if low to moderate physical activity could have benefits and to investigate if there were sex- differences of benefits. Results: In 3240 type 2 DM patients, 53.7% had Leisure Time Physical Activity (LTPA) but only 24.7% had adequate LTPA. Those who had adequate physical activity had lower BMI, longer DM duration (10.4 ± 7.6 vs 8.4 ± 6.8 years). Significantly less smoking, betel-nut chewing and alcohol drinking habits in male adequate LTPA group was found. The benefits of exercise in male subjects includes lower hemoglobulin A1C (7.4 ± 1.4 vs 7.9 ± 1.8%), lower diastolic blood pressure (80.0 ± 11.6 vs 82.9 ± 12.2 mmHg), triglyceride (136.8 ± 89.0 vs 152.3 ± 114.0), GPT (34.8 ± 29.0 vs 39.8 ± 37.3), Creatinine (1.20 ± 0.45 vs 1.28 ± 0.94). The benefit of exercise in female is lower GPT only (30.6 ± 27.5 vs 34.4 ± 31.2). The difference might be a result of less exercise intensity and volume in female subjects. The mean METs are 3.4 ± 1.1 in male and 3.1± 1.0 in female, P= 0.000, MET min/ week are 1303.7 ± 792.4 (38.5) in male group, 1188.6 ± 757.7 (39.01) in female group respectively, p=0.036. Correlation analysis showed exercise volume is the determinant of better glycemic control. Conclusion: Adequate low to moderate LTPA appears to help the achievement of metabolic risks reduction in male subjects only, who also demonstrated a healthier lifestyle. Exercise intensity and volume were higher in male subjects too. To enhance metabolic benefits from low intensity LTPA, increase of exercise volume is probably needed.

Oral Screening for Pre-cancerous Lesions Among Areca-nut Chewing Population from Rural India.

To detect early oral premalignant lesions (OPLs) in a rural population chewing tobacco-free areca nut preparations, determine their awareness level of oral cancer and educate them about maintaining good oral health. A total of 2175 18- to 65-year-old areca nut chewers (male:female ratio 2.5:1), without a history of consuming tobacco in any form, from the villages of two districts of the West Bengal state of India were screened clinically through oral examination for suspected OPLs. A pre-designed questionnaire was employed to record demographic data, information on tobacco-free areca-nut chewing habit and knowledge about oral diseases. Education on oral health was provided through distribution of printed leaflets, display of banner/posters and a public-announcement system. Chewing areca nut in the form of betel quid was more popular (90.7%) than chewing areca nut alone (9%) or tobacco-free packaged areca nut preparation sold as 'pan masala' (0.3%). OPLs were detected in 7.3% of the subjects, more among the males. An increasing incidence of OPLs could be observed with an increase in age as well as with duration and frequency of areca-nut chewing, while decreasing incidence was observed with an increase in educational level. Oral submucous fibrosis showed the highest prevalence (2.7%) among the various OPLs detected. Tobacco-free areca-nut chewing is an independent risk factor for the development of OPL and a large rural population still practices such high risk behaviour. In rural areas with limited health care resources, screening by visual oral examination involving minimum cost may prove useful to reduce oral cancer mortality.

Short-term exposure of zebrafish embryos to arecoline leads to retarded growth, motor impairment, and somite muscle fiber changes.

