Chewables have been a part of Indian cuisine and eating habits since ages. Paan leaves have been shown to have multiple benefits for digestive system. Paan is consumed with various additives. They are added for health benefits, taste, palatability etc. However, with the passage of time many ingredients & chemicals began to be added in chewables. These ingredients produced a “feel good” effect on the mind but has many systemic ill effects. Chewables produce a relaxing effect on the mind & are de-stressors & mood elevators. The de-stressor effect is by 2 ways. One is due to the chewing & grinding of chewables. This acts as pressure release valve of pent up stresses of daily life. This is akin to bruxism or grinding of teeth in sleep in stressed individuals.
The second systemic effects of ingredients of chewables which reach the brain through the blood stream after they are ingested. There perhaps could be one more cause of psychological hit. Chewables are being advertised in a very big way in mass media as being macho and fun, trendy and up market. So those who consume chewables are actually consuming the brand. Chewables are being advertised by leading film stars. It must be noted however that these film stars themselves do not consume any gutkha. If they did they would end up with very unsightly teeth & smile. The systemic effects are compounded because chewable habits coexist many a times often with alcohol and smoking habits. In this essay we will restrict ourselves to the ill effects of chewables.
Gutka is a combination of many chemicals and some of them are carcinogenic(i.e. they cause cancer). According to some reports, gutkha can have a round 4000 chemicals. Different brands have different compositions and formulations and also percentage of various ingredients may vary from brand to brand and also within the same brand at different points of time. It must be noted that all gutkha brands contain tobacco as one of their ingredients in varying percentages. As mentioned, the main purpose of chewables is to provide a psychological hit and to be a mood elevator.
So manufacturers will add those substances and chemicals which serve this purpose. Grinding teeth is stress reliever and acts as a kind of catharsis for repressed feelings and emotions. Chewing of chewables serves this purpose. However, it leads to several ill effects on dentition.
Ill effects on the teeth
It leads to attrition of teeth and gum recession. Attrition of teeth is not only vertical but also horizontal. Attrition of teeth leads to sensitivity in teeth. Gum recession leads to gaps in teeth which leads to food lodgment in interdental gaps. This makes the dentition highly prone to cavities. Many times this leads to early loss of teeth if teeth are lost they need to be replaced by various means. Even if the teeth can be restored it requires complex restorative dental treatment procedures. This is especially so if the height of the teeth have to be restored.
The professional charges of these dental treatment procedures are outside the reach of vast sections of the population. And the habit is found mainly in uneducated and semi-educated sections of the population. This section of the population cannot afford complex dental treatment procedures. So large sections of the population live with compromised dentition and its consequent oral and systemic ill effects. However please note that even educated & highly educated people are affected by this habit.
Ill effects on the skin
Chewables cause deleterious effect on the inner skin of the mouth. Some of them are oral sub mucous fibrosis, leukoplakia, erythroplakia and cancer. I will describe each of the above briefly. Oral sub mucous fibrosis is a debilitating condition of the skin of the mouth in which the skin of the mouth gets hardened and loses its elasticity. This results in limited mouth opening. In severe cases the mouth opening becomes so less that even routine chewing becomes difficult.
The other symptom is lack of tolerance to spicy foods. Dental treatment becomes difficult as the mouth opening is restricted in oral sub mucous fibrosis and impossible in severe cases. The condition is pre-cancerous which means patients with oral submucous fibrosis can develop cancer of the mouth. Treatment of oral sub mucous fibrosis involves steroid injections in skin of the mouth in mild cases and surgery in severe cases. Treatment of advanced oral sub mucous fibroses involves a complicated plastic surgery.
Leukoplakia means white patch & and erythroplakia means red patch. Initially leukoplakia develops and later on erythroplakia develops. Both of them are precancerous. Erythroplakia is more prone to cancer than leukoplakia. Those who are affected with oral sub mucous fibrosis leukoplakia or erythroplakia must get oral health checkup done at regular intervals. A biopsy of the tissue is advised in many cases & this must be done regularly.
Depending on the condition a biopsy may be advised. Biopsy is of 3 types i.e brush biopsy, punch biopsy & excisional biopsy. Brush biopsy is a simple screening method & is used mainly as a screening technique for oral cancer lesions. These conditions develop especially in the areas of the mouth where the chewable is kept. Most people keep chewables & tobacco in one area of the mouth & suck on it. The spin of that area is affected first. These who chew tobacco & gutkha usually keep them in one particular area only.
All the above pre-cancerous conditions can develop into full-fledged cancer of the mouth also. Therefore, if the above pre-cancerous conditions are detected the habit of chewables must be stopped immediately. If required, the help of a psychiatrist or a mental health professional must be taken. Besides chewables cause staining of teeth and unsightly brown patches on teeth. These also contributes to gum disease.
Tobacco chewing causes all the above side effects. Statistically tobacco is less carcinogenic than gutkha. However for all practical purposes the carcinogenic potential of both are same. The carcinogenic potential also depends on the frequency of the habit. Tobacco also produces almost the same effects as Gutkha. Attrition of teeth may be slightly less but stains & gum disease are more. Horizontal & vertical attrition of teeth is more with gutkha. Chewables and tobacco are addictive and I don’t think that a blanket ban on them is enforceable.
The only option is proper oral health education by various means. Proper regulation, supervision & testing on the manufacture sale, packaging and the composition of chewables is a must.
