Of tamul-paan and gutkha

Most oral problems and ailments are preventable. While this is a fact often stated by experts, institutions like the World Health Organisation (WHO) and the US-based Centre for Disease Control and Prevention have been often reiterating this, asking governments and the people to focus on the promotion of good oral hygiene. India in particular faces significant challenges in oral health, with high rates of dental caries and periodontal disease impacting a large portion of the population, particularly in rural and low-income areas. It is common knowledge that consumption of paan, or betel quid, and tobacco are major causes of oral diseases in India. Experts have strongly linked tobacco and paan (including tamul-paan and kwai) to oral cancer, oral submucous fibrosis, and periodontitis. Most people today know that the presence of areca nut and tobacco in paan leads to harmful chemical reactions and oxidative damage to DNA, increasing the risk of precancerous lesions like leukoplakia and eventually progressing to oral cancer. Tobacco use, both smoked and smokeless, significantly increases the risk of oral cancer, with some studies attributing over 80% of oral cancer risk in Indian men and over 90% in women to tobacco and paan. The combination of areca nut and tobacco in paan can trigger the formation of nitrosamines, which are DNA-damaging carcinogens. Paan and tamul-paan often contain slaked lime or calcium hydroxide, which is alkaline and can cause local irritation and inflammation of the oral tissues. The interaction of areca nuts with slaked lime and other components can generate substances which lead to oxidative damage to DNA and increase cancer risk. Experts have been often saying that chewing tamul-paan or using tobacco for prolonged periods can lead to chronic irritation of the oral mucosa, increasing the risk of oral submucous fibrosis, a precancerous condition. Tamul-paan, paan, and tobacco-infused varieties like gutkha and paan-masala have a high consumption rate in Northeast India, with the region showing a disturbing 12% surge in overall tobacco use, including a significant rise in smokeless tobacco (SLT) consumption, which is nearly double the national average. This is a serious matter.