The areca nut-chewing habit is common in Southeast Asia, India, and Taiwan, and arecoline is the most abundant and potent component in the areca nut. The effects of arecoline on birth defects have been explored in many species, including chicken, mice, and zebrafish. The effects of arecoline on embryos after long-term exposure are well established; however, the effects of short-term embryo exposure to arecoline are not understood. Using zebrafish, we study the effects of short-term exposure of arecoline on embryos to model the human habit of areca nut-chewing during early pregnancy. Arecoline, at concentrations from 0.001% to 0.04%, was administered to zebrafish embryos from 4 to 24 hours post fertilization. The morphological changes, survival rates, body length, and skeletal muscle fiber structure were then investigated by immunohistochemistry, confocal microscopy, and conventional electron microscopy. With exposure of embryos to increasing arecoline concentrations, we observed a significant decline in the hatching and survival rates, general growth retardation, lower locomotor activity, and swimming ability impairment. Immunofluorescent staining demonstrated a loose arrangement of myosin heavy chains, and ultrastructural observations revealed altered myofibril arrangement and swelling of the mitochondria. In addition, the results of flow-cytometry and JC-1 staining to assay mitochondria activity, as well as reverse transcription-polymerase chain reaction analyses of functional gene expression, revealed mitochondrial dysfunctions after exposure to arecoline. We confirmed that short-term arecoline exposure resulted in retarded embryonic development and decreased locomotor activity due to defective somitic skeletal muscle development and mitochondrial dysfunction.

CD44 Gene Polymorphisms and Environmental Factors on Oral Cancer Susceptibility in Taiwan

BackgroundOral squamous cell carcinoma (OSCC) is the fourth leading cause of male cancer death in Taiwan. Exposure to environmental carcinogens is the primary risk factor for developing OSCC. CD44, a well-known tumor marker, plays a crucial role in tumor cell differentiation, invasion, and metastasis. This study investigated CD44 single-nucleotide polymorphisms (SNPs) with environmental risk factors to determine OSCC susceptibility and clinicopathological characteristics.Methodology/Principal FindingsReal-time polymerase chain reaction (PCR) was used to analyze 6 SNPs of CD44 in 599 patients with oral cancer and 561 cancer-free controls. We determined that the CD44 rs187115 polymorphism carriers with the genotype AG, GG, or AG+GG were associated with oral cancer susceptibility. Among 731 smokers, CD44 polymorphisms carriers with the betel-nut chewing habit had a 10.30–37.63-fold greater risk of having oral cancer compared to CD44 wild-type (WT) carriers without the betel-nut chewing habit. Among 552 betel-nut chewers, CD44 polymorphisms carriers who smoked had a 4.23–16.11-fold greater risk of having oral cancer compared to those who carried the WT but did not smoke. Finally, we also observed that the stage III and IV oral cancer patients had higher frequencies of CD44 rs187115 polymorphisms with the variant genotype (AG+GG) compared with the wild-type (WT) carriers.ConclusionOur results suggest that gene–environment interactions between the CD44 polymorphisms and betel quid chewing and tobacco smoking increase the susceptibility to oral cancer development. Patients with CD44 rs187115 variant genotypes (AG+GG) were correlated with a higher risk of oral cancer development, and these patients may possess greater chemoresistance to advanced- to late-stage oral cancer than WT carriers do. The CD44 rs187115 polymorphism has potential predictive significance in oral carcinogenesis and also may be applied as factors to predict the clinical stage in OSCC patients.

Panax notoginseng saponins inhibit areca nut extract‐induced oral submucous fibrosis in vitro

Oral submucous fibrosis (OSF) is a premalignant and fibrosing disease, which is closely associated with the habit of chewing areca nut. Panax notoginseng Buck F. H. Chen is an often used antifibrotic and antitumor agent. To treat areca nut-induced OSF, we have developed a chewable tablet, in which one of the major medicines is total Panax notoginseng saponins (PNS). In this study, we have investigated the antifibrotic effect and mechanism of PNS on areca nut-induced OSF in vitro. Through human procollagen gene promoter luciferase reporter plasmid, hydroxyproline assay, gelatin zymography, qRT-PCR, ELISA, and Western blot, the influences of PNS on areca nut extract (ANE)-induced cell growth, collagen accumulation, procollagen gene transcription, MMP-2/-9 activity, MMP-1/-13 and TIMP-1/-2 expression, cytokine secretion, and the activation of PI3K/AKT, ERK/JNK/p38 MAPK, and TGFβ/Smads pathways were detected. Panax notoginseng saponins could inhibit the ANE-induced abnormal growth and collagen accumulation of oral mucosal fibroblasts in a concentration-dependent manner. PNS (25 μg/ml) could significantly inhibit the ANE-induced expression of Col1A1 and Col3A1, augment the ANE-induced decrease of MMP-2/-9 activity, inhibit the ANE-induced increase of TIMP-1/-2 expression, and decrease the ANE-induced transcription and release of CTGF, TGFβ1, IL-6, and TNFα. PNS (25 μg/ml) also significantly inhibited the ANE-induced activation of AKT and ERK/JNK/p38 MAPK pathways in oral mucosal fibroblasts and the ANE-induced activation of TGFβ/smad pathway in HaCaT cells. Panax notoginseng saponins possess excellent anti-OSF activity, and its mechanism may be related to its ability to inhibit the ANE-induced activation of PI3K/AKT, ERK/JNK/p38 MAPK, and TGFβ/smad pathways.

