Ever walk up to a stable, comfortable appearing patient at Elmhurst and their mouth/teeth are completely RED? Or maybe like a dark brownish/black color? Like this??
It really scared me the first I saw it as an intern. I must have asked her 100 times if she was vomiting blood. But the patient said she was chewing on a nut.
This nut is call the “betel nut” or the areca nut, and chewing it is a common practice in the Southeast Pacific and East Africa. It is used similarly to chewing tobacco in many cultures, and produces a mild euphoric and/or stimulatory effect. The nut also contains a number of alkaloids that act as agonists at nicotinic and muscarinic receptors, causing cholinergic effects.
Okay….so why do we care?
Chewing betel nut is associated with a number of oral pathologies, including acute necrotizing ulcerative gingivitis, more commonly known as “trench mouth”. These patients will prevent with both oral pain and systemic symptoms, such as fever, lymphadenopathy, and malaise. This is important to recognize, because this diagnosis requires antibiotic treatment–notably, polymicrobial coverage. Additional management includes oral rinses with chlorhexidine and a referral to a dentist for possible debridement.
The betel nut is also an oral carcinogen and patient’s should be counseled as you would someone who chews tobacco. So next time you encounter one of these betel-nut-chewing patients, take a few extra seconds to examine their oropharynx, take a few extra minutes to explain the dangers of this practice, and be sure to arrange proper follow up care.
Inspired by my TR day at Elmhurst and ALiEM Visual Pearls.