Community
Dent. Oral Epidemiol.
1977: 5: 284- 286
Oral Epidemiology
(Key words; hetel; dental earies)
Betel chewing and caries experience in New Guinea R, G, ScHAMSGHULA"", B. L,
ADKINS**, D . E . BARMES"'^** AND G . CHARLTON*
*Institute of Dental Research, Sydney, N.S.W., **Departvicnt of Mathematics, University oj Queenstand, St. Lucia, Queensland, Australia, and ***Oral Health, Wortd Health Organization, Geneva, Switzerland Ati.sTiwcT - The prevalenee of dental caries and variables relating lo the belel-eltewing habit were examined iti a sample of 301 rural New Guineans aged 12-24 years. Consistent inverse •assoeiations were demonstrated between earies experienee and the intensity of betel ehewing for individuals and aggregates of subjects. The results indieate that betel ehewing confers a degree of proteetion against earies, (Accepted for publication 21 July 1977)
The addictive habit of betel chewing is widespread among New Guineans living in lowlands and hillcountry below the altitude of 400-600 meters. As practiced in New Guinea, the habit entails mastication of a bolus comprising the shelled ntit of the betel palm Areca catechu, leaves of the plant Piper betle or a variety of aromatic tree-barks, and a hydratecl mixture of calcium oxide and carbonate usually prepared from ealcined shells. The ingredients are expectorated and renewed at periodic intervals. Mastication of the bolus stiniulates copious flow of saliva which is colored bright red on contact with its constituents. Betel chewing is intoxicating. It is also said to depress the sensations of thirst and hunger, help to sustain physical exertion and create a feeling of well being. Prolonged practice of the habit leads to the depo,sition of a strongly adherent brown-black film on exposed tooth surfaees. Relationships between the prevalence of oral soft tissue lesions and betel ehewing in Papua New Guinea have been examined in a number of studies''"'". The present paper deals with associations between the frequency of betel chewing and individual caries experience, demonstrated as part of a wider investigation of caries etiology' in a primitive population in New Guinea.
MATERIAL AND METHODS The saittple eonsisted of 301 subjeets (154 tnales and 147
fetiiales) aged 12-24 years, lifelong residents of one of 16 villages situated in a remote area, on a eonfluent watershed tributary to the Sepik River, The prevalenee of dental earies (DMFT) was assessed for pennatient teeth only, in natural daylight, using the eriteria staled iti the WHO epidetniologie tnatiual Oral HeaUh Surveys: Basic Methods^''-. In addilioti the primary surface itivolvetnent and severity of lesions were reeorded^. Over 80 pritiiary variables were examined for eaeh individual, Those relevant to lhe present report include: the ntimber of areea nuts ehewed per day, the titne elapsed sinee lhe last bolus ehewed, the total raleiutn and phospliorus eontetit of two aetivated wliole saliva samples, the eolor of three saliva satttples eolleeted on differetit oeeasions atid the total caleiuni:pliosphorus weight ratios iti saliva. Details of all field** and laboratory*^ methods employed have been previously deseribed.