Quantification of Plasma Fibrinogen Degradation Products in Areca Nut Chewers with and without Oral Submucous Fibrosis.

Fibrinogen degradation products (FDPs) are the products that are released from fibrin/fibrinogen. Recently, it has been observed that these FDPs have been identified in the plasma of OSMF patients. Areca nut being the major aetiological agent for OSMF may play a role in the increased plasma levels of FDPs in OSMF. The aim of this study was to quantify the plasma FDPs levels in the individuals with the habit of areca nut chewing with and without OSMF. Total of 95 subjects were included,35 subjects with the habit of areca nut chewing with OSMF, 30 with the habit of areca nut chewing without OSMF, 30 without any habit of areca nut chewing without OSMF (control group). Five ml of venous blood was withdrawn from all the subjects and plasma FDP levels were estimated. Plasma FDPs were detected in all the subjects of OSMF but could not be detected in other two groups. As the clinical grades of OSMF increased, levels of plasma FDPs also increased. When plasma FDP increases, fibrin deposition also increases. This strengthens the finding that these FDPs may be an early indicator of the OSMF.

Transforming growth factor β2 (TGF-β2) in pathogenesis of oral submucous fibrosis: An immunohistochemical study

Background and Objectives: Oral Submucous Fibrosis (OSF) is a potentially malignant oral disorder causing fibrosis of the oral mucosa. Commonly associated with the habit of chewing areca nut in its raw or refined forms, the progressive fibrosis causes intense debility and probable malignant transformation. Arecoline, flavinoids and tannins in the areca nut may activate pro-fibrotic cytokines like transforming growth factor beta (TGF-β) leading to fibrosis. TGF-β and its isoforms probably represent the major pathway in the deposition of collagen fibers in this condition. Very little is known of the role of TGF-β2, as compared withTGF-β1, in OSF. The present study aims to evaluate TGF-β2 immunohistochemically in OSF with a view to understanding its role in the pathogenesis. Materials and Methods: TGF-β2 antibody was detected immunohistochemically on archival paraffin sections of 70 cases of various grades of OSF, 10 cases of normal oral mucosa and five cases of scar tissue. The presence and distribution of the antibody was noted and a quantification of the positive areas was also done using image analyses software and correlated in proportion to the rest of the tissue. Results: Expression of TGF-β2 was more in all grades of OSF when compared with that of normal oral mucosa but less than that expressed in scar tissue. The antibody was detected in epithelium, around the blood vessels, in areas of inflammatory infiltrate, fibroblasts and in muscles. The intensity and proportion of expression paralleled increasing grades of OSF. There was increased expression of the antibody in the epithelium, which is probably the source, but no correlation to epithelial changes (hyperplasia, atrophy or dysplasia) was noted. Conclusion: TGF-β2 is a prominent cytokine in the TGF-β induced pathway of fibrosis but probably plays a contributory role to the main isoform TGF-β1. Its role as a marker of malignant transformation, as seen in other systemic malignant lesions, remains inconclusive in OSF.

Quantitative analysis of serum levels of trace elements in patients with oral submucous fibrosis and oral squamous cell carcinoma: A randomized cross-sectional study.

