Sweetened Areca Nut, A Risk in Dental Caries among Adolescents in Pune, Maharashtra? A Case-Control Study.

Introduction: Smokeless tobacco (SLT) causes dental caries and so does chewing of areca nut (sweetened supari) due to the presence of sugar. Since conflicting views exist about whether areca nut causes dental caries or not, and since studies are undertaken in adults and data on adolescents are not available, this study was carried out. Since those were cross-sectional or longitudinal studies, this case-control study was undertaken to understand if flavored/sweetened areca nut is a risk factor for dental caries.

Material and method: This unmatched case-control study was conducted among the male students of 8^th to 10^th standard in the age group of 12-16 of four Madhyamik Vidyalaya's (MVs) in Pimpri-Chinchwad (urban area), Pune. A directed acyclic graph (DAG) was drawn to determine the independent variables to be selected for the study and minimal variables to be adjusted during data analysis. Selection of cases was based on diagnostic and eligibility criteria. The data on the use of sweetened areca nuts and the presence of caries were collected through oral examination and a semistructured questionnaire administered by the principal investigator on a one-to-one basis between August 2022 and October 2022. Data were analyzed using epiinfo^TM 7.2.5.0.

Results: This study of 146 males in the age group of 13 to 16 years had 61 students as cases and 85 as controls. No significant difference was observed between the group with (cases) and without (controls) dental caries for areca nut use (pack years) whether consumed daily or less frequently for 1 year or more. While the exposure rate to areca nut among cases was 44.26%, for the control group it was 36.47%. The odds ratio of sweetened areca nut as being the risk factor for dental caries was 1.38 at 95% CI (0.70-2.71) with P = 0.44.

Conclusion: This study revealed that the adolescent users of sweetened areca nuts studying in government schools had a higher exposure odds ratio for dental caries. However, it was not significant statistically. Information bias including recall may have influenced the outcome.