Panmasala and Gutka Chewing in India- Cause for Concern

Gutka is a preparation of crushed betel nut, tobacco, slaked lime and sweet or savory artificial flavorings. A mild stimulant, it is sold across India in small, individual-sized packets that cost between 2 and 10 rupees per packet. It is consumed much like chewing tobacco, and like chewing tobacco it is considered responsible for oral cancer and other severe negative health effects.

Pan Masala is basically a preparation of areca nut, catechu, cardamom, lime and a number of natural and artificial flavoring materials, without tobacco. Gutka is a variant of pan masala, in which in addition to these ingredients flavored chewing tobacco is added. Both products are often sweetened to enhance the taste. Some packaging does not mention tobacco as an ingredient, some are chocolate-flavored, and some are marketed as breath fresheners.

Both Gutka and Panmasala are highly addictive and contain well known carcinogens. Used by millions of children and adults in India, it causes major health hazard in India.

Promoted by high profile advertising campaign and aggressive marketing, pan masala and Gutka have become very popular with all sections of Indian society, including school children. For most children, teenagers and women, cigarette smoking still remains taboo in India. These alternative tobacco products are often advertised as being safer than conventional cigarettes, leading to a much higher frequency of use, so that these younger chewers get oral cancer and Oral sub mucus fibrosis (OSF). Further, these habits and preparations have spread to Europe and the USA, wherever there are Asian migrant communities.

Excessive Gutka and Pan use can eventually lead to loss of appetite, promote unusual sleep patterns, and loss of concentration along with other tobacco related problems

A Gutka user can easily be identified by prominently stained teeth ranging from dirty yellowish-orange to reddish-black. The stains are difficult to remove by normal brushing and usually need the attention of a dentist.

After gutkha is consumed, it is generally spat onto a wall or at the ground, causing an unsightly red stain that is quite resistant to the elements. Some building owners have taken to combating this unpleasantness by painting murals of gods on their walls, with the idea that Gutka chewers would not spit on a god.

Gutka, Pan, Cancer and OSF

These products have been strongly implicated in the recent increase in the incidence of oral cancer and oral sub mucous fibrosis (OSF), especially in the very young, even after a short period of use. This precancerous lesion, which has a high rate of malignant transformation, is extremely debilitating and has no known cure. The use of tobacco with lime, betel quid with tobacco, betel quid without tobacco and areca nut have been classified as carcinogenic to humans. As Gutka and Pan Masala are mixtures of several of these ingredients, their carcinogenic affect can be surmised.

Oral Cancer

Oral cancer, a malignancy of the lip, mouth or tongue, is predominantly a squamous cell carcinoma. The prognosis is poor and severe functional and cosmetic defects accompany its treatment. As an early sign of damage to the oral mucosa, chewers of Gutka or Pan masala often develop clinically visible whitish (leukoplakia) or reddish (erythroplakia) lesions and/or stiffening of the oral mucosa and oral sub mucous fibrosis (OSF).

All these are precancerous lesions, some 2â€“12% of these lesions have been reported to turn malignant over several years.

OSF is predominantly caused by the use of areca nut. Besides being regarded as a precancerous condition, it is a seriously debilitating and progressive disease. Marked by stiffening of the oral mucosa and development of fibrous bands, loss of elasticity of the mucosa results in a progressive restriction of mouth opening. Affected users experience a burning sensation of the oral mucosa, occasional mucosal ulceration, a peculiar marbleâ€like blanching of the mucosa and palpable fibrous bands of the buccal mucosa, soft palate and lips. OSF does not regress and there is no known cure.

Although some recent curbs have been put on the manufacture and sale of these products, urgent action is needed to permanently ban Gutka and pan masala, together with the other established oral cancerâ€causing tobacco products. Further, education to reduce or eliminate homeâ€made preparations needs to be accelerated.