The menace of betel nut and gutka: An oral health survey of school children to assess prevalence of oral lesions in chewers versus non-chewers

Betel nut (BN) also referred to as Chalia/ Supari has been used for thousands of years. BN chewing is an important and popular cultural activity in India, Bangladesh and Pakistan (the subcontinent). The use of BN is common in the rural and urban areas of Pakistan. In several studies, an association between BN chewing and oral health problems including oral sub mucous fibrosis, leukoplakia, erythroplakia, mouth blisters and traumatic ulcers has been identified. These lesions are reported in children and adolescents. This is of great concern not only because of the high cost involved in their management but the morbidity and mortality associated with it. Low cost, easy availability, advertising, role modeling, social acceptance and perception of BN as harmless, contribute to its use. The aim of this cross-sectional study in Central District of Karachi (CDK) was to assess the prevalence of oral soft tissue lesions and to investigate associations which may exist between oral conditions and BN chewing among the young school going children. Three hundred and sixty students from 17 different schools participated in the study. The mean age was 13.86 ±1.2 years with the age range of 12 to 16 years. Out of these 360 students, 175 were females and 185 were males. The results showed a high prevalence of the pre-cancerous lesion, oral submucous fibrosis among BN chewers (BNC) compared to non-chewers (NBNC) (19% and 3% respectively). The high prevalence of BN chewing (59% of the low socio-economic young population studied) should be addressed at local and government level through support for effective preventive programs and health promotion campaigns. Promotion of oral health and eradication of BN chewing are important goals for the prevention of oral cancer among this population.