RESULTS Individual caries experience ranged from 0 to 22 DMFT, but in the virtual absence of dental care the filled component was negligible. Village means of caries experience ranged from 0.0 to 8.7 DMFT per person. The 16 villages eould be classified into four distinct Village Groups on the basis of mean caries experienee (Table 1). The b:;tel chewing habit is usually acquired between the ages of 8 and 12 years, although on a number of oecasions lactating mothers were observed pre-chewing boluses for their infants. Ninety percent of subjects practiced the habit, with individual frequencies ranging from less than one to 25
Betel cliewini; and caries 285 T a b l e 1, Mean values (s,d,) of D M F T and the iitttitber of areea nuts ehewed per day for Village Groups (VG) atul overall VG 1 ,, = 38
VG 2 (( = 112
VG 3 /i=101
VG 4 )i = 50
Overall /; = 301
DMFT 3,4(2,5) N o , areea nuts
6.4(4,7)
1,5(1,9)
0,0(0,0)
3,3(4,1)
day
3,0(2,3)
3,2(3,9)
9,0(7,2)
8,1(6,6)
5,8(6,0)
areca nuts chewed per day. The proportion of males and females who practiced the habit was similar and no material differences were observed between the sexes in the extent of addiction. However, Table 1 shows that the mean betel ehewing frequencies were nearly three times as high in Village Groups 3 and 4 where caries prevalence was low and zero than in Village Groups 1 and 2 where caries prevalence was medium and high by local standards. The high standard deviations reflect the considerable individual variation in the frequeney of betel chewing found within each Village Group. Associations between individual earies experience and betel chewing were examined in several ways. Simple regression analysis between DMFT and the number of areca nuts chewed per day over the whole sample showed a significant inverse association (r = -0.25, n = 275, P < 0.001). As the number of areca nuts chewed per day and the time elapsed since the last bolus chewed were assessed from verbal information, which may contain a subjective element, it was deeided to utilize these variables together with objective data obtained from chemical and colorimetric determinations, to approximate more closely the effect of betel chewing on caries experienee. Therefore, a variable set was created comprising the former two and 10 further variables thought to reflect manifestations of the habit, including the total calcium contents, calcium: phosphorus ratios and colors of saliva samples collected on different occasions from each individual. These were submitted to multiple linear stepwise regression analysis (MLSRA) against DMFT as dependent variable. All subjeets for whom values were available for each of the 12 variables were ineluded in the analyses. At the sixth step, after which no significant reduction in the error sum of squares was possible.
Table 2, Mean betel eliewing intetisity* atid earies e.xperietiee of subjecls stratified aeeorditig to betel ehewitig intensity values Stratum
Belel ehewing intensity (s,d,) DMFT (s,d,) n
5,28
2
3
3,74
2,85
2,03
1,35
0,40
(1,32) (0,24) (0,30) (0,21) (0,20) (0,53) 0,57 1,33 2,28 5,21 4,12 6,50 (1,13) (2,36) (2,71) (4,75) (3,61) (5,57) 42 42 42 42 42 42
•"'Values derived lrotn variables indieative of the tntensity of the habit,
the value of the multiple correlation coefficient (R) reached 0.42 (H = 252, P
Dent. Oral Epidemiol.
1977: 5: 284- 286
Oral Epidemiology
(Key words; hetel; dental earies)
Betel chewing and caries experience in New Guinea R, G, ScHAMSGHULA"", B. L,
ADKINS**, D . E . BARMES"'^** AND G . CHARLTON*
*Institute of Dental Research, Sydney, N.S.W., **Departvicnt of Mathematics, University oj Queenstand, St. Lucia, Queensland, Australia, and ***Oral Health, Wortd Health Organization, Geneva, Switzerland Ati.sTiwcT - The prevalenee of dental caries and variables relating lo the belel-eltewing habit were examined iti a sample of 301 rural New Guineans aged 12-24 years. Consistent inverse •assoeiations were demonstrated between earies experienee and the intensity of betel ehewing for individuals and aggregates of subjects. The results indieate that betel ehewing confers a degree of proteetion against earies, (Accepted for publication 21 July 1977)
The addictive habit of betel chewing is widespread among New Guineans living in lowlands and hillcountry below the altitude of 400-600 meters. As practiced in New Guinea, the habit entails mastication of a bolus comprising the shelled ntit of the betel palm Areca catechu, leaves of the plant Piper betle or a variety of aromatic tree-barks, and a hydratecl mixture of calcium oxide and carbonate usually prepared from ealcined shells. The ingredients are expectorated and renewed at periodic intervals. Mastication of the bolus stiniulates copious flow of saliva which is colored bright red on contact with its constituents. Betel chewing is intoxicating. It is also said to depress the sensations of thirst and hunger, help to sustain physical exertion and create a feeling of well being. Prolonged practice of the habit leads to the depo,sition of a strongly adherent brown-black film on exposed tooth surfaees. Relationships between the prevalence of oral soft tissue lesions and betel ehewing in Papua New Guinea have been examined in a number of studies''"'". The present paper deals with associations between the frequency of betel chewing and individual caries experience, demonstrated as part of a wider investigation of caries etiology' in a primitive population in New Guinea.
