Phoenix is comprised of many cultures and ethnicities. Eating habits and oral habits vary among various cultures, and these habits may affect overall oral health. Betel nut is a gourmet fruit that is popularly chewed in Asia. According to Dr. Ray Sahelian, the fruit acts as a psychoactive drug and gives a person a feeling of stress reduction, feelings of well-being and heightened awareness. The 2009 U.S. Census Bureau shows that Asians comprise 2.6 percent of the Arizona population. Thus, it is important to know that betel nut is a major cause of oral cancer and is the fourth most commonly abused substance in the world.

According to the Oral Cancer Foundation, 8,000 Americans die from oral cancer this year, and close to 37,000 Americans will be diagnosed with oral or pharyngeal cancer.

This alarming statistic may be due to multiple factors, including the use of tobacco products, human papilloma virus, alcohol consumption, genetics and age. Betel nut abuse is another common factor and often overlooked.

Thirty percent of oral cancers originate in the tongue. Hence, any unusual spots or sores in the mouth should be observed. The American Dental Association gives some simple signs to alert patients as to what may be suspicious and require a dentist's evaluation.

Oral cancer may start as a tiny, white or red spot or sore anywhere in the mouth that does not resolve over a few weeks time. Color changes of tissue or texture are also signs of unusual cell growth. The spots or sores may not always be painful or tender; therefore, any unusual spot should be observed.

Betel nut abuse produces red stains on the teeth, tooth erosion, and causes discoloration and texture changes to oral tissues and the tongue. Betel nut is classified as a carcinogen because, if abused over time, will cause enough tissue changes to cause oral cancer.

Primary prevention of oral cancer is to avoid carcinogens. These carcinogens include tobacco products, alcohol and betel nut. Biannual dental exams help reduce the risk of oral cancer as a dentist may be able to diagnose unusual oral spots and sores at an early stage. Be sure to call your dentist if you suspect suspicious spots or sores in your mouth.

Dr. Rashmi (Rush) Bhatnagar, DMD, MPH, can be contacted at (480) 598-5900 or visit

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