Background and Objectives:Metabolic disorders, oral precancerous conditions and oral cancer are accompanied by alterations in the concentration of one or more trace elements like copper, iron, zinc, magnesium etc., in some body fluids, especially blood serum or plasma, which can help not only in the early diagnosis and treatment but also in prognosis. The objective of the study is to evaluate the levels of circulating trace elements (copper, iron, magnesium, zinc and calcium) in serum of patients with Oral Submucous Fibrosis (OSF) and Oral Squamous Cell Carcinoma (OSCC), to analyze the alteration and identify the best predictors amongst these parameters for disease occurrence and progression and their association with areca nut and betel quid chewing habits.Materials and Method:Serum levels of trace elements (copper, iron, magnesium, zinc and calcium) were estimated using electronic absorption colorimetric method. These levels were compared with controls and statistically evaluated using ANOVA and POST-HOC TUKEY tests.Results:The data analysis revealed that serum copper levels increased gradually from precancer to cancer, as the duration of betel quid chewing habit increased. However, serum iron, magnesium, zinc levels were decreased significantly in both the groups. Serum calcium levels were increased in the cancer group owing to bone resorption in the later stages of the disease, whereas it was close to normal in OSF patients. Among all the trace elements, the best predictor for occurrence of both the lesions was copper.Conclusion:The present study shows that the above trace elements may be associated with the pathogenesis and progression of OSF and OSCC. Betel quid and areca nut chewing habits are frequently associated with both disease states and may play a role in altering the serum levels of these trace elements. Concerted efforts would, therefore, help in early detection, management and monitoring the efficacy of treatment.

Combined Effects of ICAM-1 Single-Nucleotide Polymorphisms and Environmental Carcinogens on Oral Cancer Susceptibility and Clinicopathologic Development

BackgroundIn Taiwan, oral cancer has causally been associated with environmental carcinogens. Intercellular adhesion molecule (ICAM)-1, a cell adhesion molecule with a key role in inflammation and immunosurveillance, was implicated in carcinogenesis by facilitating instability in the tumor environment. The current study explored the combined effect of ICAM-1 gene polymorphisms and exposure to environmental carcinogens on the susceptibility of developing oral squamous cell carcinoma (OSCC) and the clinicopathological characteristics of the tumors.Methodology and Principal FindingsFour single-nucleotide polymorphisms (SNPs) of the ICAM-1 gene from 595 patients with oral cancer and 561 non-cancer controls were analyzed by a real-time PCR. We found that the ICAM-1 rs5498 polymorphism and the TAGG or TACG haplotype of 4 ICAM-1 SNPs (rs3093030, rs5491, rs281432, and rs5498) combined were associated with oral-cancer susceptibility. Among 727 smokers, ICAM-1 polymorphisms carriers with the betel-nut chewing habit had a 27.49–36.23-fold greater risk of having oral cancer compared to ICAM-1 wild-type (WT) carriers without the betel-nut chewing habit. Among 549 betel-nut chewers, ICAM-1 polymorphisms carriers who smoked had a 9.93–14.27-fold greater risk of having oral cancer compared to those who carried the WT but did not smoke. Finally, patients with oral cancer who had at least 1 T allele of ICAM-1 rs5491 or 1 G allele of rs281432 were at lower risk of developing an advanced clinical stage (III/IV) (p<0.05), compared to those patients with AA or CC homozygotes.ConclusionsOur results suggest that the ICAM-1 rs5498 SNP and either of 2 haplotypes of 4 SNPs combined have potential predictive significance in oral carcinogenesis. Gene-environment interactions of ICAM-1 polymorphisms, smoking, and betel-nut chewing might alter oral-cancer susceptibility. ICAM-1 rs5491 and rs281432 may be applied as factors to predict the clinical stage in OSCC patients.