MATERIAL AND METHODS The saittple eonsisted of 301 subjeets (154 tnales and 147
fetiiales) aged 12-24 years, lifelong residents of one of 16 villages situated in a remote area, on a eonfluent watershed tributary to the Sepik River, The prevalenee of dental earies (DMFT) was assessed for pennatient teeth only, in natural daylight, using the eriteria staled iti the WHO epidetniologie tnatiual Oral HeaUh Surveys: Basic Methods^''-. In addilioti the primary surface itivolvetnent and severity of lesions were reeorded^. Over 80 pritiiary variables were examined for eaeh individual, Those relevant to lhe present report include: the ntimber of areea nuts ehewed per day, the titne elapsed sinee lhe last bolus ehewed, the total raleiutn and phospliorus eontetit of two aetivated wliole saliva samples, the eolor of three saliva satttples eolleeted on differetit oeeasions atid the total caleiuni:pliosphorus weight ratios iti saliva. Details of all field** and laboratory*^ methods employed have been previously deseribed.
RESULTS Individual caries experience ranged from 0 to 22 DMFT, but in the virtual absence of dental care the filled component was negligible. Village means of caries experience ranged from 0.0 to 8.7 DMFT per person. The 16 villages eould be classified into four distinct Village Groups on the basis of mean caries experienee (Table 1). The b:;tel chewing habit is usually acquired between the ages of 8 and 12 years, although on a number of oecasions lactating mothers were observed pre-chewing boluses for their infants. Ninety percent of subjects practiced the habit, with individual frequencies ranging from less than one to 25
Betel cliewini; and caries 285 T a b l e 1, Mean values (s,d,) of D M F T and the iitttitber of areea nuts ehewed per day for Village Groups (VG) atul overall VG 1 ,, = 38
VG 2 (( = 112
VG 3 /i=101
VG 4 )i = 50
Overall /; = 301
DMFT 3,4(2,5) N o , areea nuts
6.4(4,7)
1,5(1,9)
0,0(0,0)
3,3(4,1)
day
3,0(2,3)
3,2(3,9)
9,0(7,2)
8,1(6,6)
5,8(6,0)
areca nuts chewed per day. The proportion of males and females who practiced the habit was similar and no material differences were observed between the sexes in the extent of addiction. However, Table 1 shows that the mean betel ehewing frequencies were nearly three times as high in Village Groups 3 and 4 where caries prevalence was low and zero than in Village Groups 1 and 2 where caries prevalence was medium and high by local standards. The high standard deviations reflect the considerable individual variation in the frequeney of betel chewing found within each Village Group. Associations between individual earies experience and betel chewing were examined in several ways. Simple regression analysis between DMFT and the number of areca nuts chewed per day over the whole sample showed a significant inverse association (r = -0.25, n = 275, P < 0.001). As the number of areca nuts chewed per day and the time elapsed since the last bolus chewed were assessed from verbal information, which may contain a subjective element, it was deeided to utilize these variables together with objective data obtained from chemical and colorimetric determinations, to approximate more closely the effect of betel chewing on caries experienee. Therefore, a variable set was created comprising the former two and 10 further variables thought to reflect manifestations of the habit, including the total calcium contents, calcium: phosphorus ratios and colors of saliva samples collected on different occasions from each individual. These were submitted to multiple linear stepwise regression analysis (MLSRA) against DMFT as dependent variable. All subjeets for whom values were available for each of the 12 variables were ineluded in the analyses. At the sixth step, after which no significant reduction in the error sum of squares was possible.
Table 2, Mean betel eliewing intetisity* atid earies e.xperietiee of subjecls stratified aeeorditig to betel ehewitig intensity values Stratum
Belel ehewing intensity (s,d,) DMFT (s,d,) n
5,28
2
3
3,74
2,85
2,03
1,35
0,40
(1,32) (0,24) (0,30) (0,21) (0,20) (0,53) 0,57 1,33 2,28 5,21 4,12 6,50 (1,13) (2,36) (2,71) (4,75) (3,61) (5,57) 42 42 42 42 42 42
•"'Values derived lrotn variables indieative of the tntensity of the habit,
the value of the multiple correlation coefficient (R) reached 0.42 (H = 252, P
