Title	Oral Cancer Risk Is Higher If Betel Nuts Are Chewed With Tobacco Compared To Chewing Betel Nuts Without Tobacco
Clinical Question	Is the risk of developing oral neoplasms with the use of betel nuts increased if betel nuts are chewed with tobacco compared to chewing betel nuts alone? (See Comments on the CAT below)
Clinical Bottom Line	The oral mucosa sustains more genotoxic damage when betel nuts are chewed with the simultaneous use of tobacco products.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 18688850 Thomas/2008 197 cases and 1,282 controls Case Control Study/ Systematic Review Key results Leukoplakia was present in 11.7% of betel quid chewers that were also smokers. “In the nested case-control study of 197 cases and 1,282 controls, current betel chewing was associated with increased risk of leukoplakia with an adjusted odds ratio for current chewers of 3.8 (95% CI 1.7, 8.4) and in the heaviest chewers of 4.1 (95% CI 1.8, 9.1) compared to non-chewers.” Smokers were found to have a risk of leukoplakia with an odds ratio for smokers of 6.4 (95% CI 4.1, 9.9) and amongst heaviest smokers of 9.8 (95% CI 5.9, 16.4) when compared to non-smokers. The systemic review found 5 studies for betel nut chewing without tobacco in populations that controlled for smoking, the combined odds ratio was 7.9 (95% CI 4.3, 14.6) in betel quid chewers.
Evidence Search	(("Areca/adverse effects"[Mesh]) and ("Leukoplakia, Oral/epidemiology"[Mesh] OR "Leukoplakia, Oral/ethnology"[Mesh] )) AND "Tobacco/adverse effects"[Mesh]
Comments on The Evidence	The evidence was representative in that the study group was large and met the criteria of being a combination of betel nut chewers and tobacco users. Simultaneous use of both tobacco and betel nuts has an additive effect on oral neoplasms.
Applicability	The subjects in this study were chosen and examined based on their way of life. This evidence is useful for dentists in tobacco use counseling. Betel chewers should be advised to quit or at least avoid using it with tobacco. The evidence is of practical use in patient populations from southeast Asia.
Specialty	(General Dentistry) (Oral Surgery) (Periodontics) (Dental Hygiene)
Keywords	Betel Nuts, Oral Cancer, Tobacco
ID#	2224
Date of submission	04/26/2012
E-mail	pateldh@livemail.uthscsa.edu
Author	Devish H. Patel
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Georgiana S. Gross, MPH
Faculty mentor e-mail	grossg@uthscssa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available