Awareness of Dental Health Checkup omong the Patients Attending at Selected Hospital in Dhaka City

This descriptive type of cross sectional study was conducted in selected hospital of Dhaka in order to find out the awareness of dental health check up among the patient in selected hospital in Dhaka city. The study was conducted from September to December 2011 with sample of 150. Results revealed that there is a huge difference between the awareness and practice on oral hygiene. The study showed that most of the respondents are in between 30-39 years of age (39.3%), 22.7% in 20-29 years of age, only very few 0.7% in &gt; 70 years of age with mean age 35.75 + 12.03. Among the respondents 34.7% are housewife, service holder 28%, business 15.3% and others are 22%. Study also showed that 65.3% brushes their teeth once daily and 34.7% in twice daily, 52% brushes only before breakfast, 18.7% before breakfast and before go to bed, 15.3% after breakfast and before go to bed, 12% only after breakfast and rest 2% only before go to bed. Among the respondents 38% visit to dentist more than 1 years for cleaning purpose, 28.7% visit after 1 year, 23.3% visit within 6 months to 1 year and very few only 10% visit before 6 months. Most of the respondent about 66% knows that consumption of sweet food can cause caries and rest 34% have no idea. About 40% feels the necessity of visiting dental surgeon after 1 year, 28% feels the time is after 6 months, 17.3% feels that more than 1 year and 14.1% have no idea. There is statistically highly significant association between the age of the respondent and the material used for cleaning teeth , sex of the respondent and habit of taking tobacco in both association (P = 0.000). Another statistically highly significant association between occupation of the respondent and habit of taking tobacco and also between age of the patient and habit of chewing areca nut and lime (P = 0.000), between frequency of cleaning teeth and monthly income of the respondent (P = 0.050). Another statistically significant association between age of the respondent and knowledge about sweet food can cause dental caries where (P = 0.023). and between monthly income of the respondent and knowledge about sweet food can cause dental caries (P = 0.013). From the study results it is revealed that only 30-39 years old patients aware about dental health check up, most of patient brushes their teeth only before breakfast, visit to dental surgeon visit to dentist more than 1 years for cleaning purpose, and feels the necessity of visiting dental surgeon after 1 year, So, it is necessary for everyone to attain dental health checkups to look at the health of mouth, find existing problems and discuss planned treatments. It helps to take further steps to minimize future problems of the oral cavity.DOI: http://doi.dx.org/10.3329/bjdre.v2i2.16244 Bangladesh Journal of Dental Research &amp; Education Vol.2(2) 2012: 47-51

Sweetened areca-nut chewing habit: A public health issue among school children of Indore, India

Chewing of the areca-nut usually starts early in life leading to a multitude of problems in adulthood. The areca-nut can be correlated with an increased incidence of cancer. Like tobacco, chewing the areca-nut also leads to oral and oro-pharyngeal cancers. The areca-nut is usually marketed in the form of a sweetened areca-nut (locally known as sweet supari) to target young children. A high proportion of school children use areca-nut daily in some form. This study was conducted to determine the prevalence of sweetened areca-nut use and assess the awareness of health risks among school students of Indore, India. Till date none of the studies have pointed out the prevalence of sweet-ened areca use. Population based studies on the habit of areca-nut chewing among children from the district of Indore, Central India have not been reported earlier in the studies. In our study we found 81% of the children used the sweetened form of the areca-nut. Fifty five percent of areca-nut users reported that they learnt the habit from their friends or siblings. The majority of the users (70.4%) were unaware of the harmful effects of areca-nut use, and only a few were aware that it may cause cancer or oral submucous fibrosis. Government school children are more involved in areca-nut chewing habit. Boys were more indulged than girls. Actively communicating the areca-nut’s health risks to the public, and creating strategies involving parents, teachers and local communities could be initiated to discourage areca-nut use. DOI: http://dx.doi.org/10.3329/seajph.v2i2.15959 South East Asia J Public Health | Jul-Dec 2012 | Vol 2 Issue 2 | 73-76

Association between betel nut consumption and folate deficiency among pregnant women in rural Bangladesh

