SUMMARY.-Changes in the buccal mucosa of 296 Indian and Malay betelnut chewers in Perak, West Malaysia, were studied clinically. 167 out of 212 Indian subjects incorporated tobacco in their quids, while 45 out of 84 Malay subjects incorporated " Gambir ". The Indians appeared to show a higher proportion of mucosal changes, particularly when tobacco was used. " Gambir " did not appear to be potent in the production of mucosal changes.Comparison with studies in other parts of the world suggested comparable findings with respect to both tobacco and non-tobacco chewing samples, and there would appear to be some evidence that tobacco-containing quids are likely to produce a higher proportion of mucosal changes as compared to nontobacco-containing quids. An attempt to demonstrate a dose-effect relationship by dividing the subjects into " slight " and " heavy " chewers did not yield significant differences between these two categories in each of the groups.THE high incidence of oral cancer in South-East Asia has for long been linked with the habit of betel-nut chewing, particularly when tobacco has been incorporated into the quid. Hirayama (1966) in an extensive epidemiological study of oral and pharyngeal cancer in Central and South-East Asia showed (1) that there is a relationship between the site of cancer within the mouth and the site where the tobacco-containing quids are kept, (2) that there is a dose-response relationship and that the relative risk of developing a cancer of the mouth increases with the amount chewed, and (3) that within the mouth this relative risk for tobacco chewers is greater for the anterior parts of the mouth and not so great for the posterior parts. He concluded that the chewing of tobacco and lime mixtures play an important role in the aetiology of oral cancer in most parts of South-East Asia and Central Asia causing cancer at the place in which the quid is habitually put. He pointed out, however, that whether it was the tobacco or the lime which played the major role was a matter for future study, as it is also known that oral cancer is rare in territories where people chew tobacco without lime, and that it can be high in territories where betel-nut and lime are chewed without tobacco. The composition, chemistry and pharmacology of the quid have been reviewed by Muir and Kirk (1960).The changes that occur in the oral mucosa as a result of betel-nut chewing in * Present address: Dental Clinic, District Hospital, Kluang, Johore, West Malavsia.
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