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The Potential Association Between Betel Nut Consumption and Apical Periodontitis: A Multicenter Cross-Sectional

Tousif Iqbal Nathani1, Vaibhav Kumar2, Satvinder Singh3

  • 1Department of Endodontics, International University of Catalonia (UIC), Barcelona, Spain, uic.es.

International Journal of Dentistry
|June 22, 2026
PubMed
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Betel nut (BN) chewing is linked to more apical periodontitis (AP) lesions. Longer duration of BN use showed a stronger association with AP, suggesting a dose-dependent relationship.

Area of Science:

  • Oral pathology
  • Dental radiology
  • Public health

Background:

  • Betel nut (BN) chewing is a known risk factor for oral diseases like periodontal disease.
  • Evidence directly linking BN chewing to pulpal and periapical (PA) pathology is limited.
  • Apical periodontitis (AP) is a common inflammatory condition affecting the periapical tissues of the teeth.

Purpose of the Study:

  • To investigate the association between habitual betel nut (BN) chewing and the prevalence of radiographic apical periodontitis (AP).
  • To determine if BN chewing frequency or duration is more strongly associated with AP.
  • To contribute to understanding the oral health impacts of betel nut consumption.

Main Methods:

  • A cross-sectional observational study involving 222 participants (113 BN chewers, 109 non-chewers) from two Indian dental institutions.
Keywords:
arecabetel nutendodonticsepidemiologic studiesoral healthperiapical periodontitis

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  • Data collection included demographic, clinical, and radiographic examinations.
  • Radiographs were evaluated by calibrated endodontists for PA radiolucencies, and statistical analyses (chi-square, Mann-Whitney U, Poisson regression) were performed.

    • Main Results:

    • Betel nut (BN) chewers exhibited a significantly higher number of apical periodontitis (AP) lesions compared to non-chewers (p < 0.05).
    • BN chewing was independently associated with a higher prevalence of radiographic AP (IRR=1.290, p=0.034).
    • A dose-dependent relationship was observed, with longer chewing duration showing a stronger association with AP lesion counts than chewing frequency.

    Conclusions:

    • Betel nut (BN) chewing is significantly associated with an increased prevalence of radiographic apical periodontitis (AP).
    • The duration of BN chewing appears to be a more critical factor than the frequency of chewing in relation to AP.
    • Further longitudinal studies are recommended to establish causality and explore confounding factors.