Background: Betel nut (BN) or areca nut (AN) chewing habits on its own or with other ingredients including chewing tobacco are highly prevalent in many South East Asian countries as well as among the migrants from these countries residing around the world. The major alkaloid arecoline in the BN has been found to carcinogenic and to be associated with a range of health risks, including negative effects on pregnancy outcomes. Pregnancy imposes stress on folate stores because of increased requirements for growth of maternal tissues, fetus, and placenta. Folate deficiency during pregnancy is a major public health concern as is associated with many adverse health outcomes including neural tube defects, low birth weight, preterm birth, and delayed maturation of the nervous system, growth retardation, and megaloblastic anemia. Objective: To investigate any association between BN consumption and folate status among pregnant women in rural Bangladesh. Materials and Methods: Data of 730 pregnant women aged 14-50 years from the Maternal and Infant Nutrition Intervention in Matlab (MINIMat) trial in Bangladesh were included in this study. Logistic regression analysis and analyses of covariance (ANCOVA) were used. Results were adjusted for potential confounders. Results and Interpretation: Two-third (63%) of the women consumed BN and 17% had folate deficiency. The women who consumed BN combined with chewing tobacco were 2.57 times more likely to have folate deficiency (OR = 2.57; 95% CI = 1.23-5.36; P = 0.012;) and the women who consumed BN 2-3 times/day were 2.51 times more likely to develop folate deficiency among users (OR = 2.51; 95% CI = 1.07-5.92; P = 0.035). Mean serum folate levels were significantly lower among BN users as compared to nonusers. Conclusion: The results suggest that betel nut consumption combined with chewing tobacco is associated with lower serum folate level and folate deficiency among pregnant women in rural Bangladesh. Strategies are needed for prevention and control of betel nut consumption in order to prevent adverse health outcomes.

Atherogenic effect of Arecoline: A computational study.

There are over 600 million people worldwide covering Asian and Oceanic countries including India have the habit of chewing areca nut as masticator in different forms. Arecoline (C8H13NO2) has been reported as one of the abundant constituents of areca nut. A good number of scientific publications have made Arecoline responsible for oral cancer. Based on observation from clinical situation in North East India, one of the most betel quid chewing region of the country, we suspected a link between consumption of areca nut and Cerebro Vascular Disease like stroke. Therefore, we considered Low Density Lipoprotein (LDL) receptor as target and Arecoline as ligand and studied ligand –target interaction using computational tools. Also we considered High Density Lipoprotein (HDL) receptor as another target to see if Arecoline has any binding potential with it over and above LDL receptor. Docking result indicated that Arecoline and Cholesterol both, have affinity towards extracellular domain of Human LDL receptor but affinity of Arecoline is much higher (-12.3560.) than that of Cholesterol(-0.1810). Docking of Arecoline and 1, 2-Hexyl-1- cyclopentanone thiosemicarbazone (thiosemicarbazone) with Bovine HDL receptor showed that Arecoline also has the potential (Score, -6.2690Kcal/Mol) to block HDL receptor though its potential is less than that (score, -10.0509 Kcal/Mol) of control (thiosemicarbazone). We, therefore, suggest that by inhibiting endocytosis of LDL cholesterol because of blocking LDL receptor function and also by preventing LDL cholesterol uptake by liver from blood because of interference with HDL receptor, Arecoline may contribute to atherosclerosis. The study therefore, indicates a positive correlation between chewing of betel quid and Cerebro Vascular Disease.

Status kebersihan gigi dan mulut Suku Papua pengunyah pinang di Manado Oral and dental hygiene status of Papua’s Areca nut chewer

Areca nut chewing habits is one of the greatest threats to oral health today. It is estimated that 600 million peoplehave areca nut chewing habit, including Papua ethnic group. The purpose of this study was to evaluate the oralhygiene status of Papua ethnic group who have areca nut chewing habits living in at Manado. The study is adescriptive cross sectional type using survey technique. Thirty respondents, males and females aged between 18 to40 years old were collected as purposive sample. Clinical data of oral hygiene status was assesed by OHI-S IndexGreene and Vermillion, including debris and calculus score. Results indicated that oral hygiene score (OHI-S)is2.32. The conclusion of this study is the oral hygiene status of Papua’s areca nut chewers living in at Manado, ismedium category.